History

Fact Explanation
Incidental diagnosis on pap smear Primary vaginal cancers are rare but metastatic cancers are common. Squamous cell carcinomas are the commonest histological variant and other variants are clear cell adenocarcinoma and Melanoma. Etiological factors identified are infections such as HPV, HSV, Trichomonas vaginalis,and HIV. Also history of cervical intraepithelial neoplasia (CIN) is considered as a risk factor probably due to association with HPV in both conditions. Diethylstilbestrol is a drug which is implicated as an etiological factor for vaginal cancer. Cigarette smoking, immunosuppressive therapy, chemotherapy, and radiation therapy are also identified as predisposing factors. This is more common in elderly females. Modes of spread are by direct invasion by the tumor, Lymphatic dissemination and hematogenous spread. [1] [2] [3] [4] [5] [6] [7]
Painless vaginal bleeding [1] [2] This is the most common symptom, which could manifest as postmenopausal bleeding [1] [2]
Itching and vaginal discharge [1] [2] [7] This could be due to infectious lesions involved in the pathogenesis or the malignancy it self. [1] [2] [7]
Urinary symptoms [1] [2] [7] Anterior lesions can spread to involve bladder and can cause urinary symptoms such as dysuria, urgency and hematuria. [1] [2] [7]
Pelvic pain [1] [2] [7] Compress of nerves due to tumor spread causes pain. [1] [2] [7]
Tenesmus or constipation [1] [2] Posterior lesions invade the rectum and cause these symptoms [1] [2]
vaginal mass or vaginal prolapse [1] [2] [7] Only seen if the tumor is very large. [1] [2] [7]
Cough, hemoptysis, shortness of breath [1] [2] [7] These pulmonary symptoms are seen once the malignancy spreads to the lungs by blood [1] [2] [7]
Back pain, bone pain [1] [2] [7] These are symptoms due to metastasis to the bone. [1] [2] [7]
Yellowish discoloration of the eyes and sclera, abdominal pain [1] [2] [7] These are symptoms due to metastasis to the liver [1] [2] [7]
Asymptomatic [1] [2] [7] Could be asymptomatic as well and the diagnosis is only made during routine pelvic examination. [1] [2] [7]
References
  1. BHALODIA JIGNASA N., KAPAPURA DHIREN V., PAREKH MALAY N.. Primary Small Cell Neuroendocrine Carcinoma of Vagina: A Rare Case Report. Pathology Research International [online] 2011 December, 2011:1-3 [viewed 25 August 2014] Available from: doi:10.4061/2011/306921
  2. LIU X, YUE Y, ZONG S. Post-hysterectomy vaginal cuff cancer secondary to HPV infection and CIN: A case report Pak J Med Sci [online] 2013, 29(4):1068-1070 [viewed 25 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3817789
  3. MADELEINE M. M., DALING J. R., SCHWARTZ S. M., CARTER J. J., WIPF G. C., BECKMANN A. M., MCKNIGHT B., KURMAN R. J., HAGENSEE M. E., GALLOWAY D. A.. Cofactors With Human Papillomavirus in a Population-Based Study of Vulvar Cancer. JNCI Journal of the National Cancer Institute [online] 1997 October, 89(20):1516-1523 [viewed 25 August 2014] Available from: doi:10.1093/jnci/89.20.1516
  4. GRAHAM JANICE E, MISHRA AMRITA. Global challenges of implementing human papillomavirus vaccines. Array [online] 2011 December [viewed 25 August 2014] Available from: doi:10.1186/1475-9276-10-27
  5. MCLACHLAN J. A. Commentary: Prenatal exposure to diethylstilbestrol (DES): a continuing story. International Journal of Epidemiology [online] 2006 July, 35(4):868-870 [viewed 25 August 2014] Available from: doi:10.1093/ije/dyl140
  6. PALMER J. R.. Prenatal Diethylstilbestrol Exposure and Risk of Breast Cancer. Cancer Epidemiology Biomarkers & Prevention [online] 2006 August, 15(8):1509-1514 [viewed 25 August 2014] Available from: doi:10.1158/1055-9965.EPI-06-0109
  7. BILLOW MEGAN, JAMES REBECCA, RESNICK KIMBERLY, HIJAZ ADONIS. An unusual presentation of a urethral diverticulum as a vaginal wall mass: a case report. Array [online] 2013 December [viewed 25 August 2014] Available from: doi:10.1186/1752-1947-7-171

