Vulvar tumors

　　Vulvar tumors can be caused by local or systemic factors. The ten common causes are as follows:

　　1. Vulvar infection:Such as sexually transmittedSex. Vulvitis caused by diseases, viruses, bacteria, trichomonads, fungi, etc. The vulva is the primary and common site.

　　2. Mechanical stimulation:Such as poor hygiene habits, vulvar dirt, tight underwear, sweat stain stimulation, etc.

　　3. Allergic vulvitis:Allergic dermatitis caused by detergents, cosmetics, condoms, and medical supplies, etc.

　　4. Foreign bodies in the vagina:Long-term placement of pessaries, residual foreign bodies in the vagina causing infection and stimulation of the vulva, resulting in swelling and pain.

　　5. Stimulation of urine and feces:Urinary diseases, feces, diabetic patients' diabetic irritation.

　　6. Systemic diseases:Diabetes, systemic lupus erythematosus, psoriasis vulgaris, etc.

　　7. Vulvar malignant tumors:Vulvar cancer, vulvar Paget's disease, vaginal cancer, etc.

　　8. Vulvar Bartholin's abscess.

　　9. Vulvar pain of unknown cause:Vulvar vestibular swelling accompanied by frequent urination, urgency, and urinary syndrome of unknown etiology.

　　10. Hematoma after trauma:It can cause severe swelling and pain.

　　Vulvar tumors can cause vulvar edema, vulvar varicose veins, and vulvar elephantiasis. The specific complications are described as follows.

　　1. Vulvar edema:Vulvar edema can be divided into primary and secondary edema. The former is caused by congenital maldevelopment of lymphatic vessels, and the latter is due to systemic diseases such as malignant tumors metastasizing to lymph nodes or filariasis blocking lymphatic vessels. Edema of the vulva can also be caused by circulatory disorders due to lymphangitis caused by obstructed lymphatic return and inflammation after lymphadenectomy in the inguinal or pelvic area.

　　2. Vulvar varicose veins:It is the most common disease in the venous system. Vulvar varicose veins can be seen under the skin during normal times. If a person stands for a long time or in the later stages of pregnancy, the veins become prominent, like worms coiling, mainly due to circulatory disorders and long-term expansion of blood vessels. Generally, no special treatment is required. Necessary rest, elevation of the lower limbs, and the use of elastic bandages to wrap the legs are recommended to prevent rupture, bleeding, and infection.

　　3, vulvar elephantiasis:After vulvar filariasis, the female worm continuously produces microfilariae in the human lymphatic vessels, which寄生 in the lymphatic system, causing lymphangitis and lymphatic obstruction. Finally, the obstructed lymphatic vessels become varicose, and the skin nutrition in the governed area is impaired, leading to chronic thickening of the skin, forming vulvar elephantiasis. In addition, recurrent vulvar cellulitis and chronic inflammation of the vulva, such as tuberculosis and syphilis, can cause fibrosis of connective tissue, thereby obstructing venous and lymphatic return, and finally leading to vulvar elephantiasis.

　　Vulvar tumors are divided into benign tumors and malignant tumors, while benign tumors are less common. Malignant tumors have symptoms such as nodules, masses, ulcers, and erosions, and the specific clinical manifestations are described as follows.

　　One, the early signs of female vulvar cancer usually include four types:

　　1, leukoplakia:There are small, smooth white spots or streaks in the vulva, which later fuse into thick and glossy milky white spots, with a hard and rough feeling when touched.

　　2, nodule:There are soybean-sized nodules or papillary masses in the vulva, accompanied by itching around them.

　　3, ulcer:If there is a long-term non-healing ulcer with a concave hard base in the female vulva, accompanied by pain and bleeding, it is mostly a sign of female vulvar cancer.

　　4, itching:After excluding vulvar itching caused by candidiasis, pubic lice, scabies, trichomoniasis, and other factors, if vulvar itching does not subside after long-term treatment and the cause cannot be found, and it presents as stubborn and severe itching, female vulvar cancer should be considered.

　　Two, benign tumors

　　Benign vulvar tumors are rare, mainly including papillomas, fibromas, lipomas, and sweat gland adenomas.

　　1, papilloma:Most common in solitary swellings on the large labia or mons pubis, with fine and dense papillae on the surface, and slightly hard texture. The rate of malignancy is high.

　　2, fibroma:Most common in solitary hard nodules on the large labia, which gradually grow into pedunculated solid tumors.

　　3, lipoma:Originating from the fatty layer of the mons pubis and labia, of varying sizes, grows slowly, and is relatively soft. Generally asymptomatic, with a low possibility of malignancy. However, it may cause inconvenience in movement or sexual intercourse due to its large size.

