Primary vaginal cancers are rare malignancies, with 80-90% of them being metastatic tumors from the rectum, bladder, cervix, and vulva. They are the least common malignancies among gynecological cancers. More than 50% of patients are 70 years old and older.
EPIDEMIOLOGY / ETIOLOGY
The etiology of vaginal carcinoma is similar to that of cervical cancer. Its incidence increases after the age of sixty and peaks at ages 70-80. Risk factors for vaginal cancers include multiple sexual partners, smoking, alcohol use, early age at first sexual intercourse, low socioeconomic status, similar to cervical cancers.
Previously undergone hysterectomy, endometriosis, chronic irritation, cervical or vaginal radiotherapy are also among the risk factors. HPV has been isolated in 21-76% of vaginal cancers, with HPV 16 being the most common subtype. Clear cell adenocarcinoma, one of the rare vaginal cancers, has been shown to be associated with exposure to diethylstilbestrol (DES) in utero. Clear cell cancers are more common in women under the age of 30.
STAGING
Since primary vaginal cancer is a very rare gynecological cancer, it usually occurs as a result of metastasis from the cervix and vulva, the primary focus. To diagnose primary vaginal cancer, cervical and vulvar cancers need to be eliminated.
The FIGO staging is based on clinical assessment. Physical examination, pelvic examination, cystoscopy, rectoscopy, chest X-ray, bone scintigraphy for distant metastases. Due to its proximity to the bladder and rectum, surgical-pathological staging is often not possible due to the difficulty.
Vaginal cancer spreads through primary local invasion. Due to the thin wall of the vagina and the dense lymphatic network, the tumor spreads rapidly to regional lymph nodes, paravaginal tissues, urethra, bladder, and rectum. Fistulas to adjacent organs may develop in advanced stages.
The anterior wall of the vagina has lymphatics that drain into the lateral pelvic lymph nodes and bladder lymphatics, while hematogenous spread is rare. Distant metastases are rare and can occur in the lungs, liver, and bones.
Prognostic Factors
Clinical Findings and Evaluation
In the early stages of the disease, there is usually a watery and/or colored discharge, which is often painless. In advanced stages, pain during intercourse, changes in bowel movements, and bladder dysfunction may occur. Vaginal bleeding usually occurs in advanced stages, especially in post-hysterectomy bleeding, and one should be careful about vaginal cancer.
Vaginal colposcopic examination is difficult. In colposcopic examination, lesions are similar to those in the cervix. In those who have previously had a hysterectomy for premalignant or malignant reasons, vaginal cuff smears should be taken. After the diagnosis of vaginal cancer, as in cervical cancer, clinical staging should be performed by investigating the extent of the cancer. Depending on the localization of the lesion, cystoscopy and rectoscopy should be performed. Magnetic resonance imaging and computed tomography should be used to determine the extent of the disease, supported by fine needle biopsies, and a primary treatment plan should be made.
Content Update Date: December 26, 2022