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Invasives Karzinom der Vulva

  • Sven Ackermann
  • Christian Dannecker
  • Lars-Christian Horn
  • Hans-Georg Schnürch
  • Celine Alt-Radtke
  • Monika Hampl
  • Linn Wölber
  • Benjamin Wolf
  • Simone Marnitz-Schulze
  • Jana Barinoff
  • Grit Mehlhorn
  • Andreas Günthert
  • Peter Mallmann
Chapter

Zusammenfassung

Vulvakarzinome werden immer häufiger. Als Risikofaktoren gelten HPV-Infektion, Lichen sclerosus und Nikotinabusus. Damit wird ein primärer Präventionseffekt durch die HPV-Impfung erwartet. Eine spezifische Früherkennungsuntersuchung ist nicht etabliert. Die definitive Diagnose wird histologisch gesichert, in fortgeschrittenen Stadien erfolgt ein Staging durch zusätzliche apparative Diagnostik. Eine Metastasierung in die Leistenlymphknoten ist nicht zu erwarten bei Basalzellkarzinomen und verrukösen Karzinomen und bei Karzinomen mit einer Infiltrationstiefe ≤1 mm. Die Therapie erfolgt überwiegend operativ. Zumeist erfolgt nach weiter lokaler Resektion ein primärer Wundverschluss, nur bei großen Resektionen sind plastische Rekonstruktionen erforderlich. Bei multifokalen Primärtumoren ist eine Vulvektomie indiziert. Das Lymphknoten-Staging wird durch getrennte Leistenschnitte durchgeführt (“triple incision”). Die inguinalen und femoralen Lymphknoten müssen entfernt werden (LNE). Die postoperative Morbidität der Lymphonodektomie ist hoch, das Sentinel-Verfahren verspricht bessere Verträglichkeit. Dafür bestehen onkologische Risiken, die sich genau beziffern lassen. Präzise Aufklärung und Abwägung sind unabdingbar.

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Copyright information

© Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature 2018

Authors and Affiliations

  • Sven Ackermann
    • 1
  • Christian Dannecker
    • 2
  • Lars-Christian Horn
    • 3
  • Hans-Georg Schnürch
    • 4
  • Celine Alt-Radtke
    • 5
  • Monika Hampl
    • 6
  • Linn Wölber
    • 7
  • Benjamin Wolf
    • 8
  • Simone Marnitz-Schulze
    • 9
  • Jana Barinoff
    • 10
  • Grit Mehlhorn
    • 11
  • Andreas Günthert
    • 12
  • Peter Mallmann
    • 13
  1. 1.FrauenklinikKlinikum DarmstadtDarmstadtDeutschland
  2. 2.Klinik und Poliklinik für Frauenheilkunde und GeburtshilfeKlinikum der Universität MünchenMünchenDeutschland
  3. 3.Arbeitsgruppe Mamma-, Gynäko- & PerinatalpathologieInstitut für Pathologie, Universitätsklinikum LeipzigLeipzigDeutschland
  4. 4.Ehem. Lukaskrankenhaus NeussKaarstDeutschland
  5. 5.Institut für Diagnostische und Interventionelle RadiologieUniversitätsklinikum DüsseldorfDüsseldorfDeutschland
  6. 6.Klinik für Frauenheilkunde und GeburtshilfeUniversitätsklinikum DüsseldorfDüsseldorfDeutschland
  7. 7.Klinik und Poliklinik für GynäkologieUniversitätsklinikum Hamburg-EppendorfHamburgDeutschland
  8. 8.Klinik und Poliklinik für FrauenheilkundeUniversitätsklinikum LeipzigLeipzigDeutschland
  9. 9.Klinik und Poliklinik für StrahlentherapieUniversitätsklinikum KölnKölnDeutschland
  10. 10.Klinik für GynäkologieCharité Berlin, Campus Benjamin FranklinBerlinDeutschland
  11. 11.FrauenarztpraxisErlangenDeutschland
  12. 12.FrauenklinikLuzerner KantonsspitalLuzernSchweiz
  13. 13.Klinik und Poliklinik für Frauenheilkunde und GeburtshilfeUniversitätsklinikum KölnKölnDeutschland

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