Cáncer Vaginal

Descripción General

Definición

El cáncer vaginal primario es un tumor Tumor Inflammation maligno que surge del tejido de la vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy.

Revisión de anatomía

La vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy es:

• Un tubo fibromuscular
• Revestido con epitelio escamoso estratificado no queratinizado
• No contiene glándulas dentro de la propia pared vaginal.
• Situado entre la vejiga y el recto en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis: Anatomy femenina

Clasificación histológica

Los LOS Neisseria tumores malignos vaginales pueden ser primarios (que se originan en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la propia vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy) o metastásicos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy desde otros sitios primarios.

Cánceres vaginales primarios:

Los LOS Neisseria subtipos más comunes de cáncer vaginal primario (que se originan en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy) incluyen:

• Carcinoma de células escamosas: aproximadamente 80%–85%
  • Carcinoma de células escamosas “típico” (cáncer vaginal primario más común)
  • Carcinoma verrugoso: una variante rara de carcinoma de células escamosas que generalmente no hace HACE Altitude Sickness metástasis a través de vasos sanguíneos o linfáticos, aunque es localmente agresivo
• Adenocarcinoma (neoplasias malignas glandulares): aproximadamente 10%
  • Adenocarcinoma de células claras (2do cáncer vaginal primario más común)
  • Tumor Tumor Inflammation del seno endodérmico (también llamado tumor Tumor Inflammation del saco vitelino; tumor Tumor Inflammation derivado de células germinales)
• Sarcomas (neoplasias malignas de tejidos blandos): aproximadamente 2,5%
  • Sarcoma botryoides (un rabdomiosarcoma embrionario, que es un tumor Tumor Inflammation maligno del músculo esquelético)
  • Leiomiosarcoma (neoplasia maligna del músculo liso, muy rara)
• Melanoma Melanoma Melanoma is a malignant tumor arising from melanocytes, the melanin-producing cells of the epidermis. These tumors are most common in fair-skinned individuals with a history of excessive sun exposure and sunburns. Melanoma: aproximadamente 2%
• Otros tipos: 1 %–2% del total
  • Indiferenciado
  • De células pequeñas
  • Linfoma
  • Carcinoide

Cáncer metastásico de otros sitios primarios:

• Representa el 80% de todos los LOS Neisseria tumores malignos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy
• Ocurre por:
  • Extensión directa
  • Propagación linfática/hematológica
• Sitios primarios más comunes que metastatizan a la vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy:
  • Cérvix
  • Endometrio/útero
  • Vulva Vulva The vulva is the external genitalia of the female and includes the mons pubis, labia majora, labia minora, clitoris, vestibule, vestibular bulb, and greater vestibular glands. Vagina, Vulva, and Pelvic Floor: Anatomy
  • Ovario
  • Mama
  • Recto
  • Riñón

Epidemiología

Cáncer vaginal primario:

• Raro: representa solo 1%–2% de todas las neoplasias malignas ginecológicas
• Incidencia ajustada por edad en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria Estados Unidos: aproximadamente 1 por cada 100 000 habitantes
• Sarcoma botryoides: cáncer vaginal más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niñas
• Edad promedio al AL Amyloidosis diagnóstico:
  • Carcinoma de células escamosas: 60 años
  • Adenocarcinoma de células claras:
    • 15-20 años (niñas que estuvieron expuestas al AL Amyloidosis dietilestilbestrol in utero)
    • Hacia el final de los LOS Neisseria 60-70 años (mujeres que no estuvieron expuestas al AL Amyloidosis dietilestilbestrol in utero)
  • Sarcoma botryoides: < 5 años (aunque es posible en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum niñas y mujeres mayores)

Etiología y Patogénesis

Factores de riesgo

• Carcinoma de células escamosas:
  • Infección por tipos de VPH de alto riesgo:
    • Factor de riesgo más importante
    • Tipos de alto riesgo: 16 y 18
  • Atipia de células escamosas del cérvix o la vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy (ver Lesiones intraepiteliales escamosas (LIE) vaginales y Neoplasia intraepitelial vaginal ( NIV NIV Noninvasive ventilation (NIV) is an advanced respiratory support that does not require an artificial, invasive airway. This technique is commonly used during acute respiratory failure. The most common forms of NIV are noninvasive positive pressure ventilation (NIPPV) and high-flow nasal cannula (HFNC). Noninvasive Ventilation) a continuación)
  • Tabaquismo
  • Múltiples parejas sexuales
  • Edad creciente
  • Antecedentes de carcinoma cervical o vulvar
  • Antecedente de radiación pélvica
  • Inmunosupresión
• Adenocarcinoma de células claras: exposición in utero a dietilestilbestrol
  • El estrógeno sintético dietilestilbestrol se administró a mujeres embarazadas para prevenir abortos espontáneos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las décadas de 1950 y 1960.
  • Las hijas de mujeres que tomaron dietilestilbestrol durante el embarazo corren el riesgo de padecer adenocarcinoma de células claras.
  • Debido a esta asociación, el dietilestilbestrol se suspendió en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum 1971.

