Primary vaginal cancer is considered a relatively rare form of malignancy. It accounts for 1 to 3% of all tumors of the female reproductive system. The Oncology Clinic of the Yusupov Hospital has created all the necessary conditions for the treatment of patients who have been diagnosed with a malignant tumor in the vagina:
- European level of room comfort;
- Highly qualified oncologists and gynecologists;
- Equipping with the latest equipment from leading global manufacturers;
- The use of modern antitumor drugs for chemotherapy, which are highly effective and have a minimal range of side effects;
- Individual approach to the choice of surgical intervention and radiation therapy regimen;
- Attentive attitude of medical personnel to the intimate problems of patients.
For vaginal cancer, the prognosis depends on the stage of the disease, the adequacy of the treatment, the presence of concomitant pathology, and the general condition of the patient. Five-year survival rates are, according to summary data from FIGO (International Federation of Obstetrics and Gynecology), for the first stage - 61.5%, the second - 33.7%, the third - 25.5%, the fourth - 8.9%. These figures in the Russian Federation are 81.4%, 40.0%, 24.8% and 8.8%. Considering that 25–30% of patients are diagnosed with stages III–IV of the disease upon initial treatment, treatment results remain disappointing. For this reason, in patients who come to the Yusupov Hospital with complaints of discomfort, pain or vaginal discharge, gynecologists first of all rule out a tumor in the vagina.
Benign tumors of the vagina
Benign tumors of the vagina are volumetric formations of the vaginal tube that develop from the structures of connective tissue, epithelium, and blood vessels. The course of benign vaginal tumors is often asymptomatic. As the tumor increases in size, it can cause foreign body sensations, discomfort during sexual intercourse, and problems with urination and defecation. Vaginal tumors are diagnosed by gynecologists at the Yusupov Hospital during a gynecological examination, colposcopy, and transvaginal ultrasound.
The following benign tumors localized in the vagina are distinguished:
- Fibroma;
- Lipoma;
- Cyst;
- Hemangioma.
The need for surgical treatment of benign vaginal tumors is dictated by the possibility of their suppuration, necrosis and malignant degeneration. Gynecologists perform organ-preserving operations. During surgery, the tumor is removed, leaving the female reproductive organ. After surgery, the symptoms of the disease disappear, and the tumor rarely recurs.
Diagnostics
To thoroughly examine your problem, the gynecologist uses additional examination methods in addition to examination and history taking. He will prescribe the following tests to the woman:
- UAC and OAM;
- Biochemical blood test, including tumor markers and antibodies to infections;
- Smear for flora and oncocytology;
- Analysis of vaginal discharge.
The doctor will also perform a colposcopy and, if necessary, offer a biopsy followed by histology.
When the test results are ready, the doctor will make a diagnosis. If the clinical picture requires treatment, then it will be prescribed. Finally, a woman can relax if the tumor at the entrance to the vagina turns out to be benign. Share:
Causes of vaginal cancer
Scientists still do not have a consensus on the cause of vaginal cancer and how the disease develops. Since the vulva, vagina and cervix develop from the urogenital sinus, it is assumed that the causes and mechanism of development of malignant neoplasms are the same. This tumor cannot be identified absolutely, since vaginal carcinoma is 30–40 times less common than cervical cancer, and the average age of patients with cervical cancer is 10–15 years younger than with malignant vaginal tumors.
One of the leading causes of the development of a malignant tumor of the vagina is considered to be a viral infection that is sexually transmitted. Genital condylomas of the vagina, the viral nature of which is absolutely proven, are a precancerous process. The leading role in the occurrence of squamous cell carcinoma of the vagina is played by the human papillomavirus. The HPV-16 and HPV-18 viruses are responsible for the occurrence of 70% of cancers of the vagina, cervix and anal canal and 30–40% of malignant tumors of the vulva, penis, mouth and oropharynx.
For the progression of human papillomavirus infection to cancer, a number of factors must be present:
- Long-term use of hormonal contraceptives;
- Sexual activity;
- Smoking tobacco;
- Infection with chlamydia trachomatis and herpes simplex virus type 2.
A certain role in the occurrence of vaginal cancer is assigned to burdened heredity and impaired immunological defense. Clear cell adenocarcinomas of the vagina occur in women whose mothers used 17 beta-estradiol and diethylstilbestrol to treat various complications of pregnancy, threatening miscarriages. The development of vaginal tumors may be associated with neoplasms in other localizations. Most often, malignant neoplasms of the vagina are detected after treatment for cervical cancer. In some patients with vaginal carcinoma, radiation therapy was performed the day before for other locations of the cancerous tumor.
Chemotherapy
Chemotherapy for vaginal cancer is given before surgery to shrink the tumor, combined with radiation therapy to enhance its effect. Various drugs are used: cisplatin, carboplatin, 5-fluorouracil, docetaxel, paclitaxel. It is often difficult to say which chemotherapy regimen will be most effective, since vaginal cancer is rare and there is not much research done at the moment.
Types of malignant tumors of the vagina
Histologically, most vaginal tumors are represented by squamous cell carcinoma of varying degrees of differentiation. 2–3.5% of all malignant tumors of the vagina are adenocarcinomas and sarcomas. Vaginal melanomas are even less common. Most vaginal neoplasms deterministically undergo a sequential development cycle, which includes dysplasia, preinvasive and invasive forms. A precancerous condition of vaginal cancer is dysplasia. It, depending on the severity of pathological changes in the surface layer of stratified squamous epithelium, can be mild, moderate and severe. There is no specific macroscopic picture of dysplasia and preinvasive cancer. They may look like leukoplakia or erythroplakia, develop against the background of a visually unchanged vaginal mucosa or in condylomas.
