Vaginal cancer natural history
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Syed Musadiq Ali M.B.B.S.[2]
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Overview
Depending on the extent of the tumor at the time of diagnosis, the prognosis of vaginal cancer may vary. However, the prognosis is generally regarded as good.The 5-year survival rate can also depend on the type of vaginal cancer. For squamous cell carcinoma of the vagina, the 5-year survival rate is 54%. For adenocarcinoma of the vagina, the rate is about 60%. Symptoms are related to local extension of disease, urinary symptoms (eg, frequency, dysuria, hematuria), or gastrointestinal complaints (eg, tenesmus, constipation, melena)
Natural History
- Vaginal bleeding is the most common clinical presentation of vaginal cancer. Many women are asymptomatic.
- Vaginal bleeding associated with vaginal cancer is typically postcoital or postmenopausal.
- A watery, blood-tinged, or malodorous vaginal discharge may also be present[1].
- A vaginal mass may also be noted by the patient.
- Symptoms are related to local extension of disease, urinary symptoms (eg, frequency, dysuria, hematuria), or gastrointestinal complaints (eg, tenesmus, constipation, melena)[2].
- Pelvic pain from extension of disease beyond the vagina is present in 5 percent of patients.
- 20 percent of women are asymptomatic at time of diagnosis [17-19].
- These vaginal cancers may be detected as a result of cytologic screening for cervical cancer or may be an incidental finding of a vaginal mass on pelvic examination.
Complications
- Infection
- VTE
- Haemorrhage
- Vesicovaginal fistula
- Bladder dysfunction
- Fever
- lymphocyst formation
- Short Vagina
Prognosis
- Data from a United States National Cancer Database showed an increased risk of mortality in women with vaginal cancer with stage II or greater disease and/or tumor size >4 cm (five-year survival 65 versus 84 percent in tumors ≤4 cm)[4].
- Mortality was 51 percent higher in women with melanoma compared with squamous vaginal cancer.
- Patient prognosis depends primarily on the stage of disease, but survival is reduced among those who are older than 60 years, are symptomatic at the time of diagnosis.
- In addition, the length of vaginal wall involvement has been found to be associated with survival and stage of disease in vaginal Squamous cell cancer(SCC) patients.
- Non–DES-associated adenocarcinomas generally have a worse prognosis than Squamous cell cancer(SCC) tumors, but DES-associated clear cell tumors have a relatively good prognosis[5].
References
- ↑ Choo YC, Anderson DG (August 1982). "Neoplasms of the vagina following cervical carcinoma". Gynecol. Oncol. 14 (1): 125–32. PMID 7095583.
- ↑ Herbst AL, Ulfelder H, Poskanzer DC (April 1971). "Adenocarcinoma of the vagina. Association of maternal stilbestrol therapy with tumor appearance in young women". N. Engl. J. Med. 284 (15): 878–81. doi:10.1056/NEJM197104222841604. PMID 5549830.
- ↑ Nori D, Hilaris BS, Stanimir G, Lewis JL (October 1983). "Radiation therapy of primary vaginal carcinoma". Int. J. Radiat. Oncol. Biol. Phys. 9 (10): 1471–5. PMID 6629889.
- ↑ Beller U, Sideri M, Maisonneuve P, Benedet JL, Heintz AP, Ngan HY, Pecorelli S, Odicino F, Creasman WT (2001). "Carcinoma of the vagina". J Epidemiol Biostat. 6 (1): 141–52. PMID 11385773.
- ↑ Hellman K, Lundell M, Silfverswärd C, Nilsson B, Hellström AC, Frankendal B (2006). "Clinical and histopathologic factors related to prognosis in primary squamous cell carcinoma of the vagina". Int. J. Gynecol. Cancer. 16 (3): 1201–11. doi:10.1111/j.1525-1438.2006.00520.x. PMID 16803507.