Lesiones intraepiteliales escamosas (LIE) vaginales y neoplasia intraepitelial vaginal ( NIV NIV Noninvasive ventilation (NIV) is an advanced respiratory support that does not require an artificial, invasive airway. This technique is commonly used during acute respiratory failure. The most common forms of NIV are noninvasive positive pressure ventilation (NIPPV) and high-flow nasal cannula (HFNC). Noninvasive Ventilation)

• Lesiones intraepiteliales escamosas vaginales:
  • Definidas como atipia de células escamosas sin invasión
  • Tradicionalmente conocida como NIV NIV Noninvasive ventilation (NIV) is an advanced respiratory support that does not require an artificial, invasive airway. This technique is commonly used during acute respiratory failure. The most common forms of NIV are noninvasive positive pressure ventilation (NIPPV) and high-flow nasal cannula (HFNC). Noninvasive Ventilation; sin embargo, se recomendó una terminología actualizada en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum 2012
  • Clasificadas según la profundidad de la afectación epitelial
  • La LIE/ NIV NIV Noninvasive ventilation (NIV) is an advanced respiratory support that does not require an artificial, invasive airway. This technique is commonly used during acute respiratory failure. The most common forms of NIV are noninvasive positive pressure ventilation (NIPPV) and high-flow nasal cannula (HFNC). Noninvasive Ventilation es considerada una lesión premaligna:
    • Posible resolución espontánea
    • Riesgo de transformación maligna de LIE/ NIV NIV Noninvasive ventilation (NIV) is an advanced respiratory support that does not require an artificial, invasive airway. This technique is commonly used during acute respiratory failure. The most common forms of NIV are noninvasive positive pressure ventilation (NIPPV) and high-flow nasal cannula (HFNC). Noninvasive Ventilation a carcinoma vaginal invasivo: aproximadamente 10%
• Lesión intraepitelial escamosa de bajo grado (LSIL, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés):
  • Involucra < ⅓ del epitelio vaginal (profundidad)
  • Nomenclatura tradicional: NIV-I
• Lesión intraepitelial escamosa de alto grado (HSIL, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés):
  • Involucra > ⅓ del epitelio vaginal (profundidad)
  • Nomenclatura tradicional: NIV-II y NIV-III
  • Mayor riesgo de progresión maligna
  • Carcinoma in situ: involucra todo el espesor del epitelio

Patogénesis

La patogénesis del carcinoma de células escamosas suele estar relacionada con las infecciones por VPH. La patogénesis de otros tipos está menos caracterizada.

• Infección por VPH → LSIL/NIV-I → HSIL/NIV-II/III→ carcinoma in situ → invasión a través de la membrana basal = cáncer invasivo
• Más comúnmente debido al AL Amyloidosis VPH-16
• El VPH tiene 2 oncoproteínas principales:
  • E6 inactiva la proteína supresora tumoral p53.
  • E7 inactiva la proteína supresora tumoral Rb RB Chlamydia.
• Después de que las células pierden proteínas supresoras tumorales → proliferación no regulada → HSIL

Patrones de propagación

• Crecimiento del tumor Tumor Inflammation primario
• Extensión a los LOS Neisseria órganos circundantes.
• Embolización hacia los LOS Neisseria ganglios linfáticos:
  • Parte superior de la vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy: se comunica con el drenaje linfático del cérvix → ganglios pélvicos → ganglios paraaórticos
  • Parte inferior de la vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy: drena en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria ganglios inguinales y femorales → ganglios pélvicos → ganglios paraaórticos
• Diseminación a través de vasos hematológicos y linfáticos (generalmente manifestación tardía):
  • Pulmones
  • Hígado
  • Hueso

