Vaginal cancer natural history: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{CMG}} | {{CMG}} {{AE}} {{sali}} | ||
{{Vaginal cancer}} | {{Vaginal cancer}} | ||
==Overview== | ==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. | 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=== | ===Natural History=== | ||
* Vaginal bleeding is the most common clinical presentation of vaginal cancer. Many women are asymptomatic. | * [[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. | *[[Vaginal]] bleeding associated with [[vaginal cancer]] is typically [[postcoital]] or [[postmenopausal]]. | ||
*A watery, blood-tinged, or malodorous vaginal discharge may also be present<ref name="pmid7095583">{{cite journal |vauthors=Choo YC, Anderson DG |title=Neoplasms of the vagina following cervical carcinoma |journal=Gynecol. Oncol. |volume=14 |issue=1 |pages=125–32 |date=August 1982 |pmid=7095583 |doi= |url=}}</ref>. | *A watery, blood-tinged, or malodorous [[vaginal]] discharge may also be present<ref name="pmid7095583">{{cite journal |vauthors=Choo YC, Anderson DG |title=Neoplasms of the vagina following cervical carcinoma |journal=Gynecol. Oncol. |volume=14 |issue=1 |pages=125–32 |date=August 1982 |pmid=7095583 |doi= |url=}}</ref>. | ||
*A vaginal mass may also be noted by the patient. | *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)<ref name="pmid5549830">{{cite journal |vauthors=Herbst AL, Ulfelder H, Poskanzer DC |title=Adenocarcinoma of the vagina. Association of maternal stilbestrol therapy with tumor appearance in young women |journal=N. Engl. J. Med. |volume=284 |issue=15 |pages=878–81 |date=April 1971 |pmid=5549830 |doi=10.1056/NEJM197104222841604 |url=}}</ref>. | *Symptoms are related to local extension of disease, [[urinary symptoms]] (eg, [[frequency]], dysuria, hematuria), or gastrointestinal complaints (eg, [[tenesmus]], constipation, [[melena]])<ref name="pmid5549830">{{cite journal |vauthors=Herbst AL, Ulfelder H, Poskanzer DC |title=Adenocarcinoma of the vagina. Association of maternal stilbestrol therapy with tumor appearance in young women |journal=N. Engl. J. Med. |volume=284 |issue=15 |pages=878–81 |date=April 1971 |pmid=5549830 |doi=10.1056/NEJM197104222841604 |url=}}</ref>. | ||
*Pelvic pain from extension of disease beyond the vagina is present in 5 percent of patients. | *[[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]. | *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. | *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 == | |||
===Surgery related=== | |||
* | *[[Infection]] | ||
*[[VTE]] | |||
*[[Haemorrhage]] | |||
*[[Vesicovaginal fistula]] | |||
* | *[[Bladder]] dysfunction | ||
*[[Fever]] | |||
* | *[[lymphocyst]] formation | ||
*Short [[Vagina]] | |||
===Radiotherapy related=== | |||
*[[Vaginal]] dryness<ref name="pmid6629889">{{cite journal |vauthors=Nori D, Hilaris BS, Stanimir G, Lewis JL |title=Radiation therapy of primary vaginal carcinoma |journal=Int. J. Radiat. Oncol. Biol. Phys. |volume=9 |issue=10 |pages=1471–5 |date=October 1983 |pmid=6629889 |doi= |url=}}</ref> | |||
*[[Vaginal]] [[stenosis]] | |||
*Radiation [[cystitis]] | |||
*[[Radiation]] [[proctitis]] | |||
*Loss of [[ovarian]] function | |||
==Prognosis== | ==Prognosis== | ||
* 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 | *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)<ref name="pmid11385773">{{cite journal |vauthors=Beller U, Sideri M, Maisonneuve P, Benedet JL, Heintz AP, Ngan HY, Pecorelli S, Odicino F, Creasman WT |title=Carcinoma of the vagina |journal=J Epidemiol Biostat |volume=6 |issue=1 |pages=141–52 |date=2001 |pmid=11385773 |doi= |url=}}</ref>. | ||
* 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. | *Mortality was 51 percent higher in women with [[melanoma]] compared with [[squamous vaginal cancer]]. | ||
* Non–[[Diethylstilbestrol|DES]]-associated [[adenocarcinomas]] generally have a worse prognosis than [[Squamous cell cancer]](SCC) tumors, but [[Diethylstilbestrol|DES]]-associated clear cell tumors have a relatively good prognosis. | * 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–[[Diethylstilbestrol|DES]]-associated [[adenocarcinomas]] generally have a worse prognosis than [[Squamous cell cancer]](SCC) tumors, but [[Diethylstilbestrol|DES]]-associated [[clear cell]] tumors have a relatively good prognosis<ref name="pmid16803507">{{cite journal |vauthors=Hellman K, Lundell M, Silfverswärd C, Nilsson B, Hellström AC, Frankendal B |title=Clinical and histopathologic factors related to prognosis in primary squamous cell carcinoma of the vagina |journal=Int. J. Gynecol. Cancer |volume=16 |issue=3 |pages=1201–11 |date=2006 |pmid=16803507 |doi=10.1111/j.1525-1438.2006.00520.x |url=}}</ref>. | |||
==References== | ==References== | ||
Latest revision as of 12:48, 6 February 2019
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.