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Vaginal Cancers

by

Thomas Ind

Consultant Gynaecological Surgeon

St George's & Royal Marsden Hospitals

 

Introduction

By definition a vaginal carcinoma must not reach the cervix or vulva as they are then defined as cervical or vulval cancers.

 

Incidence

Consist of a about 3% of genital tract cancers

 

Age

Normally present in the 60s

 

Aetiology

Some are related to persistent CIN and the HPV / CIN aetiology of disease. Some sarcomas are related to previous radiotherapy. Between 1940 and 1970 Diethystilboestrol (DES) was used to treat miscarriages. This was found to be associated with vaginal adenosis and adenocarcinoma in the adolescent offspring of these women. The population at risk is now much reduced since 30 years have passed.

 

Staging

1                   Limited to vaginal wall

2                   Spread to subvaginal tissue but not pelvic side wall

3                   Spread to pelvic side wall

4                   Spread beyond the true pelvis or to the bladder or rectum

Treatment

Radical hysterocolpectomy is the usual treatment for stage 1 disease with chemoradiotherapy if there is lymph node involvement. Chemoradiotherapy is the mainstay of treatment for more advanced disease.

 

Prognosis

This is generally poor. The five year survival for stage 1 disease is about 70% decreasing to 50% for stage 2 and below 30% for stage 3 and 4 disease.

 

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