Vaginal Cancer

Question 1

Average age of diagnosis vaginal cancer

Answer 1

60-65

Question 2

What is the most common histological type

Answer 2

Squamous cell carcinoma 85%

Other types
Leiomyosarcoma
Yolk sac tumor
Embryonal rhabdomyosarcoma- (peak age 3 )
Melanoma
Clear cell adenocarcinoma (younger pop and des exposure)
Verrucous carcinoma

Question 3

What is the lymphatic drainage of the vagina

Answer 3

1) upper and middle third: cervical-obturator-int+ext iliac - Para aortic

2) lower third- inguinal- pelvic

3) post wall- rectal- inf gluteal/sacral/rectal nodes

Question 4

Risk factors for vaginal cancer

Answer 4

• long term pessary use: chronic irritation
• smoking
• immunosuppressive therapy
• chemotherapy
• radiation
• hpv
• in utero des
• any hpv associated changes or cancer

Question 5

What are the symptoms of vaginal cancer

Answer 5

1) painless bleeding 65-80%

• PMB 70%
• IMB, PCB, HMB
• watery discharge 30%
• Urinary symptoms 20%
• rectal symptoms
• pelvic pain 15-30%
• vaginal mass 10%
• asymptomatic 10-27%

Question 6

How is vaginal cancer staged

Answer 6

Clinically-
CA125 and cea should be performed

Except adenocarcinoma- other sites must be excluded such as endometrial, colon, ovary, cervix
- D+C
- barium enema + sigmoidoscopy/colonoscopy
- mammogram
- CT ABDPEL
-chest xray
- CA125

Question 7

What is the main mode of treatment of vaginal cancer

Answer 7

Radiation therapy

Question 8

What are the indications for surgical TX of vaginal cancer

Answer 8

• SCC stage 1 in upper post vagina
• Stage 4a disease esp with fistula formation
• central recurrence post radiation
• clear cell ca
• verrucous ca : radiation contraindicated
• Melanoma, Yolk sac