The prognosis factors for lymphogenous metastasis are the clinical assessment of the lymph nodes, the age of the patient, the degree of differentiation of the tumor, the stage of the disease, the primary size and location of the tumor, the depth of stromal invasion, the presence of cancer emboli in the lumens of the lymphatic and blood vessels, the predominance of aneuploid cells. The risk of metastasis to the lymph nodes is practically zero when the depth of stromal invasion of the tumor is less than 2 mm, 20% is more than 2 mm and about 40% is more than 4 mm. With damage to the lymph nodes, overall survival approaches 50-60%. The histological structure of the tumor has a certain prognostic value. A more favorable clinical course is observed with squamous keratinizing cancer; in patients with squamous non-keratinizing cancer, metastases in regional lymph nodes are 1.5 times more common.

Vulvar Cancer Relapses

Relapse of vulvar cancer can be local, regional or locally regional. The frequency of their occurrence depends on the stage of the disease, the depth of the invasion and, most importantly, the defeat of the regional lymph nodes. The relapse rate for squamous cell carcinoma is 15-40%. The prognosis for relapse of vulvar cancer depends on the location of the lesion and the timing of occurrence. Treatment is effective only with isolated relapse in the vulva without damage to the lymph nodes. A persistent cure for relapse in the vulva is observed in 40-80% of cases. If a late local relapse occurs (after 2 years or more) after the initial combined treatment (radiation therapy + surgery), the 5-year survival rate is more than 50%.
The causes of relapse are non-radical tumor resection (closer than 1 cm from its edge) – 50%, deep invasion and large tumor size. The tactics of treatment for recurrence of vulvar cancer are individual: if possible, then radical resection is performed, in other cases combined or complex treatment. Patients with metastases in the inguinal lymph nodes, especially multiple, bilateral, with germination in the surrounding tissue, are more likely to relapse with damage to the iliac or pelvic lymph nodes and internal organs. The prognosis in patients with regional or systemic recurrence of the disease is poor. Metastases in the lymph nodes do not allow radical resection, radiation therapy for large recurrent tumors is unpromising, and there are no effective chemotherapy regimens. An insignificant number of patients with lesions of the iliac lymph nodes can undergo radical lymphadenectomy followed by radiation therapy.

Selection methods:

1. Wide local excision with radiation therapy or without it with local relapses.
2. Enhanced vulvectomy with pelvic exenteration.
3. Chemotherapy with or without surgical treatment .
4. Conducting non-standard chemotherapy or other types of systemic treatment. In the gynecological department of the Russian Research Center. NN Blokhina RAMS is currently undergoing chemotherapy according to the scheme: cisplatin 80 mg / m2 iv on the 1st day, 5-fluorouracil 400 mg / m2 iv on the 1st, 3rd, 5th, 8th days, bleomycin 15 mg iv in the 1st, 3rd, 5th, 8th days, cyclophosphamide 400 mg iv in the 1st, 3rd, 5th, 8th days. This scheme is used with a positive effect and with a primary spread tumor.

Vulvar Cancer Prevention

Despite the fact that vulvar cancer is a visually detectable disease, a significant number of patients see a doctor in the presence of a common process. On the one hand, this is due to the anatomical features of the external genitalia, which have abundantly developed blood and lymphatic networks, pronounced proliferative activity of non-squamous cell carcinoma and its early metastasis to regional zones, and on the other hand, the absence of pathogenetically substantiated prevention and effective treatment of neurodystrophic processes. This is also due to the fact that patients in this category are elderly and senile women who have not consulted a doctor for a long time and performed self-medication. Another reason is associated with medical errors, which consisted in the fact that patients for a long time were not unreasonably given a tumor biopsy and were limited to anti-inflammatory treatment. From these positions, the correct assessment of the anamnesis, clinical symptoms and the rational construction of the diagnostic process can contribute to the timely recognition of cancer of this localization.
Currently, there are three main ways to improve treatment outcomes: primary and secondary prevention, early diagnosis and adequate treatment.
According to the pathogenetic mechanisms of the development of vulvar cancer, primary prevention should be aimed at preventing sexually transmitted infections, eliminating metabolic and endocrine disorders, etc. Secondary prevention measures include: • treatment of neurodystrophic processes (leukoplakia and kraurosis), which should not be started without a histological clarification of the diagnosis; • treatment of squamous hyperplasia (hypertrophic and warty forms) should preferably be surgical, using cryodestruction or a CO2 laser; • conservative drug treatment of neurodystrophic diseases in the absence of effect should not be carried out for more than six months. In these cases, surgical treatment should be discussed; • in patients with neurodystrophic diseases, histological examination reveals dysplasia and pre-invasive vulvar cancer with a high frequency. Surgical treatment of dysplasia and in situ cancer is the most effective way to prevent invasive vulvar cancer; • expansion of indications for surgical treatment for vulvar dysplasia; • development of methods for sparing organ-preserving operations and cryodestruction or laser destruction in young patients with dysplasia or pre-invasive vulvar cancer, which contributes to the sexual rehabilitation of women.