　　4, sweat gland adenoma:Originating from the large labia and perineum, usually 1-2 cm in size. The tumor grows slowly and is asymptomatic. A few may have cancerous changes.

　　Three, malignant tumors

　　Vulvar squamous cell carcinoma is the most common malignant tumor of the vulva, with an average age of onset of 60 years. It is most common in the labia, clitoris, and perineum. The etiology is not yet clear, but it has a high coexistence rate with sexually transmitted diseases (such as condyloma acuminatum, gonorrhea, syphilis, and trichomoniasis); it develops into invasive cancer from viral infection (human papillomavirus); it is related to weakened or damaged immune function of the body, such as after renal transplantation, lupus erythematosus, etc.; vulvar malnutrition and vulvar warts can both develop into vulvar squamous cell carcinoma.

　　Early local appearance of small and hard nodules, masses, or ulcers, often accompanied by pain or itching; in the late stage, it presents as typical erosion, masses, or irregular papillomatous tumors, which may be white, gray, pink, or have melanotic deposits. One or both inguinal lymph nodes may enlarge, becoming hard and fixed. When the tumor ulcerates or becomes secondary infected, symptoms such as frequent urination, dysuria, difficulty in defecation may occur. However, most patients have a history of vulvar itching for many years before the lesion, which is more severe at night, and there may be vulvar leukoplakia and other conditions.

　 Stress is a very important trigger in the occurrence of vulvar tumors, and good living habits are also crucial for the prevention of the disease. The specific preventive measures are briefly described as follows.

    1. Develop good living habits, quit smoking, and limit alcohol intake.

    2. Do not eat too much salty and spicy food, do not eat overheated, cold, expired, or deteriorated food; the elderly, the weak, or those with certain genetic predispositions to diseases should eat some cancer-preventive foods and alkaline foods with high alkaline content in moderation to maintain a good mental state.

    3. Maintain a good mental state to cope with stress, combine work and rest, and avoid overfatigue. It can be seen that stress is an important trigger for cancer. Traditional Chinese medicine believes that stress leads to overwork and physical weakness, which in turn causes a decrease in immune function, endocrine disorders, and internal metabolic disorders, leading to the deposition of acidic substances in the body; stress can also lead to mental tension, causing qi stagnation and blood stasis, internal fire, and other symptoms.

    4. Strengthen physical exercise, enhance physical fitness, and exercise more often in the sunshine. Sweating can help expel acidic substances from the body through sweat, thus avoiding the formation of an acidic constitution.

　　The diagnosis of vulvar tumors should prioritize the preclinical symptoms and local lesions. For vulvar itching, leukoplakia, condyloma acuminatum, and other conditions that are not responsive to general treatment, especially when small nodules, ulcers, or papillary exophytic tumors occur, one should be vigilant about the possibility of developing or having vulvar tumors. Therefore, it is necessary to perform local tissue biopsy in a timely manner to clarify the diagnosis. Pathological tissue section examination is the main basis for the diagnosis of vulvar tumors. It is essential to obtain samples properly, preferably from non-necrotic areas of the suspicious tumor tissue to avoid missing the diagnosis. For patients with suspicious biopsy results, a deeper tissue biopsy should be performed again. To improve the positive rate of biopsy, in recent years, China has adopted the method of applying 1% toluidine blue solution to the vulva, allowing it to dry for 2-3 minutes before using 1% acetic acid to decolorize. If there is atypical hyperplasia, in situ tumor, or invasive cancer, toluidine blue will bind to the active nuclei of the DNA within the cells, causing the lesion area to appear purple-blue without decolorization. Biopsy in the non-decolorized area can improve the positive rate of early diagnosis and the diagnosis of multifocal central tumors. However, this method can cause false-positive results in benign ulcers; while for those with hyperkeratosis in atypical lesion areas, decolorization can occur after acetic acid washing, resulting in false-negative results. Vulvar leukoplakia, vulvar ulcer, vulvar papilloma, vulvar lichen sclerosis et atrophicus, granuloma, vulvar tuberculosis, and other conditions are generally indistinguishable from vulvar tumors, and biopsy should be performed after toluidine blue staining to clarify the diagnosis for differentiation.

      Routine vaginal cytological smear examination can help determine whether vulvar tumor patients have associated vaginal cancer, cervical tumor, or corpus uteri cancer. Cytological smear examination has an approximately 50% positive rate for the diagnosis of vulvar tumors, and direct scraping of materials from the lesion site or local tissue imprinting for cytological examination can increase the positive rate. Intravenous injection of 32P (700 millicuries in physiological saline) can help with diagnosis due to the higher concentration at the lesion site, with higher counts of intraepithelial cancer and infiltrative cancer.