Presentación Clínica

Síntomas

• Sangrado vaginal (síntoma más común), que suele ser:
  • Postcoital
  • Postmenopáusico
• Flujo vaginal anormal, que puede ser:
  • Acuoso
  • Maloliente
• Dolor Dolor Inflammation pélvico
• Las lesiones que involucran la pared vaginal anterior pueden presentarse con:
  • Disuria
  • Hematuria Hematuria Presence of blood in the urine. Renal Cell Carcinoma
  • Urgencia
• Las lesiones que involucran la pared posterior pueden presentarse con:
  • Estreñimiento
  • Disquecia
  • Hematoquecia (sangre de color rojo rutilante del ano)
• Alrededor del 20% de las mujeres son asintomáticas al AL Amyloidosis momento del diagnóstico (detectado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum exámenes pélvicos de tamizaje).

Hallazgos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el examen físico

• Masa vaginal:
  • Forma irregular
  • Componentes sólidos
  • Friable (sangra fácilmente)
  • Masa fungiforme
  • Puede constreñir la anatomía
  • Localizada más comúnmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la pared posterior, en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el ⅓ superior de la vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy, pero puede darse en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cualquier parte
  • Sarcoma botryoides: masa que sobresale de la vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy, como un tejido similar a un racimo de uvas
• Placas
• Úlceras
• Extensión de la lesión al AL Amyloidosis cérvix
• Adenopatías inguinales

Diagnóstico y Estadificación

Se requiere un examen histológico de una biopsia para un diagnóstico formal de cáncer vaginal. Los LOS Neisseria hallazgos por imagenología ayudan con la estadificación y la planificación quirúrgica. La evaluación de laboratorio (aparte de la citología/histología) generalmente no es útil.

Exámenes y citología

• Examen pélvico:
  • Evaluar cuidadosamente todas las paredes de la vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy (requiere la rotación de las hojas del espéculo).
  • Palpar en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum busca de áreas elevadas o endurecidas.
  • Identificar cualquier masa o lesión anormal que deba ser biopsiada.
  • Medir el tamaño de cualquier lesión.
  • Palpar los LOS Neisseria ganglios linfáticos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum busca de linfadenopatía.
• Citología:
  • Citología vaginal (i.e., prueba de Papanicolaou vaginal): debe obtenerse en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cualquier área anormal (o en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el manguito vaginal si la mujer se ha HA Hemolytic anemia (HA) is the term given to a large group of anemias that are caused by the premature destruction/hemolysis of circulating red blood cells (RBCs). Hemolysis can occur within (intravascular hemolysis) or outside the blood vessels (extravascular hemolysis). Hemolytic Anemia sometido a una histerectomía)
  • Prueba de Papanicolaou cervical: debe estar actualizada según las guías de tamizaje debido a la alta tasa de patología cervical concurrente
• Colposcopia:
  • Se realiza en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cérvix, la vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy y posiblemente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la vulva Vulva The vulva is the external genitalia of the female and includes the mons pubis, labia majora, labia minora, clitoris, vestibule, vestibular bulb, and greater vestibular glands. Vagina, Vulva, and Pelvic Floor: Anatomy (dependiendo de la presentación)
  • Remojar el cérvix y la vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum ácido acético y examinar con aumento con un colposcopio.
  • Permite la identificación de:
    • Cambios acetoblancos (anomalías)
    • Patrones vasculares anormales
• Cistoscopia: de haber preocupación por afectación vesical
• Proctoscopia: de haber preocupación por afectación rectal

Biopsia

• Requerida para el diagnóstico (estándar de oro)
• Se puede obtener con una biopsia en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum sacabocados en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el consultorio, aunque puede requerir un examen bajo anestesia en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum casos como:
  • Estenosis cervical severa
  • Vasculatura anormal que genera preocupación por sangrado significativo
• Usada para:
  • Confirmar el diagnóstico de cáncer (descartar patología benigna)
  • Determinar el tipo histológico de cáncer
  • Evaluar la profundidad de la invasión

Imagenología

Las imágenes de las cavidades abdominopélvica y/o torácica están indicadas para complementar el examen físico y ayudar en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la estadificación y la planificación quirúrgica.

