[Tactical diagnostic-therapeutic procedures in early stages of vulvar cancer]

The objective of this report is to present the diagnostic and therapeutic tactics in early vulvar carcinoma i.e. carcinoma in situ and carcinoma in I stage (IA and IB) which aim is to limit the radicalisation of the surgery. The clinical material is 57 women aged 27-63 years, colposcopy, cytology and histology diagnosed. The histology examination was made under colposcopic control, and the initial staging was settled i.e. ca in situ in 11 cases, carcinoma IA in 7 cases and carcinoma IB in 39 cases. In qualifying criteria for surgery, unifocal or multifocal location in carcinoma in situ was analysed, and presence of dystrophic lesions in ca in situ and ca IA was taken into consideration. In ca IB the additionally diameter of the lesion (1 cm and 1-2 cm), location (clitoris, perineum, or pudendal lip) and in carcinoma located within the pudendal lip, presence of metastases in lymphatic nodes of inguino-femoral region was taken into consideration. Local excision of lesion was therapeutical procedure in majority of cases in carcinoma in situ and carcinoma IA stage. In multifocal localisation of ca in situ or in coexistence of dystrophic lesions in ca in situ and ca IA vulvectomy was performed. But in carcinoma IB located within the pudendal lips, where lack of metastases to lymphatic nodes in intraoperative histopathology was confirmed, local excision of neoplastic lesion was performed. Presence of lesion within the clitoris, perineum or presence of metastases in lymphatic nodes led to more radical procedure including radical vulvectomy with bilateral lymphadenectomy of inguino-femoral region.