Vagina Cancer Surgery

Cancer Vagina

The vaginal tissues, in sharp contrast to the uterine cervix and other gynecologic organs, rarely undergo malignant transformation. Primary cancer of the vagina comprises approximately three percent of all malignant neoplasms of the female genital tract.

The incidence of this disease is approximately 1 case in 100,000 women.

When primary cancer does occur in the vagina, it is usually in the upper third and it is usually an epithelial carcinoma.

HPV subtype 16 presence has been associated with the development of vaginal cancer.

The natural course of vaginal intraepithelial neoplasia (VaIN) is not well understood because most patients are treated once diagnosed.

Signs and symptoms

The signs and symptoms of invasive vaginal cancer are similar to those of cervical cancer.

Painless vaginal discharge, often bloody, is the most frequent symptom in most series.

Postcoital or postmenopausal vaginal bleeding is the initial symptom in many patients with invasive lesions, and a gross lesion is obvious on speculum examination.

Urinary symptoms (pain and frequency) are more common than with cervical cancer because neoplasms lower in the vagina are close to the vesicle neck, with resulting compression of the bladder at an earlier stage of the disease.

Tenesmus – pain while passing stools is commonly associated with posterior vaginal lesions.

Definitive diagnosis is made by biopsy. Metastatic carcinoma to the vagina is seen much more frequently than primary disease. Over 80% of patients with vaginal tumors have secondary lesions. The cervix (32%) and endometrium (18%) are the most common primary sites of cancer.

Management

Until the 1930s, vaginal cancers were considered incurable. With advances in radiation oncology, cure rates for even advanced cancers approach those for cervix cancer

Stage 0 and I

Vaginal intraepithelial neoplasia (VaIN) usually occurs at the vaginal apex. It is also a multifocal disease and is common in patients with a history of cervical dysplasia. Treatment options for patients with VaIN include surgery (i.e., wide local excision or vaginectomy), 5% fluorouracil cream, local ablation (LASER, cryotherapy, electrodiathermy, etc.) and intracavitary radiation

In the young, sexually active patient with diffuse involvement of the vaginal epithelium, total or subtotal vaginectomy with split-thickness skin graft reconstruction of the vagina often allows excellent long-term results.

Surgical management is an option for lesions 0.5 cm or less in patients with invasive carcinoma. For early lesions, particularly in the upper vagina, surgery may be preferred in many patients.

Stage II to IVa

For patients who have stage II–IV vaginal cancer, treatment is tailored to the extent of the disease and the radiation therapy plan should reflect consideration of the depth of invasion of the lesion. Proper planning of radiation therapy and individualization of treatment plans are essential.