Vaginal malignancy is an abnormal proliferation of vaginal epithelium demonstrating malignant cells below the basement membrane.
PHYSICAL FINDINGS & CLINICAL
- Majority of cases are asymptomatic
- Postmenopausal vaginal bleeding and/or vaginal discharge are the most common symptoms
- May also present as pelvic pain or pressure, dyspareunia, dysuria, malodor, or postcoital bleeding
- May present as a vaginal lesion or abnormal Pap smear
- The exact etiology is unknown.
- Vaginal intraepithelial neoplasia is believed to be a precursor for squamous cell carcinoma of the vagina.
- Long-term pessary use has been associated with vaginal malignancy.
- Prior pelvic radiation may be a risk factor.
- Clear-cell adenocarcinoma is related to in utero diethylstilbestrol exposure.
- Extension from other primary carcinoma more common than primary vaginal cancer
- Diagnosis is made histologically by biopsy.
- Colposcopy and biopsy should follow suspicious Pap smear.
- Cystoscopy, proctosigmoidoscopy, chest radiography, IV urography, and barium enema may be used for clinical staging.
- CT scan , FDG, PET scan, and MRI are used to evaluate spread.
- Staging I to IV
- Chest radiography, IV urography, and barium enema are used for staging.
- CT scan and MRI are good for assessing tumor spread.
- Radiation therapy is the mainstay of treatment.
- Stage I tumors that are small and confined to the posterior, upper third of the vagina may be treated with radical surgery.
- Other stages require a whole-pelvis, interstitial, and/or intracavitary radiation therapy.
- Chemotherapy is used in conjunction with radiotherapy in rare select cases.