Mikroskopische Diagnostik in der Frauenarztpraxis (German Edition)


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In addition to these LNs, very advanced lymphogenic metastatic vaginal cancer may also affect the paraaortic LNs. As with SLN procedures, pretherapeutic systematic LNE in the above-mentioned lymphatic drainage areas may be useful to determine the extent of the required radiation for subsequent primary radio chemo therapy based on staging findings.

Lymph node regions shown to have no metastatic involvement should not be irradiated. If metastatic involvement is found to be present in pelvic lymph nodes on one side, it is important to ensure that both sides are treated with radiotherapy in accordance with the uniform approach used to treat pelvic lymph node metastasis from other primary tumors carcinomas of the uterine cervix, prostate, endometrium, rectum, and anus , There are no data available on hemipelvis radiotherapy for vaginal cancer.

In cases with advanced vaginal carcinoma and large circumscribed lymph node metastases in the groin or pelvis, the option to carry out preparatory surgical debulking as a means of improving the response to radio chemo therapy should be considered. Radiotherapy alone has been used since many decades to treat both local and advanced squamous cell carcinoma and adenocarcinoma of the vagina. Please refer to this chapter in the long version of the guideline for details on the dose-response relationship, the different radiotherapy techniques and the target volume definitions.

A second resection should be considered if the tumor was not resected in its entirety. If this is not feasible or if the expected functional results of this second resection are expected to be unsatisfactory, then local radiotherapy should be administered to improve local control. If inguinal lymph node metastasis has been confirmed histologically, the recommendations to administer postoperative radiotherapy will be based on the recommendations used to treat vulvar cancer.

Radiotherapy planning should opt for modern proton therapy in preference to electron therapy.


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Radiotherapy with bilateral radiation of the pelvic lymph drainage pathways is recommended if pelvic lymph node metastasis has been confirmed histologically. Even if metastasis is only confirmed on one side, radiotherapy should always be administered to both sides.

The recommendation to administer simultaneous radiochemotherapy to treat vaginal cancer is a transfer of the experience with this approach in other tumors. Please refer to this chapter in the long version of the guideline for details on therapy-related toxicity, the choice of radiation technique and its impact on toxicity.

Symptomatic measures such as treatment for diarrhea, sitz baths, vaginal douching and the intravaginal application of a topical ointment poss. Acute reactions are common but usually heal after the end of radiotherapy with no further effects.

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The current data on the use of systemic therapy to treat vaginal cancer is based on single case reports and small series which were analyzed retrospectively. Most therapeutic concepts were adapted from the treatment concepts used for cervical cancer. The references for the few available reports and studies on vaginal cancer are given in the long version of the guideline.

The long version of this guideline includes additional information on the clinical follow-up, the short and long-term impact of the disease and its therapy, and the effects of lifestyle choices and psychosexual and psychosocial follow-up care. A palliative concept is used to treat distant metastasis; it is important to exclude any distant metastasis before deciding on the appropriate therapy to treat locoregional recurrence.

The following diagnostic workup should be carried out if there is a suspicion of locoregional recurrence:. It should be noted in this context that it is not uncommon for primary therapy to create long-term complications which can mimic recurrence, particularly fistula formation The long version of the guideline has drafted some cornerstones for treating recurrence which must be followed.

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The limited options to treat distant metastasis are explained in the long version. Matthias W. Frankgasse 8, AT Wien stephanie. Beachtung des Ausbreitungsmusters. Teilnahme an der Registerstudie zum Vaginalkarzinom. Letztere sind die Vertreter der Fachgesellschaften, Arbeitsgemeinschaften, Organisationen, Vereine, die Interesse an der Mitwirkung bei der Erstellung des Leitlinientextes und der Teilnahme an der Konsensuskonferenz bekundet haben. Die Moderation der Leitlinie wurde dankenswerterweise von Dr. Zu Erstellung der Lang- und dieser Kurzversion hat Dr. Die Methodik zur Erstellung dieser Leitlinie wird durch die Vergabe der Stufenklassifikation vorgegeben.

Im Jahr wurde die Stufe S2 in die systematische evidenzrecherchebasierte S2e oder strukturelle konsensbasierte Unterstufe S2k gegliedert. Die Evidenzgraduierung und Empfehlungsgraduierung einer Leitlinie auf S2k-Niveau ist nicht vorgesehen. Es werden die einzelnen Statements und Empfehlungen nur sprachlich — nicht symbolisch — gewichtet Tab.

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Lebensjahr diagnostiziert 4. Eine vaginale intraepitheliale Neoplasie VaIN kann sequenziell oder auch simultan zu einem Vaginalkarzinom gefunden werden. Die genaue Inzidenz der VaIN ist nicht gesichert. Diese definiert das Plattenepithelkarzinom der Vagina als ein Karzinom der Vagina ohne vorangegangenes Zervix- bzw. In Tab. Das therapeutische Vorgehen richtet sich u. Angaben zu Rezidiv- und Progressionsraten finden sich in der Langversion.

