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FRCR CO2A Clinical Oncology > Vaginal Cancer FRCR CO2A > Flashcards

Vaginal Cancer FRCR CO2A Flashcards

(52 cards)

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1
Q

what factors determine treatment of vaginal cancer?

A
  1. tumor site
  2. tumor size and
  3. stage
  4. involvement of adjacent anatomical structures
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2
Q

what are the majority of tumors affecting vagina?

A

from adjacent structures i.e cervix and vulva

only 23% of tumors arise from vagina itself

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3
Q

What’s the Lymphatic drainage of vagina?

A

upper 2/3rd: pelvic nodes
lower 1/3rd: inguinal nodesq

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4
Q

what are the RFs for vaginal cancer?

A
  1. old age
  2. HPV 16 and 18
  3. smoking
  4. chronic vaginal trauma (procidentia)
  5. DES exposure in utero
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5
Q

what’s the common histology of vaginal cancer?

A

sq cell carc (80%)
AC

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6
Q

How does Vaginal cancer spread locally?

A

locally to paravaginal tissue and pelvic side walls and rectum and anus and bladder, urethra and ureter

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7
Q

what’s the s/s vaginal cancer?

A

bleeding (MC), postmenopausal or post coital
Discharge
Dysuria
Pain/dyspareunia
or fistula

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8
Q

How is vaginal cancer diagnosed?

A

EUA, Biopsy ‘

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9
Q

what investigations are done in vaginal cancer?

A

cystoscopy
proctoscopy
rule out pregnancy in premenopausal ladies

CT / MRI for local disease extension

CT chest or CxR

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10
Q

what are the regional LNs for vaginal cancer?

A

Pelvic for upper 2/3: ext, int and common iliac

Inguinal and femoral for lower 1/3rd

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11
Q

How is stage I vaginal cancer defined and treated?

A

limited to vaginal wall

Rx: BT alone for smaller and superficial lesion

RT (EBRT and BT)

Surgery and/or RT

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12
Q

How are st II and III vaginal cancer defined and treated?

A

II: involved subvaginal tissue but not extended to pelvic side walls

III: extends to pelvic side walls

Rx
RT (EBRT and BT)
RT alone
surgery and/or post op RT

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13
Q

How is st IVA vaginal cancer defined and treated?

A

IVA: invades bladder / rectal mucosa and or direct extension beyond the true pelvis

Rx
RT (EBRT and BT)
RT alone
surgery and/or post op RT

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14
Q

How is st IV B defined and treated (vaginal cancer)?

A

spread to distant organs

pall RT, ChT and BSC

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15
Q

when can surgery be considered for vaginal cancer?

A

stage I and small st II tumors (radical hysterectomy and vaginectomy)

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16
Q

when is post op RT indicated in Vaginal Cancer?

A

margin +
LN +

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17
Q

How is RT delivered for vaginal carcinoma?

A

two phases:
phase I : EBRT to pelvis
Phase II: boost depending on location of tumor
Apical tumors: Intracavitory if < 0.5 cm thick, interstitital if ? 0.5 cm
Mid vaginal:
Interstitital BT for small anter and lat tumors and EBRT for postr or larger tumors
Distal tumors: INterstitial or EBRT for larger tumors

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18
Q

what about conc cisplatin for vaginal carcinoma Rx?

A

No evidence of benefit, but cisplatin is used

extrapolation from other cancers

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19
Q

What is beam arrangement of RT for vaginal cancer?

A

upper: 4 field
lower: AP and PA

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20
Q

what RT dose is usually given for Vaginal Carcinoma?

A

EBRT 50.4 Gy/ 28# followed by boost with HDR (21 Gy/ 3#) or LDR (20/25 Gy in single fraction)

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21
Q

when is external beam boost done in vaginal carcinoma RT treatment?

Study These Flashcards
A

larger, postr or deeply infiltrating tumor
dose : 18 to 24 Gy in 10 to 12 fractions

22
Q

what are S/Es of RT for vaginal cancer?

Study These Flashcards
A

rectal ulceration, proctitis, urethral stricture, necrosis, small bowel obstruction

late: VVF and RVF or stricture urethra

23
Q

when is recurrence risk high in vaginal cancer post Rx?

