Vaginal Cancer

Vaginal Cancer


INTRODUCTION:

  • Accounts for 0.2% of all women cancers.
  • An unusual tumor, clear cell Adenocarcinoma was seen in younger women exposed to DES.

 RISK FACTORS:

  • Younger women exposed to DES in utero [involvement of upper 1/3rd of vagina]
  • Following tropic ulcers with procidentia
  • Prolonged, neglected use of ring pessary for prolapse.
  • Viral infections
  • Radiation Rx for Ca. cervix

 FEATURES:

  • Primary cancers are rare (1-2% of gynecologic cancers)
  • 85% are epidermoid cancers and others in decreasing order of frequency is adenocarcinomas, sarcomas, and melanomas.
  • A tumor should not be considered a primary vaginal cancer unless the cervix is uninvolved or only minimally involved by a tumor obviously arising in the vagina.
  • By convention, any malignancy involving both cervix and vagina that is histologically compatible with the origin in either organ is classified as cervical cancer.
  • Secondary carcinoma of the vagina is seen more frequently than primary vaginal cancers.
  • Extension of cervical cancer to the vagina is probably the most common malignancy involving the vagina.
  • M/C form: Squamous cell carcinoma (80% – 90%).
  • M/c in the upper one third, posterior wall of the vagina.
  • Mean age of squamous cell ca: 60 years
  • Malignant melanoma is the second most common cancer of the vagina.
  • Primary adenocarcinoma of the vagina is rare, constituting 9% of primary tumors of the vagina.
  • The most common adenocarcinoma of the vagina is metastatic, originating from the colon, endometrium,’ ovary, or, rarely, pancreas and stomach.
  • In women exposed to DES in utero, adenocarcinoma may develop in vaginal adenosis.
  • An association between clear cell adenocarcinoma of vagina and maternal ingestion of DES during pregnancy was identified by the Registry for Research on Hormonal transplacental Carcinogenesis.
  • The estimated risk for developing clear cell adenocarcinoma for an exposed offspring is 1 in 1,000 or less.
  • The mean age of diagnosis is 19 years.
  • Clear cell adenocarcinoma in women with a history of in utero exposure to DES typically presents in the exocervix or anterior, upper one third of the vagina.

TREATMENT:

  • Bowen’s disease: Simple vulvectomy
  • Paget’s disease:
  • No underlying lesion: simple excision or vulvectomy.
  • Underlying lesion +: radiotherapy/ chemotherapy with 5-FU & Bleomycin.
  • Bartholin’s gland tumour: unilateral, usually Adenocarcinoma, poor prognosis. Treated by radical vulvectomy.
  • Vulval sarcoma: metastasis is common, poor prognosis, treatment is local excision.
  • Rodent ulcer: locally malignant, responds well to wide local excision.
Exam Question
 
  • Most common type of vaginal carcinoma is Squamous cell carcinoma
  • Ingestion of Diethyl stilbestrol  during pregnancy increase the risk of vaginal adenocarcinoma in a female offspring
  • Vaginal adenocarcinomas in children is caused by Adminstration of DES to pregnant mothers
Don’t Forget to Solve all the previous Year Question asked on Vaginal Cancer

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