Standardtherapie ist eine Radio- chemo- therapie. Aufgrund fehlender Studien zum Sentinel-Verfahren beim Vaginalkarzinom handelt es sich um ein experimentelles Verfahren beim Vaginalkarzinom.

Radio- chemo- therapie der entsprechenden Gebiete. Alle Kliniken, die Vaginalkarzinome in der Tumorkonferenz besprechen und dann behandeln, werden aufgerufen, den Kontakt mit der Registerstelle herzustellen. Nachweislich nicht metastatisch befallene Lymphknotenregionen sollten nicht bestrahlt werden. Auf den Einsatz von Elektronenfeldern ist zugunsten einer modernen Strahlentherapieplanung mit Photonen zu verzichten. Bei histologisch gesicherten pelvinen Lymphknoten wird eine Strahlentherapie der beidseitigen pelvinen Lymphabflusswege empfohlen.

Die Bestrahlung erfolgt immer beidseits, auch wenn nur einseitig Metastasen nachgewiesen wurden. Die aktuelle Datenlage basiert auf Einzelfallberichten und kleinen Serien, die retrospektiv analysiert wurden. Die therapeutischen Konzepte sind in der Regel von der Therapie eines Zervixkarzinoms abgeleitet.

Literaturhinweise auf die wenigen Berichte werden in der Langversion gegeben. Bildgebung durch MRT des Beckens Die Langversion formuliert einige Eckpfeiler der Rezidivtherapie, die beachtet werden sollen.

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National Center for Biotechnology Information , U. Geburtshilfe Frauenheilkd. Published online Jul Celine D. Jana Barinoff 5 St. Carolin C. Martin C. Michael J. Author information Article notes Copyright and License information Disclaimer.


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  • Frauenklinik Lukaskrankenhaus, Neuss, Germany. Received May 13; Accepted May Key words: vaginal cancer, VaIN, sentinel lymph node biopsy. Numbering This text version of the guideline is a concise abridged version which has omitted generally applicable chapters 12 Supportive Therapy, 13 Psycho-oncology and Quality of Life, 14 Rehabilitation, 15 Integrative Medicine, 18 Palliative Medical Support.

    Caroline C.

    Open in a separate window. Targeted areas of patient care The guideline covers the full spectrum of diagnosis, treatment and follow-up of patients with vaginal cancer, including patients with microinvasive lesions and high-grade precursors. Adoption and period of validity The validity of this guideline was confirmed by the executive boards of the participating medical societies, working groups, organizations and associations as well as by the executive board of the DGGG, the DGGG guidelines commission and the DKG in October and was thus confirmed in its entirety.

    This guideline is classified as: S2k Grading of recommendations The grading of evidence and of recommendations is not envisaged for S2k-level guidelines. Quality indicator The QI working group of the Vulva and Vagina Commission has proposed that histological confirmation of the primary vaginal cancer prior to planning therapy in a tumor conference should be the only quality indicator for this rare entity. Consensus-based Statement 1. The team should have access to all necessary medical specialties and occupations in a cross-sectoral network.

    A certified center is most likely to be able to provide this extensive access. The findings report must use the most recent valid WHO classification of tumor types and the most current TNM classification for staging. Consensus-based Recommendation 4. The lesion must be biopsied if the findings are suspicious.

    Consensus-based Recommendation 5. Consensus-based Statement 5. If there is a cytological suspicion of invasion, destructive therapy must not be carried out and treatment must consist of excision instead. Consensus-based Recommendation 7.


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    • Consensus-based Recommendation 8. Exenteration to treat stage IV vaginal carcinoma is an individual therapy decision.

      Mikroskopische Diagnostik in der Frauenarztpraxis (German Edition) Mikroskopische Diagnostik in der Frauenarztpraxis (German Edition)
      Mikroskopische Diagnostik in der Frauenarztpraxis (German Edition) Mikroskopische Diagnostik in der Frauenarztpraxis (German Edition)
      Mikroskopische Diagnostik in der Frauenarztpraxis (German Edition) Mikroskopische Diagnostik in der Frauenarztpraxis (German Edition)
      Mikroskopische Diagnostik in der Frauenarztpraxis (German Edition) Mikroskopische Diagnostik in der Frauenarztpraxis (German Edition)
      Mikroskopische Diagnostik in der Frauenarztpraxis (German Edition) Mikroskopische Diagnostik in der Frauenarztpraxis (German Edition)
      Mikroskopische Diagnostik in der Frauenarztpraxis (German Edition) Mikroskopische Diagnostik in der Frauenarztpraxis (German Edition)
      Mikroskopische Diagnostik in der Frauenarztpraxis (German Edition) Mikroskopische Diagnostik in der Frauenarztpraxis (German Edition)
      Mikroskopische Diagnostik in der Frauenarztpraxis (German Edition) Mikroskopische Diagnostik in der Frauenarztpraxis (German Edition)
      Mikroskopische Diagnostik in der Frauenarztpraxis (German Edition)

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