Vaginal cancer differential diagnosis: Difference between revisions

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*Leg edema suggests lymphatic or vascular obstruction
*Leg edema suggests lymphatic or vascular obstruction
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*Pre-cancerous changes in a biopsy,cervical intraepithelial neoplasia (CIN). 
*There is no screening test for vaginal cancer.
*Hypoechoic, vascular mass on [[MRI]]
*HPV vaccine can prevent the strains of HPV responsible for most cervical, vaginal and vulvar cancers.
*Colposcopic visualization confirms the diagnosis
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|[[Cervical Carcinoma]]
|[[Cervical Carcinoma]]
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Revision as of 16:08, 18 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Syed Musadiq Ali M.B.B.S.[2]

Overview

Vaginal cancer must be differentiated from cervical carcinoma, rectal carcinoma, uterine carcinoma, vaginal lymphoma, vaginal cyst, vaginal node of endometriosis, and uterine fibroids.

Differential diagnosis

For large lesions consider invasion of the vagina by:

Malignant involvement of the vagina from metastatic spread is much more common, and except for isolated reports of metastases from extragenital cancers, the most common cause of metastatic disease is direct local invasion from the female urogenital tract. Therefore some authors state the diagnosis of primary vaginal carcinoma should be diagnosed only if other gynecologic malignancies have been excluded.

Other differential considerations include:

Diseases with similar symptoms (bleeding or vaginal discharge) are the following:

Clinical Features Physical Examination Diagnostic Findings
Vaginal Carcinoma
  • gross erosion, ulcer, or mass in vagina
  • pelvic or parametrial metastasis
  • Leg edema suggests lymphatic or vascular obstruction
  • There is no screening test for vaginal cancer.
  • HPV vaccine can prevent the strains of HPV responsible for most cervical, vaginal and vulvar cancers.
Cervical Carcinoma
  • Endophytic enlarged, indurated cervix whose surface is smooth, "barrel shaped cervix."
  • Adnexal masses
  • superficial ulceration, exophytic tumor in the exocervix, or infiltration of the endocervix
  • Lateral displacement of the cervix
  • Pre-cancerous changes in a biopsy,cervical intraepithelial neoplasia (CIN). 
  • Hypoechoic, vascular mass on MRI
  • Colposcopic visualization confirms the diagnosis
Rectal Carcinoma[1]
  • Dark or red blood in stool
  • Mucus in stool
  • Narrow stool
  • Abdominal pain
  • Painful bowel movements
  • Iron deficiency anemia
  • On DRE, fixation of the lesion to the anal sphincter,
  • Proctoscopy determine the distance between the distal tumor margin and the dentate line.
  • Carcinoembryonic antigen (CEA) is higher than normal
Submucous uterine leiomyomas[2]
  • Mobile uterus with an irregular contour
Uterine Carcinoma
  • Vaginal bleeding, spotting, or discharge
  • Difficulty or pain when urinating
  • Dyspareunia
  • Pain in the pelvic area
  • Endometrium is thicker than usual
  • Uterus and Adnexal masses
Vaginal Lymphoma
  • Presence of a painless mass in the area
  • Abnormal vaginal bleeding or discharge
  • Pain during and bleeding after intercourse
  • Abdominal pain and back pain
  • Unintentional weight loss
  • Painless enlargement of one or more lymph nodes
  • Lymph node biopsy is the definitive test for diagnosing
Endometriosis
  • Increased serum cancer antigen-125 
  • Nodules of the recto vaginal septum and hypoechoic, vascular mass on MRI
  • Laproscopic visualization confirms the diagnosis
Adenomyosis[1]
  • Diffuse uterine enlargement always less than size corresponding to less than 12 weeks of gestation
  1. 1.0 1.1 Parker JD, Leondires M, Sinaii N, Premkumar A, Nieman LK, Stratton P (2006). "Persistence of dysmenorrhea and nonmenstrual pain after optimal endometriosis surgery may indicate adenomyosis". Fertil Steril. 86 (3): 711–5. doi:10.1016/j.fertnstert.2006.01.030. PMID 16782099.
  2. Donnez J, Donnez O, Matule D, Ahrendt HJ, Hudecek R, Zatik J; et al. (2016). "Long-term medical management of uterine fibroids with ulipristal acetate". Fertil Steril. 105 (1): 165–173.e4. doi:10.1016/j.fertnstert.2015.09.032. PMID 26477496.