Study These Flashcards
A

first 2 years

24
Q

how is F/U done in vaginal cancer post Rx?

Study These Flashcards
A

1st year: 3 monthly
2nd year: 4 monthly
3rd and 4th year: 6 monthly
then annually

25
What's the predominant site of relapse in vaginal carcinoma post Rx?
Locoregional
26
How is rec treated in vaginal cancer ?
prev RT done, pelvic exenteration prev Sx: RT radical
27
what are poor Prognostic Factors in vaginal cancer?
lower vagina Adenocarcinoma increased tumor bulk and higher stage
28
what are favorable prognostic factors for vaginal carcinoma?
1. young age < 60 yrs 2. early stage 3. HPV +
29
what RT dose is a/w improved survival in vaginal carcinoma?
70 Gy
30
What are 5 yr OS in vaginal Carcionma?
I: 75% II: 60% III: 35% IVA: 20% IVB: 0%
31
what are systemic treatment for IV B vaginal cancer? (NCCN) 2025
PD-L1–positive tumors Pembrolizumab + cisplatin/paclitaxel ± bevacizumab Pembrolizumab + carboplatin/paclitaxel ± bevacizumab Cisplatin/paclitaxel/bevacizumab Carboplatin/paclitaxel/bevacizumab
32
33
What percentage of female genital tract cancers does primary vaginal cancer constitute?
2% ## Footnote Approximately 240 new cases are diagnosed annually in the UK.
34
In which age group is the incidence of vaginal cancer greatest?
60–70 years ## Footnote More than 70% of cases occur in this age group.
35
What are the main risk factors for vaginal cancer?
* Fetal exposure to diethylstilboestrol * Persistent HPV infection (especially HPV 16) * History of in-situ or invasive cervical cancer * Chronic vaginal irritation * Use of ring pessaries * Previous treatment with radiotherapy * Lower education level * Lower income * Five or more lifetime sexual partners * Early age at first intercourse * Smoking
36
What is the most common histological type of vaginal cancer?
Squamous cell carcinoma ## Footnote It accounts for over 90% of vaginal cancers.
37
What percentage of vaginal cancers are due to adenocarcinoma?
20% ## Footnote Clear cell adenocarcinoma is associated with in utero exposure to diethylstilboestrol.
38
What are common symptoms presented by women with vaginal cancer?
* Bleeding * Discharge * Dyspareunia * Vaginal irritation * Vaginal mass ## Footnote In advanced disease, symptoms may include pelvic pain, constipation, difficulty in micturition, and lower limb edema.
39
What is the role of MRI in diagnosing vaginal cancer?
Assessing local extension of the tumor.
40
What is the FIGO staging for stage I vaginal cancer?
Tumour limited to vaginal wall.
41
What factors are considered when planning treatment for vaginal cancer?
* Stage * Size and location of the lesion * Previous pelvic irradiation * Performance status
42
What is the treatment of choice for early-stage vaginal cancer?
Surgery ## Footnote Curative in selected women with early-stage (I, small stage II) disease.
43
What is the typical treatment for superficial lesions in vaginal cancer?
Wide local excision.
44
What is the treatment approach for stage II vaginal cancer?
Surgery may be considered if lesions allow a less aggressive procedure than radical vaginectomy.
45
What is the treatment of choice for advanced vaginal cancer when clear resection margins cannot be achieved?
Radiotherapy.
46
What are the two types of radiation used for larger and more advanced lesions in vaginal cancer?
* External irradiation * Brachytherapy
47
What is the main chemotherapy used in chemoradiotherapy for vaginal cancer?
Cisplatin or cisplatin with 5-FU.
48
What is the overall 5-year survival rate for vaginal cancer?
44%.
49
What factors are considered poor prognostic indicators for vaginal cancer?
* Age over 60 years * Lesions in the middle and lower third of the vagina * Poorly differentiated tumours
50
What is the main site of relapse for vaginal cancer?
Pelvis.
51
What is the 5-year survival rate following recurrence of vaginal cancer?
Approximately 12%.
52
What are common treatment-induced morbidities in vaginal cancer survivors?
* Vaginal scarring * Stenosis * Late bladder and bowel toxicities * Early menopause

FRCR CO2A Clinical Oncology (35 decks)

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