Preinvasive cancer is most often localized in the upper third of the vagina. The tumor is characterized by multicentric growth. Considering the fact that preinvasive cancer is detected on average 10–12 years earlier than invasive cancer, gynecologists at the Yusupov Hospital carry out early diagnosis of the disease at the initial stage of the pathological process. Consistent cytological examination, colposcopy and biopsy provide a reliable diagnosis. To determine the boundaries of the lesion, use Lugol's solution or 3% acetic acid solution.
The histological structure of invasive cancer is represented by three main forms:
- Squamous cell keratinizing;
- Non-keratinizing;
- Poorly differentiated.
In patients with vaginal cancer, squamous cell neoplasms predominate. Keratinizing and non-keratinizing forms of cancer are observed with equal frequency. Poorly differentiated cancer occurs in 10.8% of patients, and vaginal adenocarcinoma – in 2.3%. The exophytic form of growth occurs 2 times more often than the endophytic one.
Vaginal tumors predominantly spread through the lymphogenous route. Neoplasms located in the upper third of the vagina metastasize to the iliac and obturator lymph nodes. Tumors of the lower part of the vagina spread to the inguinal-femoral lymph nodes, and cancer of the middle third of the vagina metastasizes in all directions.
Vaginal adenocarcinomas are more common in young women aged 17–21 years. Their histological structure is very diverse. The following types of vaginal adenocarcinoma are distinguished:
- Mesonephroid (clear cell);
- Endometrioid;
- Adenoid cystic tumor;
- Dimorphic glandular squamous cell carcinoma.
Vaginal melanomas are most often located in the lower third of the vagina. The tumor is characterized by an aggressive course, early hematogenous metastasis, rapid relapses after treatment and resistance to chemotherapy.
Symptoms of vaginal cancer
With vaginal cancer, a woman complains of pain and leucorrhoea. Bloody vaginal discharge due to cancer is observed in 58–67% of patients. In 5–13% of patients the disease is asymptomatic. Quite often, the course of the disease is characterized by a combination of several symptoms. In 16% of patients, gynecologists find a cancerous tumor in the vagina by chance during a routine examination.
The clinical picture of vaginal cancer is quite polymorphic. This determines certain features and difficulties of diagnosis. They are detected when analyzing symptoms at various stages of the disease. If the frequency of bloody or mucous discharge from the vagina that is white or yellowish in color does not depend on the stage of the pathological process, then the proportion of pain syndrome increases significantly according to the degree of spread of the neoplasm. The presence of pain in a patient with a vaginal tumor indicates that the cancer process has spread beyond the organ. Most often, carcinoma is accidentally detected in the early stages of tumor development.
With a careful gynecological examination, diagnosing vaginal cancer is not difficult. During a speculum examination, gynecologists carefully examine the vaginal vaults, not forgetting that most malignant neoplasms of the vagina, especially in the early stages of development, are localized in its upper third. Tumors of the vagina belong to the “visual” localization. A reliable diagnosis is provided by cytological examination, colposcopy and biopsy. These diagnostic procedures are performed sequentially.
Where can I get a biopsy of a vaginal tumor in Moscow? At the Oncology Clinic of the Yusupov Hospital, doctors professionally perform targeted biopsies of suspicious areas and send the material for histological examination. It allows you to confirm or exclude a malignant tumor with high accuracy (up to 95%). To clarify the extent of spread of the tumor process in the Yusupov Hospital, the following diagnostic methods are used:
- Ultrasound examination of the pelvic and abdominal organs;
- Cystoscopy;
- Sigmoidoscopy;
- Radioisotope renography;
- Chest X-ray;
- Isotopic study of skeletal bones.
High-tech examination methods, which include magnetic resonance, computed tomography and positron emission tomography using the radiopharmaceutical drug fluorodeoxyglucose, are very informative, but, given their cost, are not mandatory. In vaginal cancer, magnetic resonance imaging is useful in diagnosing regional lymph node metastases, but MRI characteristics of the primary vaginal tumor are nonspecific.
To plan treatment and follow-up of patients at the Yusupov Hospital, a comprehensive diagnosis of human papillomavirus (HPV) infection is carried out using the following methods:
- Cytological - allows you to identify specific cells that are characteristic of HPV infection;
- Extended colposcopy after treating the vaginal mucosa with a solution of acetic acid;
- Molecular - determination of HPV DNA in the cells and tissues of the genital organs (polymerase chain reaction).
Using a comprehensive step-by-step approach to diagnosing vaginal cancer allows gynecologists at the Yusupov Hospital to quickly establish an accurate diagnosis and develop a treatment regimen. All cases of vaginal tumors that are difficult to diagnose and treat are discussed at a meeting of the Expert Council with the participation of professors and doctors of the highest category.
Sex life after treatment
In order for a woman to be able to have a sexual life after surgical treatment and removal of the vagina, they resort to reconstructive plastic surgery. The vagina can be reconstructed, for example, using a section of intestine.
Usually, after reconstructive surgery, orgasm becomes impossible. But, if it is possible to preserve the clitoris, the woman retains the ability to experience a clitoral orgasm.
Radiation therapy can cause the vagina to narrow, making sexual intercourse painful. Moisturizing creams with hormones and special dilators help cope with this symptom.