Examination

Fact Explanation
Lesion/ mass in the vagina [1] [2] [3] [6] [7] A mass/ lesion or the prolapse of the vagina is seen when the tumour mass is large. The lesion/ mass maybe felt in the digital vaginal examination if exophytic or contact bleeding can be present. In advanced malignancies pelvic structures maybe fixed. Speculum examination will also show masses, lesions, discharges. [1] [2] [3] [6] [7]
Vaginal discharge [1] [2] [3] [4] [5] [6] [7] This could be due to infectious lesions or the malignancy it self [1] [2] [3] [4] [5] [6] [7]
Genital warts [4] [5] As HPV is an etiological factor, genital warts caused by HPV could be seen in the vicinity. [4] [5]
Rectal masses [1] [2] [3] [6] [7] Direct spread to the rectum may show rectal masses or felt during digital rectal examination. [1] [2] [3] [6] [7]
Lymph node enlargement [1] [2] [3] [6] [7] Lymphatic spread of the malignancy produces lymph node deposits in the inguinal nodes if the malignancy is in the lower third of the vagina as well as the para aortic nodes if in the upper third of the vagina. [1] [2] [3] [6] [7]
Hepatomegaly/ Ascits [1] [2] [3] [6] [7] Liver metastasis may cause enlarged liver and ascites [1] [2] [3] [6] [7]
Bone tenderness [1] [2] [3] [6] [7] Bone metastasis may produce bone tenderness over spine [1] [2] [3] [6] [7]
Jaundice [1] [2] [3] [6] [7] Liver metastasis leads to jaundice. [1] [2] [3] [6] [7]
Pallor [1] [2] [3] [6] [7] Profuse bleeding may be sufficient to cause clinical pallor [1] [2] [3] [6] [7]
Dullness on percussion and reduced breath sounds in respiratory system examination [1] [2] [3] [6] [7] Lung metastasis leads to these lung signs [1] [2] [3] [6] [7]
References
  1. BHALODIA JIGNASA N., KAPAPURA DHIREN V., PAREKH MALAY N.. Primary Small Cell Neuroendocrine Carcinoma of Vagina: A Rare Case Report. Pathology Research International [online] 2011 December, 2011:1-3 [viewed 25 August 2014] Available from: doi:10.4061/2011/306921
  2. LIU X, YUE Y, ZONG S. Post-hysterectomy vaginal cuff cancer secondary to HPV infection and CIN: A case report Pak J Med Sci [online] 2013, 29(4):1068-1070 [viewed 25 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3817789
  3. BILLOW MEGAN, JAMES REBECCA, RESNICK KIMBERLY, HIJAZ ADONIS. An unusual presentation of a urethral diverticulum as a vaginal wall mass: a case report. Array [online] 2013 December [viewed 25 August 2014] Available from: doi:10.1186/1752-1947-7-171
  4. GRAHAM JANICE E, MISHRA AMRITA. Global challenges of implementing human papillomavirus vaccines. Array [online] 2011 December [viewed 25 August 2014] Available from: doi:10.1186/1475-9276-10-27
  5. MADELEINE M. M., DALING J. R., SCHWARTZ S. M., CARTER J. J., WIPF G. C., BECKMANN A. M., MCKNIGHT B., KURMAN R. J., HAGENSEE M. E., GALLOWAY D. A.. Cofactors With Human Papillomavirus in a Population-Based Study of Vulvar Cancer. JNCI Journal of the National Cancer Institute [online] 1997 October, 89(20):1516-1523 [viewed 25 August 2014] Available from: doi:10.1093/jnci/89.20.1516
  6. DHOREPATIL BHARATI, LADDA DIPAKKUMAR, RAPOL AARTIU. Rare case of primary mucinous adenocarcinoma of vagina. J Can Res Ther [online] 2013 December [viewed 25 August 2014] Available from: doi:10.4103/0973-1482.119366
  7. HUSSAIN N., MURALA K. S., WEBSTER D.. Abnormal vaginal bleeding. InnovAiT: Education and inspiration for general practice [online] 2014 April [viewed 25 August 2014] Available from: doi:10.1177/1755738014530892