• Puede evaluar:
  • Tamaño del tumor Tumor Inflammation
  • Grado de progresión local
  • Ganglios linfáticos agrandados
  • Metástasis hepática o pulmonar
• Métodos de imagen:
  • RM pélvica
  • PET PET An imaging technique that combines a positron-emission tomography (PET) scanner and a ct X ray scanner. This establishes a precise anatomic localization in the same session. Nuclear Imaging/TC
  • Radiografía de tórax

Estadificación

El cáncer vaginal se clasifica por estadios utilizando el sistema de estadificación TNM. Hay 4 estadios principales.

• La estadificación TNM tiene en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cuenta:
  • Tamaño del tumor Tumor Inflammation
  • Extensión de la invasión local
  • Metástasis a los LOS Neisseria ganglios linfáticos
  • Metástasis distante
• La estadificación clínica utiliza hallazgos de:
  • Examen físico
  • Cistoscopia y proctoscopia
  • Radiografía de tórax y esquelética
• La estadificación quirúrgica incluye información obtenida de:
  • Lesiones resecadas
  • Ganglios linfáticos resecados

Los individuos se estadifican según sus hallazgos “más elevados”. Por ejemplo, el tumor Tumor Inflammation en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un individuo con un tumor Tumor Inflammation confinado a la vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy, pero con ganglios linfáticos positivos, se clasifica como estadio III. De manera similar, la invasión tumoral directa a la mucosa de la vejiga es estadio IV, incluso si no hay afectación de los LOS Neisseria ganglios linfáticos ni metástasis a distancia.

Tratamiento y Pronóstico

Tratamiento

El cáncer vaginal es raro, por lo que se carece de evidencia sobre enfoques de tratamiento óptimos. Las recomendaciones de tratamiento generalmente se adoptan de cánceres cervicales y anales similares (que son más comunes).

• El tratamiento se individualiza según la ubicación del tumor Tumor Inflammation, el tamaño y el estadio clínico.
• La enfermedad en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum estadio I generalmente se trata con:
  • Escisión quirúrgica +/– radioterapia
  • Solo con radioterapia
• Los LOS Neisseria estadios II-IV generalmente se tratan con radiación + quimioterapia:
  • La quimioterapia generalmente implica:
    • Fluorouracilo
    • Cisplatino
  • La radioterapia generalmente implica una combinación de:
    • Braquiterapia
    • Radioterapia de haz externo
• Vigilancia posterior al AL Amyloidosis tratamiento para buscar recurrencia local:
  • Exámenes pélvicos regulares
  • Pruebas de Papanicolaou anuales
  • Colposcopia y biopsia si se detectan anomalías.

Tratamiento quirúrgico en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cáncer vaginal

• La cirugía se asocia con peores resultados en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum carcinoma de células escamosas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum estadios II-IV → generalmente se evita
  • Dada la invasión local, típicamente implica la extirpación de estructuras adyacentes, incluidos la vejiga y el intestino.
  • Las tasas de complicaciones pueden llegar al AL Amyloidosis 50% en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria procedimientos de exenteración pélvica total.
• Indicaciones de cirugía:
  • Carcinoma verrugoso
  • Sarcoma botryoides
  • Leiomiosarcomas bien diferenciados
  • Melanoma Melanoma Melanoma is a malignant tumor arising from melanocytes, the melanin-producing cells of the epidermis. These tumors are most common in fair-skinned individuals with a history of excessive sun exposure and sunburns. Melanoma
  • Indicaciones paliativas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum enfermedad avanzada
  • Preservación de la fertilidad: transposición quirúrgica de los LOS Neisseria ovarios fuera de la pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis: Anatomy en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum mujeres jóvenes antes de iniciar la radioterapia

Pronóstico

• Los LOS Neisseria factores pronósticos más importantes incluyen:
  • Tipo histológico
  • Estadio de presentación (especialmente el tamaño del tumor Tumor Inflammation y la metástasis a ganglios linfáticos)
  • Edad
• Tasas de supervivencia a los LOS Neisseria 5 años según el estadio:
  • Estadio I: 75%–80%
  • Estadio II: aproximadamente 50%
  • Estadio III: aproximadamente 40%
  • Estadio IV: aproximadamente 10 %–20%

Diagnóstico Diferencial

Sangrado anormal

El síntoma de presentación en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cáncer vaginal suele ser el sangrado postcoital o postmenopáusico. El diagnóstico diferencial para estos síntomas de presentación incluye:

