Cancer of Vagina

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Cancer of Vagina

Cancer of Vagina occur in vagina and commonly it is of squamous cell carcinoma , and less commonly it is adenocarcinoma variety . In younger age group , though rare sarcoma botroides, germ cell tumor or rhabdo myosarcoma varieties may occur.

Risk Factors

1. > 60 years age
2. HPV infection
3. women exposed to DES( Diethyl stilbesterole)in utero

Stage of Vaginal Cancer

Stage 0 (Carcinoma in Situ): when cancer is localized to epithelial lining of vagina
Stage I: Cancer breaches the basement membrane of epithelium, but localized to vagina only
Stage II: cancer spread to surrounding tissues around vagina
Stage III: cancer spread to lymph nodes in pelvis or groin or it reaches up to pelvic walls
Stage IV: Distant metastasis


Sign & symptoms

1. bleeding per vaginum
2. white discharge per vaginum
3. in advanced cases : pain in lower abdomen, backache, pain radiating to legs, urinary or fecal incontinence

Diagnosis

1. History & Examination
2. Pap's Smear
3. Colposcopy
4. Biopsy
5. X Ray chest , CT Scan, MRI, Lymphangiography, Cytoscopy, Ureteroscopy, Proctoscopy help in planning of treatment

Treatment options by stage :

Stage 0 Vaginal Cancer (carcinoma in situ):

1. Wide local excision, with or without a skin graft
2. Partial or total vaginectomy, with or without a skin gzaft.
3. Topical chemotherapy or Laser surgery or internal radiation therapy.

Stage I squamous cell carcinoma of Vagina:

1. Internal radiation therapy, with or without external radiation therapy to lymph nodes or large tumors
2. Wide local excision or vaginectomy with vaginal reconstruction. Radiation therapy may be given after the surgery
3. Vaginectomy and lymphadenectomy, with or without vaginal reconstruction. Radiation therapy may be given after the surgery.

Treatment

Stage I : Vaginectomy or , hysterectomy, and lymphadenectomy. This may be followed by vaginal reconstruction and/or radiation therapy. Radiotherapy also gives equally good results.

Stage II: either only radiotherapy or surgery (Vaginectomy or pelvic exenteration) with or without radiation therapy.

Stage III: in advanced stages radiotherapy gives better results, in stage IV A & B, the aim is palliative treatment, to give symptomatic relief and improve the quality of life. Chemotherapy may also be given. Patient can participate in clinical trial of chemotherapy and / or radio sensitizers.