Differential Diagnoses

Fact Explanation
Cervical carcinoma [1] Cervical cancer is one differential diagnosis because of it's close proximity to vagina and sometimes cervical cancer metastatic deposits can occur in the vagina and may cause diagnostic confusion [1]
Rectal carcinoma [2] As metastatic involvement is common, local spread of a rectal cancer should be considered as one of the differentials. Vaginal cancers in the posterior vagina can also produce rectal symptoms mimicking a rectal cancer. [2]
Endometrial carcinoma [3] As metastatic involvement is common, spread of a uterine cancer should be considered as a differential diagnosis. [3]
Vulval cancer [4] Should be considered in a tumor involving both vulva and the vagina Vulval cancer maybe difficult to be differentiated from a vaginal cancer. [4]
Gartner's Duct Cyst [5] When there's incomplete regression of the mesonephric duct during fetal development these cysts can occur. Biopsies are performed and larger cysts are excised. [5]
Paramesonephric Duct Cyst [5] These are lined with secretory epithelium similar to endocervix or fallopian tube, suggesting müllerian origin. These cysts may be found anywhere in the vagina and contain mucus. Biopsies are performed and larger cysts are excised. [5]
Inclusion Cyst [5] Inclusion cysts of the vagina result during surgical procedures such as episiotomy, colporrhaphy, or trauma including childbirth [5]
Endometriosis [5] [6] Nodularity of the posterior vaginal fornix, especially at previous scars are seen in endometriosis. Endometrial glands and stroma are identified histologically [5] [6]
Leiomyoma [5] [7] These arise from smooth muscles and benign. They are usually asymptomatic. [5] [7]
Fibroepithelial Polyp [5] [8] Fibroepithelial polyps of the vagina are asymptomatic and are usually small and may be multiple. [5] [7]
Condyloma Acuminatum [5] [9] [10] Condyloma acuminatum occur due to human papillomavirus infection. Histologic evaluation confirms the diagnosis. [5] [9] [10]
Urethral Caruncle [5] [11] Urethral caruncles present as red, friable lesions at the urethral meatus and can cause urinary symptoms. [5] [11]
References
  1. COLOMBO N., CARINELLI S., COLOMBO A., MARINI C., ROLLO D., SESSA C.. Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology [online] December, 23(suppl 7):vii27-vii32 [viewed 25 August 2014] Available from: doi:10.1093/annonc/mds268
  2. GLIMELIUS B., PAHLMAN L., CERVANTES A.. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology [online] December, 21(Supplement 5):v82-v86 [viewed 25 August 2014] Available from: doi:10.1093/annonc/mdq170
  3. PLATANIOTIS G., CASTIGLIONE M.. Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology [online] December, 21(Supplement 5):v41-v45 [viewed 25 August 2014] Available from: doi:10.1093/annonc/mdq245
  4. RUMBOLD ALICE R, TAN SARAH E, CONDON JOHN R, TAYLOR-THOMSON DEBBIE, NICKELS MARIA, TABRIZI SEPEHR N, DAVY MARGARET LJ, O’BRIEN MARGARET M, CONNORS CHRISTINE M, ZARDAWI IBRAHIM, STANKOVICH JIM, GARLAND SUZANNE M. Investigating a cluster of vulvar cancer in young women: a cross-sectional study of genital human papillomavirus prevalence. Array [online] 2012 December [viewed 25 August 2014] Available from: doi:10.1186/1471-2334-12-243
  5. DELMORE JAMES E.. Benign Neoplasms of the Vagina. GLOWM [online] 2009 December [viewed 25 August 2014] Available from: doi:10.3843/GLOWM.10005
  6. MAHENDRU RAJIV, SIWACH SUNITA, AGGARWAL DEEPTI, RANA PARVEEN, DUHAN AMRITA, AGGARWAL TANYA, MAHENDRU TINA ANAND. A rare case of Endometriosis in vaginal hysterectomy scar. Array [online] 2013 December [viewed 25 August 2014] Available from: doi:10.1186/1750-1164-7-6
  7. ISMAIL SM, ADAMS SA. Vaginal vault leiomyoma. J Obstet Gynaecol [online] 2009 Feb, 29(2):160-1 [viewed 25 August 2014] Available from: doi:10.1080/01443610802643972
  8. MADUEKE-LAVEAUX OBIANUJU, GOGOI RADHIKA, STONER GARY. Giant fibroepithelial stromal polyp of the vulva: largest case reported. Array [online] 2013 December [viewed 25 August 2014] Available from: doi:10.1186/1750-1164-7-8
  9. LéONARD BORIS, KRIDELKA FREDERIC, DELBECQUE KATTY, GOFFIN FREDERIC, DEMOULIN STéPHANIE, DOYEN JEAN, DELVENNE PHILIPPE. A Clinical and Pathological Overview of Vulvar Condyloma Acuminatum, Intraepithelial Neoplasia, and Squamous Cell Carcinoma. BioMed Research International [online] 2014 December, 2014:1-11 [viewed 25 August 2014] Available from: doi:10.1155/2014/480573
  10. GATTAI RICCARDO, TORCHIA DANIELE, SALVINI CAMILLA, MAGINI BEATRICE, COMACCHI CLAUDIO, CAPPUCCINI ALESSIO, RUFFINO IRENE, PINTON PIER GIACOMO CALZAVARA, CAPPUGI PIETRO. Photodynamic Therapy for the Treatment of Endoanal Condylomata Acuminata. CLIN INFECT DIS [online] 2010 November, 51(10):1222-1223 [viewed 25 August 2014] Available from: doi:10.1086/656920
  11. WILLIAMSON S. R., SCARPELLI M., LOPEZ-BELTRAN A., MONTIRONI R., CONCES M. R., CHENG L.. Urethral caruncle: a lesion related to IgG4-associated sclerosing disease?. Journal of Clinical Pathology [online] December, 66(7):559-562 [viewed 25 August 2014] Available from: doi:10.1136/jclinpath-2012-201218

