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Management of VIN and VAIN
Precancerous lesions of the vulvar (VIN) and birth canal (VAIN) are a sign of oncogenic activity within this tissue. A large percentage of such lesions will resolve spontaneously but it is impossible to know which ones will progress. The goal of treatment is to prevent the development of invasive cancer both. The risk of cancer is not limited to the current site of the change but includes other areas of the genital tract and also extends into the distant future. VIN and VAIN require long-term care and surveillance.
The choice of treatment is dependent on many factors. The location and size of the lesion must be considered when choosing therapy. Treatment of a single lesion is different than treating multiple lesions at different locations. Finally individual factors should be considered. The treatment of a first lesion might be different than a recurrent lesion. A healthy person might me treated differently than a woman who is immunosuppressed. These and other factors are usually considered when a provider makes recommendations for treatment.
Simple excision of the involved area is the most common and logical treatment choice. This allows for complete removal and confirmation of the diagnosis. The depth of involvement can be described, which may be grade 1, 2 or 3 and worse case could include a detection of an early invasive cancer. This is more challenging when the lesion is high in the birth canal or covers a large area. In such cases, a more radical excision maybe required.
Treatment of multifocal lesions can be challenging. Laser ablation is often used when there is a wide area of involvement. Treatment with medications is also an option. Aldara (Imiquimod) cream is a popular treatment since it is easy to use. It can be self-applied and has minimal side effects. It is described as an immune response modifier and has antiviral and antitumor effects. Other options for treatment include 5-fluoruracil and radiation treatment.
Prevention is always better. The greatest risk factors for the development of these cancers are smoking and Human Papilloma Virus (HPV) infection. If you smoke, quitting is the best thing you can do for yourself. If you are a candidate, consider receiving the quadrivalent HPV vaccine, which is highly effective in preventing cancer of the female genital tract due to HPV infection.
I hope this article has provided you with information that will help you make wise choices, so you may:
Live healthy, live well and live long!
Content copyright © 2013 by Dr. Denise Howard. All rights reserved.
This content was written by Dr. Denise Howard. If you wish to use this content in any manner, you need written permission. Contact Dr. Denise Howard for details.
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