Makindo Medical Notes

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Vaginal carcinoma is a rare type of cancer originating in the cells lining the vagina, accounting for about 1-2% of all gynecologic malignancies. It is more common in older women and may develop from different cell types within the vagina, leading to various histological subtypes, with squamous cell carcinoma being the most common.

Aetiology

• Vaginal carcinoma is most often squamous and typically affects the upper third of the vagina.
• Associated with human papillomavirus (HPV) infection.

Pathology

• Premalignant Condition: Vaginal intraepithelial neoplasia (VAIN).
• Squamous Cell Carcinoma: Accounts for 90% of cases.
• Adenocarcinoma: 5% of cases, including clear cell adenocarcinoma associated with in utero exposure to diethylstilbestrol (DES) before 18 weeks of gestation.
• Other rare types: Malignant melanomas and sarcomas.

Clinical Features

• Post-menopausal or irregular PV bleeding and discharge.
• Dyspareunia (pain during intercourse).
• Vaginal mass, dysuria, urinary frequency.
• Local and lymphatic spread, leading to symptoms like lymph node enlargement.
• Changes in bowel habits, particularly if the cancer invades the rectum.

Investigations

• Pelvic Examination: Physical assessment to evaluate any abnormalities.
• Biopsy: Definitive diagnosis through biopsy of the lesion.
• Colposcopy and Biopsy: Visual examination with biopsy to assess the extent of the disease.
• Imaging Studies: CT, MRI, or PET scans to evaluate spread and stage of the disease.

Vaginal carcinoma is rare but serious, necessitating early detection and treatment for better outcomes. Risk factors include HPV infection, DES exposure, and a history of cervical cancer. Treatment typically involves surgery, radiation therapy, and sometimes chemotherapy, depending on the stage and type of cancer. Regular gynecological exams and awareness of symptoms are essential for early diagnosis and management.

Management

• Surgery: Depends on the stage and location of the tumor. Options include local excision, partial or total vaginectomy (removal of the vagina), and pelvic exenteration for advanced cases.
• Radiotherapy: Often used for women unable to undergo surgery.
• Chemotherapy: May be used in combination with radiation or surgery, depending on the stage of the disease.