• Cáncer cervical: cáncer invasivo del cérvix (y el cáncer ginecológico más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum todo el mundo). Hay 2 tipos histológicos principales de cáncer cervical: carcinoma de células escamosas y adenocarcinoma, la gran mayoría de los LOS Neisseria cuales son causados por infecciones por VPH de alto riesgo. La neoplasia cervical temprana es asintomática, aunque la enfermedad más avanzada puede presentarse con sangrado anormal (especialmente sangrado por contacto). El diagnóstico se realiza mediante prueba de Papanicolaou con citología, prueba de VPH y biopsia.
• Cáncer endometrial: cáncer del revestimiento interno del útero (y el cáncer ginecológico más común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria Estados Unidos). Cualquier cosa que aumente la exposición al AL Amyloidosis estrógeno aumentará el riesgo de cáncer endometrial; estos riesgos incluyen obesidad, anovulación crónica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum mujeres en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum edad reproductiva, terapia de reemplazo hormonal y uso de tamoxifeno. El cáncer endometrial se diagnostica con una biopsia de endometrio; el ultrasonido puede mostrar un revestimiento endometrial engrosado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum mujeres postmenopáusicas. El manejo es principalmente quirúrgico.
• Atrofia endometrial: condición benigna en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la cual el revestimiento endometrial se vuelve delgado y atrófico debido a estados prolongados de niveles bajos de estrógeno. Con poco o ningún líquido en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la cavidad, la fricción puede provocar microerosiones y una reacción inflamatoria posterior que generalmente se presenta con sangrado o manchado leve postmenopáusico. La atrofia endometrial se diagnostica mediante ultrasonido (que muestra un revestimiento endometrial delgado) ante una biopsia endometrial negativa. No se requiere tratamiento.
• Pólipos endometriales o cervicales: proyecciones pedunculadas o sésiles del endometrio que resultan del crecimiento excesivo de las glándulas endometriales y el estroma alrededor de un tallo vascular central. Aunque estos pólipos suelen ser benignos, pueden ser malignos, especialmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum mujeres postmenopáusicas. Los LOS Neisseria pólipos endometriales o cervicales se presentan con hemorragia uterina o postmenopáusico anormal, aunque muchos son asintomáticos. Los LOS Neisseria pólipos endometriales se diagnostican mejor con ultrasonido con infusión de solución salina ( SIS SIS Infertility, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés) y generalmente se tratan con resección histeroscópica.
• Leiomiomas (fibromas uterinos): tumores benignos comunes que surgen de las células del músculo liso en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el miometrio uterino. Los LOS Neisseria leiomiomas generalmente se presentan con sangrado anormal, dolor Dolor Inflammation pélvico y/o síntomas asociados al AL Amyloidosis tamaño del tumor Tumor Inflammation. Los LOS Neisseria fibromas se identifican como una masa hipoecogénica, bien delimitada y redonda en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el ultrasonido pélvico. Los LOS Neisseria leiomiomas de la pared vaginal también son posibles, aunque extremadamente raros.
• Adenomiosis: condición uterina benigna muy común caracterizada por la presencia de glándulas endometriales ectópicas y estroma dentro del miometrio. La adenomiosis se presenta típicamente con sangrado menstrual abundante y dismenorrea. El diagnóstico es clínico o asistido con imágenes pélvicas, generalmente ultrasonido transvaginal o, en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum ocasiones, RM. El manejo se basa en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la preferencia de la mujer de tener hijos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un futuro y puede incluir histerectomía, otras opciones quirúrgicas o supresión hormonal médica con progestinas.
• Vulvovaginitis Vulvovaginitis The term vulvovaginitis is used to describe an acute inflammation of the vulva and vagina. Vulvovaginitis can be caused by several infectious and non-infectious etiologies, and results from disruption of the normal vaginal environment. Common signs and symptoms include pain, pruritus, erythema, edema, vaginal discharge and dyspareunia. Vulvovaginitis: inflamación aguda de la vulva Vulva The vulva is the external genitalia of the female and includes the mons pubis, labia majora, labia minora, clitoris, vestibule, vestibular bulb, and greater vestibular glands. Vagina, Vulva, and Pelvic Floor: Anatomy y la vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy, más comúnmente debido a infecciones por Candida albicans Candida albicans A unicellular budding fungus which is the principal pathogenic species causing candidiasis (moniliasis). Candida/Candidiasis, vaginosis bacteriana e infecciones por Trichomonas Trichomonas A genus of parasitic flagellate eukaryotes distinguished by the presence of four anterior flagella, an undulating membrane, and a trailing flagellum. Nitroimidazoles vaginalis. Las causas no infecciosas incluyen vaginitis atrófica y dermatitis Dermatitis Any inflammation of the skin. Atopic Dermatitis (Eczema) de contacto. Los LOS Neisseria signos y síntomas comunes incluyen flujo anormal, dolor Dolor Inflammation/dispareunia, prurito, eritema y edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema de la región afectada. El manejo depende de la etiología.
• Cervicitis Cervicitis Inflammation of the uterine cervix. Gonorrhea: inflamación del cérvix, más comúnmente debido a infecciones por Chlamydia trachomatis Chlamydia trachomatis Type species of Chlamydia causing a variety of ocular and urogenital diseases. Chlamydia y/o Neisseria gonorrhoeae Neisseria gonorrhoeae A species of gram-negative, aerobic bacteria primarily found in purulent venereal discharges. It is the causative agent of gonorrhea. Neisseria. Los LOS Neisseria individuos a menudo son asintomáticos, pero pueden presentar una descarga anormal purulenta, dolor Dolor Inflammation pélvico y sangrado irregular (especialmente sangrado por contacto). El diagnóstico es con una prueba de amplificación de ácidos nucleicos (NAAT, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés) y el manejo es con antibióticos.

