Vaginal Carcinoma

Snapshot

• A 62-year-old woman reports having abnormal vaginal bleeding that occurs intermittently between her predictable menstrual cycles. Pelvic examination is notable for a vaginal mass. She underwent a vaginal biopsy that was remarkable for squamous cell carcinoma.

Introduction

• Overview
  • malignancy affecting the vagina
    • most common histologic type is squamous cell carcinoma
      • most commonly secondary to squamous cell carcinoma of the cervix
• Epidemiology
  • incidence
    • comprises ~3% of all malignancies involving the female genital tract
    • mean age of diagnosis is ~60 years
  • risk factors
    • human papillomavirus (HPV) infection
    • extension from malignant cervical disease
    • diethylstilbestrol (DES) 
• associated with adenocarcinoma of the vagina 

Presentation

• Symptoms
  • vaginal bleeding (most common)
    • may be postcoital, intermenstrual, or postmenopausal
• Physical exam
• vaginal mass may be noted

Studies

• Lab studies
  • vaginal cytology
• Invasive studies
  • vaginal colposcopy
    • indication
      • performed if cytology is abnormal
  • vaginal biopsy
    • indication
      • confirms the diagnosis
• Histology
  • squamous cell carcinoma
    • most common histological type
  • clear cell adenocarcinoma 
    • secondary to DES exposure in utero
    • typically presents in women < 20 years of age
  • sarcoma botryoides (“botrys” is Greek for “grapes”)
    • affecting girls < 4 years of age
    • appears as a polypoid (or grape-like) mass that emerges from the vagina
• contains spindle-shaped cells that are positive for desmin

Differential

• Cervical cancer
  • differentiating factors
• evidence of dysplastic or malignat cells in the cervix only

Treatment

• Treatment planning should be individualized depending upon the location, size, and clinical stage of the tumor

Complications

• Teatment-related complications
  • rectal and vaginal strictures
  • urethral, bladder, and/or rectal injury