Особливості клінічного перебігу передраку і раку вульви у жінок репродуктивного віку

Abstract

Continuing increase of precancer, epithelial and invasive vulvar cancer rate significantly enlarges the proportion of this group of patients. Meanwhile, all the grounds to improve the system of early diagnosis and treatment of this pathology are given nowadays. No other localization of gynecological cancer proves such a close association with postmenopause and involute atrophic processes of this period of a woman’s life. The objective: is to study the features of the clinical course of cancer and precancerous lesions of the vulva in women of reproductive age. Materials and methods. From 2017 to 2020, 150 patients with dystrophic diseases, precancerous lesions and vulvar cancer were examined in the outpatient department of the National Cancer Institute. The age of patients in the study ranged from 18 to 49 years old (32±3.5). Menstrual function was unchanged in 98 (65%) of 150 women. The age of menarche varied from 11 to 18 years old (mean age – 14.5±0.3 years). The average duration of the menstrual cycle was 28±0.4 days. The doctor performed conservative treatment of «leukoplakia and kraurosis» for many months, and sometimes years, without histological clarification of the diagnosis. More than half (n=106; 71%) of patients underwent long-term and unreasonable anti-inflammatory or hormonal therapy with unsatisfactory results without cytological and / or histological examinations. Results. In the study of vulvar biopsies, the VIN diagnosis (28%) prevailed in comparison with the invasive tumor process (12%) and was asymptomatic in more than 50% of cases. Thus, the peak level of HPV was observed in young women (80%). HPV was represented by types of high oncogenic risk (16, 18, 31, 33) in 90% of cases and it was associated with a malignant process in 100% of cases. At the same time, the background disease in young patients is squamous cell hyperplasia, where the sequence of tumor development (VIN I - VIN II – VIN III) is more clearly traced and largely resembles the development of cervical cancer. It has been noted that in young women PVI is usually temporary, there is a faster spontaneous elimination of the virus and regression of existing HPV-associated pathology compared with menopausal women. Conclusion. Vulvar neoplasia is more common in the VIN form in women of reproductive age and in all cases, it is associated with human papillomavirus (HPV) of high oncogenic risk. Multicentric lesions are more typical for young patients. Keywords: vulva, cancer, precancer, anamnesis, vulvoscopy, histological examination.