Investigations - for Diagnosis

Fact Explanation
Vaginal colposcopy and biopsy [3] [4] This is done under general anesthesia. As malignant cells lack glycogen unlike healthy vaginal mucosa, they do not stain dark brown with Lugol's iodine . This directs the ares to obtain biopsy. [3] [4]
Pap smear [1] [2] [3] A routine Papanicolaou smear may identify abnormal cells but first a cervical cancer should be excluded because it's very common than vaginal cancer. [1] [2]
HR-HPV DNA testing [2] This test can be on vaginal cytologic specimens to evaluate the presence of HPV which could be a causative agent. [2]
References
  1. DASARI PAPA, RAJATHI S, KUMAR SURENDRAV. Colposcopic evaluation of cervix with persistent inflammatory Pap smear: A prospective analytical study. CytoJournal [online] 2010 December [viewed 25 August 2014] Available from: doi:10.4103/1742-6413.67112
  2. BANSAL M., LI Z., ZHAO C.. Correlation of Histopathologic/Cytologic Follow-up Findings With Vaginal ASC-US and ASC-H Papanicolaou Test and HPV Test Results. American Journal of Clinical Pathology [online] December, 137(3):437-443 [viewed 25 August 2014] Available from: doi:10.1309/AJCP9TO1OMXLDDPI
  3. LIU X, YUE Y, ZONG S. Post-hysterectomy vaginal cuff cancer secondary to HPV infection and CIN: A case report Pak J Med Sci [online] 2013, 29(4):1068-1070 [viewed 25 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3817789
  4. DRESANG L. T.. Colposcopy: An Evidence-Based Update. The Journal of the American Board of Family Medicine [online] 2005 September, 18(5):383-392 [viewed 25 August 2014] Available from: doi:10.3122/jabfm.18.5.383

Investigations - Fitness for Management

Fact Explanation
Full blood count [1] To exclude anemia prior to surgery [1]
Coagulation studies [1] To exclude any coagulopathy prior to surgery [1]
Renal function tests ( Serum Creatinine, eGFR, Blood urea nitrogen) [1] To assess the fitness for anesthesia prior to surgery [1]
References
  1. KUMAR A, SRIVASTAVA U. Role of routine laboratory investigations in preoperative evaluation J Anaesthesiol Clin Pharmacol [online] 2011, 27(2):174-179 [viewed 25 August 2014] Available from: doi:10.4103/0970-9185.81824

