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Onkologie up2date 2019; 1(04): 363-382
DOI: 10.1055/a-0978-7841
Weitere Tumorentitäten
Georg Thieme Verlag KG Stuttgart · New York

Herausforderungen in der Therapie der Patientin mit Vulvakarzinom

Katharina Prieske
,
Linn Wölber
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Publication History

Publication Date:
18 November 2019 (online)

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In den letzten Jahren ist die Inzidenz des Vulvakarzinoms deutlich angestiegen. Wegen der oft unspezifischen Frühsymptome, sollte bei jeder Vorsorgeuntersuchung die Vulva gründlich inspiziert werden – auch bei jungen Patientinnen. Liegt eine Krebserkrankung vor, kommt der Qualität der Primärtherapie eine besondere Bedeutung zu. Entscheidend für die Prognose ist das Vorliegen von inguinofemoralen Lymphknoten.
Kernaussagen

  • Der Primärtumor sollte im Gesunden reseziert werden. Ein evidenzbasierter Grenzwert für den optimalen Resektionsrand ist durch aktuelle Studien nicht belegt.

  • Der zentrale Prognosefaktor beim Vulvakarzinom ist das Vorliegen von inguinofemoralen Lymphknotenmetastasen.

  • Als Voraussetzungen für die SNB gelten derzeit klinisch unauffällige Leistenlymphknoten, Tumordurchmesser < 4 cm und ein unifokaler Primärtumor sowie die Möglichkeit des pathologischen Ultrastagings.

  • Bei Metastasennachweis im SNL wird die komplette inguinofemorale LNE empfohlen. Eine alleinige Radiatio ist nach aktueller Wissenslage nicht ausreichend.

  • Die Qualität der Primärtherapie hat eine besondere Wichtigkeit. Leistenrezidive verlaufen oft letal.

  • Durch pelvines Lymphknotenstaging bei inguinalem Metastasennachweis kann eine pelvine Radiatio bei histologisch negativen Lymphknoten im Becken vermieden werden.

Schlüsselwörter

Vulvakarzinom - Sentinel - Staging - Vulvektomie - Lymphonodektomie
 

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