Primary vaginal cancers are rare, accounting for less than 0.2% of gynecologic cancers. They can arise from the vagina itself or spread there from nearby organs like the cervix or endometrium. The most common type is squamous cell carcinoma, which usually presents with postmenopausal bleeding in women over age 70. Risk factors include a history of cervical or vulvar cancer. HPV infection may explain the increased risk after other gynecologic cancers due to field cancerization. Diagnosis is made through biopsy and examination of the histological type, with squamous cell carcinoma being the most common.
2. INTRODUCTION
Malignant diseases of the vagina are either
primary vaginal cancers or metastatic cancers
from adjacent or distant organs.
PRIMARY VAGINAL CANCERS - are defined as
arising solely from the vagina, with no
involvement of the external cervical os
proximally or the vulva distally.
METASTATIC VAGINAL CANCER - primarily from
the cervix or endometrium. Metastatic cancer
from the vulva, ovaries, choriocarcinoma,
rectosigmoid, and bladder are less common .
Cancers from distant sites that metastasize to
the vagina through the blood or lymphatic
system also occur, including colon cancer, renal
cell carcinoma, melanoma, and breast cancer.
3. ā¢ According to the International Federation of Gynecology and
Obstetrics (FIGO), a vaginal lesion involving the external os of
the cervix should be considered cervical cancer and treated
as such; a tumor involving both the vulva and the vagina
should be considered vulvar cancer.
4. INCIDENCE
Primary vaginal carcinoma is rare,
constituting <0.2% of all
malignant gynecologic tumour.
It ranks fifth in frequency behind
cancer of the uterus, cervix, ovary,
and vulva
The strict criteria used in defining
vaginal carcinoma contribute to
this low incidence.
Age - after 70 yrs of age
6. CLINICAL
FEATURES
ā¢ Generally asymptomatic (10-27%)
ā¢ Painless vaginal bleeding - most common
symptom ( 65-80%)
ā¢ Bleeding is postmenopausal (70%),which is
consistent with the peak age of 60 years for
squamous cell carcinoma, the most common type.
ā¢ Menorrhagia
ā¢ intermenstrual bleeding
ā¢ postcoital bleeding
ā¢ Vaginal discharge (30%)
ā¢ 20% of patients report urinary symptoms, which
are caused by an anterior lesion compressing or
invading the bladder, the urethra, or both. This
causes bladder pain, dysuria, urgency, and
hematuria.
ā¢ pelvic pain (15-30%)
7. PATHOGENESIS
ā¢ The presence of different stages of
histologic differentiation in vaginal
cancerāVAIN, carcinoma in situ,
possible microinvasive carcinoma, and
invasive cancerāsuggests a continuum
of transformation from less malignant
to more invasive; this is similar to the
continuum described for cervical
cancer.
8. HPV AND HISTORY OF CARCINOMA
ā¢ The significant association of vaginal cancer with a history of cervical or
vulvar cancer suggests that the entire genital tract is at risk for squamous
cell carcinoma once malignancy has occurred anywhere along the tract;
this is a phenomenon known as the "field effect."
ā¢ HPV infection, which evidence indicates is associated with the
pathogenesis of squamous cell vaginal carcinoma, could explain this
phenomenon, because HPV is associated with cervical, vaginal, and vulvar
disease.
9. Diethylstilbestrol
ā¢ The pathogenesis by which DES may play a role in inducing clear cell
adenocarcinoma is unclear.
Vaginal irritation
ā¢ Most vaginal cancers occur in the upper third of the vagina. Reports are
contradictory as to whether the anterolateral wall or the posterior wall is the
more frequent site.