Investigations - Followup

Fact Explanation
Vaginal colposcopy and biopsy [1] [2] This is done under general anesthesia. As malignant cells lack glycogen unlike healthy vaginal mucosa, they do not stain dark brown with Lugol's iodine . This directs the ares to obtain biopsy. [1] [2]
Pap smear [3] [4] A routine Papanicolaou smear may identify abnormal cells but first a cervical cancer should be excluded because it's very common than vaginal cancer. [3] [4]
References
  1. LIU X, YUE Y, ZONG S. Post-hysterectomy vaginal cuff cancer secondary to HPV infection and CIN: A case report Pak J Med Sci [online] 2013, 29(4):1068-1070 [viewed 25 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3817789
  2. DRESANG L. T.. Colposcopy: An Evidence-Based Update. The Journal of the American Board of Family Medicine [online] 2005 September, 18(5):383-392 [viewed 25 August 2014] Available from: doi:10.3122/jabfm.18.5.383
  3. DASARI PAPA, RAJATHI S, KUMAR SURENDRAV. Colposcopic evaluation of cervix with persistent inflammatory Pap smear: A prospective analytical study. CytoJournal [online] 2010 December [viewed 25 August 2014] Available from: doi:10.4103/1742-6413.67112
  4. BANSAL M., LI Z., ZHAO C.. Correlation of Histopathologic/Cytologic Follow-up Findings With Vaginal ASC-US and ASC-H Papanicolaou Test and HPV Test Results. American Journal of Clinical Pathology [online] December, 137(3):437-443 [viewed 25 August 2014] Available from: doi:10.1309/AJCP9TO1OMXLDDPI

Investigations - Screening/Staging

Fact Explanation
Cystoscopy [1] [2] [4] [5] Done to identify for anterior wall tumors [1] [2] [4] [5]
Proctoscopy [1] [2] [4] [5] As clinical staging is carried out proctoscopy is done for posterior wall tumors [1] [2] [4] [5]
Chest radiography [1] [2] [4] [5] This is done as lung metastasis by hematogenous spread is common [1] [2] [4] [5]
Skeletal x-rays [1] [2] [4] [5] If the patient reports bone pain, then skeletal x-rays are performed to rule out bone metastasis. [1] [2] [4] [5]
Computed tomography (CT) scanning of the upper abdomen and pelvis [1] [2] [4] [5] Enlarged lymph nodes, compression of ureters, hydronephrosis, and liver metastasis may be easy to be visualized using CT scan. [1] [2] [4] [5]
Magnetic resonance imaging (MRI) of the upper abdomen and pelvis [1] [2] [4] [5] Enlarged lymph nodes, compression of ureters, hydronephrosis, and liver metastasis may be easy to be visualized because of excellent soft tissue resolution. [1] [2] [4] [5]
fluorodeoxyglucose positron emission tomography (FDG-PET) scanning [1] [2] [4] [5] As malignant deposits are highly metabolically active, this principle is the basis of using PET scans specially for melanoma [1] [2] [4] [5]
Carcinoembryonic antigen (CEA), cancer antigen–125 (CA-125) [3] Some carcinoma types may cause high levels. [3]
Pap smear [6] [7] After hysterectomy Pap smear is done to assess the recurrence. [6] [7]
Colposcopy and biopsy [8] [9] Routine screening is not done but after hysterectomy this is done to assess the recurrence in the vaginal vault. [8] [9]
References
  1. ANDROUTSOPOULOS GEORGIOS, TERZAKIS EMMANOUIL, IOANNIDOU GEORGIA, TSAMANDAS ATHANASIOS, DECAVALAS GEORGIOS. Vaginal Primary Malignant Melanoma: A Rare and Aggressive Tumor. Case Reports in Obstetrics and Gynecology [online] 2013 December, 2013:1-6 [viewed 25 August 2014] Available from: doi:10.1155/2013/137908
  2. BERIWAL SUSHIL, HERON DWIGHT E, MOGUS ROBERT, EDWARDS ROBERT P, KELLEY JOSEPH L, SUKUMVANICH PANITI. High-dose rate brachytherapy (HDRB) for primary or recurrent cancer in the vagina. Array [online] 2008 December [viewed 25 August 2014] Available from: doi:10.1186/1748-717X-3-7
  3. MOSS E L. The role of CA125 in clinical practice. Journal of Clinical Pathology [online] 2005 March, 58(3):308-312 [viewed 25 August 2014] Available from: doi:10.1136/jcp.2004.018077
  4. MIYAMOTO DAVID T., VISWANATHAN AKILA N., GLYNN SHARON A.. Concurrent Chemoradiation for Vaginal Cancer. PLoS ONE [online] 2013 June [viewed 25 August 2014] Available from: doi:10.1371/journal.pone.0065048
  5. LIU X, YUE Y, ZONG S. Post-hysterectomy vaginal cuff cancer secondary to HPV infection and CIN: A case report Pak J Med Sci [online] 2013, 29(4):1068-1070 [viewed 25 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3817789
  6. DASARI PAPA, RAJATHI S, KUMAR SURENDRAV. Colposcopic evaluation of cervix with persistent inflammatory Pap smear: A prospective analytical study. CytoJournal [online] 2010 December [viewed 25 August 2014] Available from: doi:10.4103/1742-6413.67112
  7. BANSAL M., LI Z., ZHAO C.. Correlation of Histopathologic/Cytologic Follow-up Findings With Vaginal ASC-US and ASC-H Papanicolaou Test and HPV Test Results. American Journal of Clinical Pathology [online] December, 137(3):437-443 [viewed 25 August 2014] Available from: doi:10.1309/AJCP9TO1OMXLDDPI
  8. LIU X, YUE Y, ZONG S. Post-hysterectomy vaginal cuff cancer secondary to HPV infection and CIN: A case report Pak J Med Sci [online] 2013, 29(4):1068-1070 [viewed 25 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3817789
  9. DRESANG L. T.. Colposcopy: An Evidence-Based Update. The Journal of the American Board of Family Medicine [online] 2005 September, 18(5):383-392 [viewed 25 August 2014] Available from: doi:10.3122/jabfm.18.5.383

