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