Vaginal Flashcards
(25 cards)
Histological types of vaginal cancer- what is most common?
SCC most common (>80%)
Adenocarcinoma (10%)
Sarcoma
Melanoma
Small cell
Lymphoid
Carcinoid
Median age of dx for vaginal SCC cancer
65years
Frequency of vaginal cancer
Rare
<3% of all gynae cancers
6000 pa in USA
Risk factors for vaginal cancer
Similar to cervical
current Smoking
HPV (75%)
- life time number of sexual partners
- early age at first intercourse
DES exposure (clear cell Adeno)
alcohol consumption
prev RT (controversial)
What type of mucosa is the vagina
stratified squamous non keratinising
What is the lymphatic drainage of the upper third of the vagina
Internal and external iliac, common iliac nodes
parametrial nodes
obturator nodes
What is the lymphatic drainage of the middle third of the vagina
Drains to both lymphatic pathways of upper and lower vagina;
Upper: parametrial, obturator, pelvic (external and internal and common iliac) nodes
Lower: inguinal , external iliacs
Where does vaginal cancer commonly metastasise to?
Para-aortic lymph nodes
Lungs, liver, Bone
What HPV subtypes are specifically implicated in Vaginal cancer?
HPV 16 and 18
What % of gynae cancers is vaginal cancer? How does it rank compared to other gynae cancer?
3% of all gynae cancers
4th most common gynae malignancy
What is the most common location of vaginal cancer?
Posterior wall, superior third of vagina
(the speculum must be rotated to ensure exam of this region).
Are the majority of vaginal cancers primary or metastatic?
approx 75%
often arising from the endometrium, cervix, vulva, ovary, breast, rectum and kidney.
Vaginal metastases may occur by direct extension (eg, cervix, vulva, endometrium) or by lymphatic or hematogenous spread (eg, breast, ovary, kidney).
Presenting symptoms of vaginal cancer
Vaginal bleeding (typically post coital)
Vaginal discharge
Vaginal mass
Local extension of disease
- Urinary symptoms (frequency, dysuria, haematuria)
- GI symptoms (tenesmus, constipation, Malena)
Pelvic pain
How should a vaginal cancer be classified if it has occurred within 5 years of a previous gynae malignancy?
If vaginal cancer is diagnosed <5 years after previous gynaecologic malignancy, then new diagnosis should be categorised as a recurrence of the original
Increased risk for clear cell adenocarcinoma is linked with what exposure?
In utero exposure to the synthetic estrogen diethylstilbestrol (DES) is linked with an increased risk for clear cell adenocarcinoma.
What type of vaginal sarcoma is most common in adults? In children?
Adults: leiomyosarcoma
Children (≤6 yo): embryonal RMS (i.e., sarcoma botryoides)
A vaginal cancer is never considered a vaginal primary if it involves either
of what 2 structures?
Cancer involving the vulva or cervix is never considered to be a vaginal
primary (even if the bulk of Dz lies in the vagina).
What are 3 appropriate Tx options for vaginal intraepithelial neoplasia
(VAIN)?
Surgical excision, laser vaporization, and topical 5-FU are all appropriate
Tx for VAIN.
VAIN is multifocal in what % of pts?
Up to 60% of pts with VAIN have multifocal Dz. Close f/u is essential
In general, what is the preferred definitive Tx modality for vaginal
cancer?
Although Sg may be appropriate for early, stage I lesions (upper third vagina, <2cm)
, definitive RT is
generally the preferred Tx modality (as morbidity is less compared with
radical Sg).
What brachytherapy technique is commonly required for stages II–III
vaginal cancer (in addition to EBRT Tx)? How important is it to include
brachytherapy?
- Interstitial brachytherapy needle implants are commonly required to
achieve adequate brachytherapy dose coverage for stages II–III vaginal cancers (the depth–dose characteristics of intracavitary applicators are not favorable enough to treat deep lesions). - SEER analysis (Orton A et al., Gynecol Oncol 2016)
compared pts with primary vaginal cancer treated with EBRT alone
vs. EBRT with brachtherapy. All FIGO stages benefited with a reduced
rate of death by more than 20%.
What common late effect may limit sexual function as well as f/u for vaginal cancer?
Vaginal stenosis is very common following RT for vaginal cancer. All pts
should use a vaginal dilator
What is stage I vaginal cancer
Vagina confined
Stage Ib <2cm
Stage Ib >2cm
What is stage II vaginal cancer?
Invading paravaginal tissue, but not PSW (muscle, fascia, neurovas, bone)
IIA <2cm
IIB >2cm
