Vulvar ve Vajinal Kanserler
Özet
Vulva ve vajen kanserleri, diğer jinekolojik malignitelere oranla oldukça nadir görülen ve sıklıkla postmenopozal kadınlarda ortaya çıkan tümörlerdir. Anatomik yakınlıkları ve her ikisinde de skuamöz hücreli karsinomun en yaygın histolojik alttip olması nedeniyle karıştırılabilen bu kanserlerin etyolojisinde HPV enfeksiyonu, sigara kullanımı ve ileri yaş önemli risk faktörleri arasında yer almaktadır. Erken evrelerde çoğunlukla asemptomatik seyredebilen bu hastalıklar; vajinal kanama, kaşıntı ve ağrı gibi klinik bulgularla kendini gösterebilir. Tanı aşamasında biyopsi ve kolposkopi kritik rol oynarken, evrelemede MR ve uzak metastaz şüphesinde PET-CT tercih edilmektedir. Tedavi yaklaşımı multidisipliner bir konsey tarafından hastaya özgü planlanmalı; erken evre vulva ve vajen lezyonlarında öncelikle cerrahi eksizyon düşünülürken, lokal ileri veya rezeke edilemeyen olgularda definitif kemoradyoterapi (KRT) standart tedavi olarak uygulanmalıdır. Ayrıca, bu bölgelerde daha da nadir izlenen ve kötü prognoza sahip olan melanom ve sarkom gibi agresif alttiplerde tedavi algoritmaları farklılık göstermekte; target terapiler ve immünoterapiler gibi yeni nesil yaklaşımlar araştırılmaktadır. İleri evre, derin stromal invazyon ve lenf nodu pozitifliği ise sağkalımı olumsuz etkileyen en temel prognostik faktörlerdir.
Vulvar and vaginal cancers are relatively rare gynecological malignancies that predominantly affect postmenopausal patients. Due to their close anatomical localization and the fact that squamous cell carcinoma is the most common histological subtype in both, they can easily be confused; additionally, HPV infection, smoking, and advanced age constitute major risk factors in their etiology. Although often asymptomatic in the early stages, these diseases can present with clinical symptoms such as vaginal bleeding, pruritus, and pain. While biopsy and colposcopy are critical for diagnosis, MRI is preferred for staging, and PET-CT is utilized when distant metastasis is suspected. The therapeutic approach requires careful planning by a multidisciplinary tumor board; early-stage lesions are primarily managed with surgical excision, whereas definitive chemoradiotherapy (CRT) stands as the standard treatment for locally advanced or unresectable cases. Furthermore, aggressive subtypes with poorer prognoses, such as melanomas and sarcomas, demand distinct treatment algorithms where targeted therapies and immunotherapies are actively being investigated. Finally, advanced disease stage, deep stromal invasion, and positive lymph nodes represent the fundamental poor prognostic factors that significantly reduce overall survival.
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