Management - General Measures

Fact Explanation
Patient education [5] Patient education plays a major role. Especially educated regarding the etiology, nature, course and prognosis, available treatment options and the importance follow up. Patient may be worried on the effect on sexual life following surgery or chemotherapy, radiotherapy. Therefore education regarding this also essential. [5]
Counselling [5] [6] [7] Counselling is also important as it's a malignancy. Sometimes psychiatric referral may be necessary to combat grief, depression as a reaction to the news of malignancy. [5] [6] [7]
Screening [1] [2] [3] Screening is important as a preventive measure and done by Pap smear. Pap smear and HPV testing is recommended for women age 30 and older and negative test results indicate screening every 3 years. [1] [2] [3]
Vaccination [4] HPV 16 and 18 are responsible for malignancy and vaccination against these viruses are present as a preventive measure. It is recommended for both adolescent girls and boys prior to being sexually active [4]
References
  1. JIN X. W., SIKON A., YEN-LIEBERMAN B.. Cervical cancer screening: Less testing, smarter testing. Cleveland Clinic Journal of Medicine [online] December, 78(11):737-747 [viewed 26 August 2014] Available from: doi:10.3949/ccjm.78a.11033
  2. AULT K. A.. Cervical Cancer Prevention: Better Tests, Better Tools, and More Equitable Outcomes. JNCI Journal of the National Cancer Institute [online] December, 103(18):1352-1353 [viewed 26 August 2014] Available from: doi:10.1093/jnci/djr330
  3. HYACINTH HYACINTH I., ADEKEYE OLUWATOYOSI A., IBEH JOY N., OSOBA TOLULOPE, MEDEIROS RUI. Cervical Cancer and Pap Smear Awareness and Utilization of Pap Smear Test among Federal Civil Servants in North Central Nigeria. PLoS ONE [online] 2012 October [viewed 26 August 2014] Available from: doi:10.1371/journal.pone.0046583
  4. JIN X. W., LIPOLD L., SIKON A., ROME E.. Human papillomavirus vaccine: Safe, effective, underused. Cleveland Clinic Journal of Medicine [online] December, 80(1):49-60 [viewed 26 August 2014] Available from: doi:10.3949/ccjm.80a.12084
  5. LIU X, YUE Y, ZONG S. Post-hysterectomy vaginal cuff cancer secondary to HPV infection and CIN: A case report Pak J Med Sci [online] 2013, 29(4):1068-1070 [viewed 26 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3817789
  6. CARUSO ANITA, VIGNA CRISTINA, MAGGI GABRIELLA, SEGA FABIO, COGNETTI FRANCESCO, SAVARESE ANTONELLA. The withdrawal from oncogenetic counselling and testing for hereditary and familial breast and ovarian cancer. A descriptive study of an Italian sample. Array [online] 2008 December [viewed 26 August 2014] Available from: doi:10.1186/1756-9966-27-75
  7. NORDIN K. Coping style, psychological distress, risk perception, and satisfaction in subjects attending genetic counselling for hereditary cancer. [online] 2002 September, 39(9):689-694 [viewed 26 August 2014] Available from: doi:10.1136/jmg.39.9.689