Masa vaginal

Las masas vaginales benignas pueden incluir:

• Quistes de inclusión vaginal o epidérmicos: quistes benignos, pequeños (aproximadamente 1 cm) de color blanco o amarillo que pueden localizarse en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy o en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la vulva Vulva The vulva is the external genitalia of the female and includes the mons pubis, labia majora, labia minora, clitoris, vestibule, vestibular bulb, and greater vestibular glands. Vagina, Vulva, and Pelvic Floor: Anatomy. Los LOS Neisseria quistes de inclusión se producen cuando el tejido epitelial queda atrapado debajo de la superficie después de un traumatismo. Los LOS Neisseria quistes epidérmicos ocurren cuando los LOS Neisseria conductos de las glándulas sebáceas se obstruyen, lo que hace HACE Altitude Sickness que las secreciones se acumulen debajo de la piel. Estos quistes suelen ser asintomáticos, pero pueden causar dispareunia si aumentan de tamaño o se infectan.
• Quistes del conducto de Gartner: los LOS Neisseria conductos de Gartner son los LOS Neisseria remanentes embriológicos de los LOS Neisseria conductos de Wolff (mesonéfricos), que normalmente regresionan en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las mujeres in utero. Si los LOS Neisseria conductos de Gartner persisten y se llenan de líquido, pueden convertirse en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum quistes (generalmente < 2 cm) en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la pared anterolateral de la parte superior de la vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy. Estos quistes suelen ser asintomáticos y se descubren como hallazgos incidentales en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum exámenes ginecológicos o estudios de imágenes. Si se presentan síntomas, lo más común es que incluyan dispareunia y trastornos miccionales.
• Divertículo uretral: evaginaciones focales de la uretra que se presentan como una masa vaginal en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la pared anterior de la parte inferior de la vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy. Las pacientes típicamente presentarán disuria, goteo postmiccional, dispareunia, infecciones recurrentes del tracto urinario y/o hematuria Hematuria Presence of blood in the urine. Renal Cell Carcinoma. La palpación de la masa puede causar pérdidas de orina. Diagnosticado clínicamente y con cistoscopia.
• Endometriosis Endometriosis Endometriosis is a common disease in which patients have endometrial tissue implanted outside of the uterus. Endometrial implants can occur anywhere in the pelvis, including the ovaries, the broad and uterosacral ligaments, the pelvic peritoneum, and the urinary and gastrointestinal tracts. Endometriosis vaginal: La endometriosis Endometriosis Endometriosis is a common disease in which patients have endometrial tissue implanted outside of the uterus. Endometrial implants can occur anywhere in the pelvis, including the ovaries, the broad and uterosacral ligaments, the pelvic peritoneum, and the urinary and gastrointestinal tracts. Endometriosis es la implantación ectópica de tejido endometrial fuera de la cavidad uterina. Aunque es raro, es posible que el tejido endometrial se implante en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy. El implante puede presentarse como una pequeña lesión azul, negra, marrón o blanca o como un quiste más grande lleno de líquido oscuro (conocido como “quiste de chocolate”). Otros síntomas pueden incluir dispareunia, dismenorrea, sangrado anormal y síntomas urinarios/defecatorios.