　　Patients with vulvar tumors should eat more foods that have anti-vulvar tumor and leukoplakia effects, avoid smoking, alcohol, and spicy刺激性 food, and the specific dietary precautions are described as follows.

　　1, Foods to eat:Eat more foods that have anti-vulvar tumor and leukoplakia effects, such as sesame seeds, almonds, wheat, barley, cucumbers, black-bone chickens, cuttlefish, black snakes, pork pancreas, chrysanthemum, black plums, peaches, lychees, horse-tail amaranth, chicken blood, eels, abalones, crabs, horseshoe crabs, sardines, clams, and tortoises. For pain, eat horseshoe crabs, red crabs, lobsters, clams, sea cucumbers, tiger fish, beets, mung beans, radishes, chicken blood. For itching, eat amaranth, cabbage, mustard, taros, kelp, seaweed, chicken blood, snake meat, and pangolins. To enhance physical fitness and prevent metastasis, eat silver ear, black fungus, mushrooms, monkey head mushrooms, chicken gizzards, sea cucumbers, Job's tears, walnuts, crabs, monitor lizards, needlefish.

　　2, Foods to avoid:Avoid smoking, alcohol, and spicy刺激性 food. Avoid greasy, fried, moldy, and preserved foods, as well as foods that trigger growth, such as roosters and geese. When itching is severe, avoid seafood and allergenic foods. Avoid warm foods such as mutton, leeks, ginger, pepper, and cassia when ulcers and bleeding occur.

　　Vulvar tumors are primarily treated with surgery, including radiotherapy and medication. The specific treatment methods are described as follows.

　　Western medicine treatment for vulvar tumors

　　The treatment mainly includes medication, laser, radiotherapy, and surgery. Medication involves applying a 5% 5-fluorouracil ointment to the lesion, but the failure rate is 50%. Laser therapy primarily uses carbon dioxide, which can maintain the appearance of the vulva and has good efficacy, but also has a recurrence rate of 1/3. For patients with surgical contraindications or those who are not suitable for surgery in the late stage, radiotherapy can have certain efficacy.

　　Surgery is the preferred method, using extensive vulvar radical surgery and bilateral deep and superficial inguinal lymph node dissection, with good efficacy. Malignant melanoma generally occurs in the small labia and clitoris, which may be related to frequent friction and stimulation in the vulvar area, and is manifested as vulvar pruritus, enlargement of pigmented spots, increased pigmentation, surface ulcers, and hemorrhagic or serous exudates. Treatment is the same as that for vulvar squamous cell carcinoma.

　　Second, Surgical Treatment for Vulvar Tumors

    Surgical treatment is the main method, using extensive vulvar radical surgery and bilateral deep and superficial inguinal lymph node dissection, with good efficacy.

　　 Stage 0: Unilateral vulvar resection.

　　Stage Ⅰ: Extensive vulvar resection and lymph node dissection on the same side or both sides of the inguinal region.

　　Stage Ⅱ: Extensive vulvar resection and bilateral inguinal and pelvic lymph node dissection.

　　Stage Ⅲ: Same as stage Ⅱ or with resection of the anterior urethra and anal skin.

　　Stage Ⅳ: Extensive vulvar resection, lower rectal and anal canal resection, artificial anus formation, and bilateral inguinal and pelvic lymph node dissection. If the tumor invades the upper urethra and the mucosa of the bladder, a corresponding resection is required.

　　Third, Radiotherapy

　　Although vulvar squamous cell cancer is sensitive to radiation, the normal tissue of the vulva has poor tolerance to radiation, making it difficult to achieve the optimal radiation dose for the vulvar tumor. However, due to the improvement of radiotherapy equipment and technology, the side effects of the tumor range have been significantly reduced.

    Indications for radiotherapy for vulvar cancer are:

   1. In cases where surgery is not possible or the risk is high, the tumor range is too large to be completely removed or it is difficult to remove.

   2. For advanced cases, radiotherapy is performed first, and then a more conservative surgery is performed after the tumor is reduced.

   3. High probability of recurrence, such as residual cancer cells in lymph nodes, surgical cut ends, lesions close to the upper urethra and the proximal rectum. It is necessary to preserve these sites while completely removing the lesions, and radiotherapy can be added. Radiotherapy uses external beam radiotherapy and interstitial implant radiotherapy.

　　Fourth, Chemotherapy

　　Anticancer drugs can be used as a comprehensive treatment method for advanced cancer or recurrent cancer. Common drugs include doxorubicin, cisplatin, bleomycin, fluorouracil, and nitrogen mustard, etc. To increase the local concentration of drugs, pelvic artery perfusion administration can also be adopted.