Vaginal cancer

Accounts for 1 to 3% of all gynecological malignancies.

70% of cases occur to women over the age of 60 years.

80 to 90% are squamous cell type.

Peak incidence occurs in the sixth and seventh decades.

Only 10% of cancers occur in women less than 40 years of age (Creasman WT).

Majority of cases arise in the upper third of the vagina, and most commonly in the posterior wall.

In a study of 156 women with vaginal intraepithelial cancer or invasive vaginal cancer HPV DNA was detected in 80% of patients with in situ disease and 6% of patients with invasive disease (Daling DR).

Dissemination is rare at the time of diagnosis.

Most series report lower cure rates and substantially higher complications rates for vaginal carcinoma compared to comparably stage patients with carcinoma of the cervix.

Lymphatic drainage of the proximal one third of the vagina parallels that of the cervix, along the path of the obturator lymph nodes to the hypogastric lymph nodes, and then to the external and common iliac lymph nodes.

The distal one third of the vagina follows vulva or lymphatic patterns to drain to the femoral lymph nodes and subsequently to pelvic lymph nodes.

The pattern lymphatic metastases is not accurately predicted by the location of the primary tumor within the vagina.

Five year overall survival for stage III and IV disease reported as 30% and less than 10%, respectively (Hansen E).

Radiotherapy is the treatment of choice: because of the close proximity of the vagina to the urethra, bladder and rectum is difficult to get adequate surgical margins for any cancer other than small ones located in the upper, posterior region.

Radiation therapy , usually involves treating the whole pelvis with external beam therapy and breaking therapy with the combination of a vaginal cylinder and interstitial therapy.

Presently, authorities recommend concurrent platinum-based radiation be administered along with radiation.

Adenocarcinoma of the vagina associated with in utero exposure to a synthetic nonsteroidal estrogen, diethylstilbestrol (DES).

Clear cell adenocarcinoma of the vagina reported 143 cases per 97,831 person-years among women exposed to in utero DES.

Clear cell adenocarcinoma incidence among DES exposed women range from 1 in 1000 to 1 in 10,000.

Clear cell adenocacinoma in DES exposed women occurred at a median age of 19 years.

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