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Updated: Dec 27 2021

Vaginal Cancer

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https://upload.medbullets.com/topic/120460/images/vaginalca.jpg
  • Snapshot
    • A 62-year-old women presents with abnormal vaginal bleeding. She underwent menopause at the age of 50. Pelvic examination is unremarkable. Vaginal cytology is abnormal, and she undergoes vaginal colposcopy. A biopsy is taken which is positive for vaginal squamous cell carcinoma.
  • Introduction
    • Overview
      • malignancy affecting the vagina
        • most common histologic type is squamous cell carcinoma
          • most commonly secondary to squamous cell carcinoma of the cervix
  • Epidemiology
    • Incidence
      • comprises ~3% of all malignancies involving the female genital tract
      • mean age of diagnosis is ~60 years
    • Risk factors
      • human papillomavirus (HPV) infection
      • extension from malignant cervical disease
      • diethylstilbestrol (DES)
        • associated with adenocarcinoma of the vagina
  • Presentation
    • Symptoms
      • vaginal bleeding (most common)
        • may be postcoital, intermenstrual, or postmenopausal
    • Physical exam
      • vaginal mass may be noted
  • Studies
    • Lab studies
      • vaginal cytology
    • Invasive studies
      • vaginal colposcopy
        • indication
          • performed if cytology is abnormal
      • vaginal biopsy
        • indication
          • confirms the diagnosis
    • Histology
      • squamous cell carcinoma
        • most common histological type
      • clear cell adenocarcinoma
        • secondary to DES exposure in utero
        • typically presents in women < 20 years of age
      • sarcoma botryoides ("botrys" is Greek for "grapes")
        • affecting girls < 4 years of age
        • appears as a polypoid (or grape-like) mass that emerges from the vagina
        • contains spindle-shaped cells and are positive for desmin
  • Differential
    • Cervical cancer
      • differentiating factors
        • evidence of dysplastic or malignat cells in the cervix only
  • Treatment
    • Treatment planning should be individualized depending upon the location, size, and clinical stage of the tumor
  • Complications
    • Treatment-related complications
      • rectal and vaginal strictures
      • urethral, bladder, and/or rectal injury
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