Vulva Kanseri Uluslararası Jinekoloji ve Obstetrik Federasyonu (Figo) 2021 Evrelemesindeki Yenilikler ve Eski Evrelemeler İle Kıyaslanması
Özet
Yüksek sosyoekonomik ülkelerde sık görülen vulva kanseri, çoğunlukla postmenopozal dönemde ve skuamöz hücreli karsinom (SCC) histolojik alt tipinde ortaya çıkan bir jinekolojik malignitedir. Hastalık genellikle asemptomatik seyretmekle birlikte labiada tek lezyon veya kaşıntı ile klinik verir. Tanısı lokal anestezi altında yapılan biyopsi ile konulur ve yayılımı doğrudan komşu organlara, lenfatik embolizasyonla inguinofemoral/pelvik nodlara ya da hematojen yolla uzak organlara gerçekleşir. Evreleme sisteminde tarihsel süreçte önemli değişiklikler yapılmıştır; 1969 klinik evrelemesindeki yetersizlikler nedeniyle 1988'de cerrahi-patolojik evrelemeye geçilmiş, ardından lenf nodu morfolojisini detaylandıran 2009 revizyonu uygulanmıştır. Son olarak FIGO, 2021 yılında veri odaklı, daha basit ve prognostik gücü yüksek yeni bir evreleme sistemi yayınlamıştır. Bu güncel 2021 revizyonunda invazyon derinliği ölçümü netleştirilmiş, izole tümör hücreleri dışlanmış, lenf nodu sayısı kriteri kaldırılarak mikrometastaz/makrometastaz kavramları getirilmiş ve kesitsel görüntüleme bulguları ile HPV durumunun değerlendirilmesi sisteme dahil edilmiştir.
Vulva cancer, which is common in high socioeconomic countries, is a gynecological malignancy that mostly occurs in the postmenopausal period and predominantly presents as squamous cell carcinoma (SCC) histological subtype. Although the disease is generally asymptomatic, it clinically presents with a single lesion on the labia or itching. Its diagnosis is established through biopsy performed under local anesthesia, and its spread occurs directly to neighboring organs, to inguinofemoral/pelvic nodes via lymphatic embolization, or to distant organs through hematogenous routes. Significant changes have been made in the staging system throughout history; due to the inadequacies of the 1969 clinical staging, a transition to surgical-pathological staging was made in 1988, followed by the 2009 revision that detailed lymph node morphology. Finally, in 2021, FIGO published a new data-driven staging system that is simpler and possesses higher prognostic power. In this current 2021 revision, the measurement of invasion depth has been clarified, isolated tumor cells have been excluded, the criteria for the number of lymph nodes has been removed to introduce micro/macrometastasis concepts, and the integration of cross-sectional imaging findings along with the evaluation of HPV status has been incorporated into the system.
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