Management - Specific Treatments

Fact Explanation
Treatment of vaginal intraepithelial neoplasia (VAIN) [1] [2] [3] [5] [6] [7] [8] As in any malignnacy, treatment of vaginal cancer depends on the stage and size of the cancer, histological type of cancer, contraindications for available treatment options. Patient's preference also plays a big role. Pap smear and colposcopy can be used to follow up but. topical chemotherapy therapy, laser treatment, brachytherapy may also be used. Sometimes, surgery is used to remove the lesion. [1] [2] [3] [5] [6] [7] [8]
Treatment of Stage 0 (VAIN 3 or CIS) [1] [2] [3] [5] [6] Laser vaporization, local excision, and brachytherapy, topical chemotherapy with 5-FU cream and topical immunotherapy with imiquimod may be used. If there's recurrence, surgery with partial vaginectomy may be needed [1] [2] [3] [5] [6]
Treatment of Stage I [1] [2] [3] [5] [6] [9] Radiation therapy with brachytherapy or external beam radiation is effective for squamous cell carcinomas. Partial or radical vaginectomy are also options and if the cancer is in the upper vagina, radical hysterectomy with bilateral radical pelvic lymph node removal, and radical or partial vaginectomy is done. [1] [2] [3] [5] [6] [9]
Treatment of stage II [1] [2] [3] [5] [6] [9] Combination of brachytherapy and external beam radiation is used. Radical surgery (radical vaginectomy or pelvic exenteration), chemotherapy, chemoirradiation may also be used to treat stage II disease. [1] [2] [3] [5] [6] [9]
Treatment of Stage III or IVA [1] [2] [3] [5] [6] [9] Surgery is not attempted as the spread is uncertain. Treatment is with both brachytherapy and external beam radiation. Chemotherapy combined with radiotherapy will provide a better outcome. [1] [2] [3] [5] [6] [9]
Treatment of stage IVB [1] [2] [3] [5] [6] [9] Symptomatic improvement is seen with radiotherapy and chemotherapy is also useful. [1] [2] [3] [5] [6] [9]
Treatment of recurrent cancer [1] [2] [3] [5] [6] If the cancer was previously treated with surgery, radiation therapy is given and vice versa if the previous treatment is radiation. [1] [2] [3] [5] [6]
Treatment of Vaginal melanoma [4] Surgery is the main treatment for vaginal melanoma. [4]
References
  1. LIU X, YUE Y, ZONG S. Post-hysterectomy vaginal cuff cancer secondary to HPV infection and CIN: A case report Pak J Med Sci [online] 2013, 29(4):1068-1070 [viewed 26 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3817789
  2. MIYAMOTO DAVID T., VISWANATHAN AKILA N., GLYNN SHARON A.. Concurrent Chemoradiation for Vaginal Cancer. PLoS ONE [online] 2013 June [viewed 26 August 2014] Available from: doi:10.1371/journal.pone.0065048
  3. BERIWAL SUSHIL, HERON DWIGHT E, MOGUS ROBERT, EDWARDS ROBERT P, KELLEY JOSEPH L, SUKUMVANICH PANITI. High-dose rate brachytherapy (HDRB) for primary or recurrent cancer in the vagina. Array [online] 2008 December [viewed 26 August 2014] Available from: doi:10.1186/1748-717X-3-7
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