What Are the Symptoms of Vaginal Cancer?

Primary vaginal malignancies are rare, accounting for about 1% of malignant tumors of female reproductive organs. It is mainly squamous cell carcinoma and adenocarcinoma. Others such as sarcoma and malignant melanoma are more rare. Because secondary vaginal cancer is more common, the possibility of secondary vaginal cancer should be considered and excluded before the diagnosis of primary tumor.

Basic Information

English name

vaginal cancer

Visiting department

Gynecology, Oncology

Common causes

Viral infection, chronic chronic inflammation, etc.

Common symptoms

Irregular vaginal bleeding, bleeding after intercourse, and postmenopausal bleeding

Contagious

no

Clinical manifestations of vaginal cancer

The main clinical manifestations of vaginal cancer are: irregular vaginal bleeding, bleeding after intercourse and postmenopausal bleeding; increased vaginal discharge, even vaginal watery samples, bloody secretions accompanied by foul odors; as the disease progresses, waist, abdominal pain, and urination disorders can occur (Including frequent urination, hematuria, dysuria, blood in the stool, constipation, etc.); severe cases can form bladder vaginal fistula or rectal vaginal fistula; advanced patients may have renal dysfunction, anemia, such as hemoptysis of lung metastases. Local vaginal lesions are most common in the form of nipples or cauliflower, followed by ulcers or infiltration. Difficult sexual intercourse is a typical symptom of advanced vaginal tumors.

Vaginal cancer most often occurs on the 1/3 posterior wall of the vagina. Most patients complain of small amounts of irregular bleeding, malodorous discharge, and pain after menopause. A triple rectal vaginal examination can help to understand the presence of submucosal, paravaginal, or rectal involvement.

Vaginal cancer examination

About 20% of patients with vaginal cancer can be found by Pap smear and pelvic examination. In addition to chest X-rays and intravenous pyelography, bladder and rectal sigmoidoscopy can also be used as routine tests. CT and MRI can identify intraperitoneal and extraperitoneal lesions. MRI can also identify fibrotic lesions and recurrent tumors after radiotherapy.

Vaginal Cancer Treatment

Treatments for vaginal cancer include:

Radiation therapy

Radiotherapy is the treatment of choice for some early and most advanced vaginal cancer patients. Radiotherapy includes two parts: intracavity and extracorporeal irradiation. Endovascular treatment is mainly aimed at the primary vaginal lesion and its adjacent invasion area, while in vitro irradiation is mainly aimed at the tumor, the infiltration area around the tumor, and the lymphatic drainage area. Intracavity irradiation: Tumors in the upper vagina can be given intracavitary radiotherapy according to cervical cancer. Other primary tumors can use vaginal cylindrical containers (plugs), and explanted tumors can be given irradiation for tissue transplantation. Tumors or total vaginal lesions in the lower and middle vagina can be irradiated with vaginal plugs or tissue transplantation. If the tumor is located on only one side of the vagina, and the tumor is large, the tumor can be shrunk by intervening tissue implantation to reduce the tumor, and then the vaginal stopper irradiation should be selected, and the appropriate lead block should be provided at the site that does not require irradiation. The dose reference point is generally the tumor base. Conventional low-dose-rate intratumoral irradiation of general tumor bases is given at 50-60Gy, and high-dose-rate intracavitary irradiation of general tumor bases is given at 30-40Gy. Foreign scholars reported that vaginal tumor base doses of about 80 Gy (including external irradiation doses) achieved curative effects. External irradiation: The upper tumor was irradiated externally with pelvic cavity, the entire pelvic hexagonal field (after 30Gy, medium block lead (4 × 10CM)) was irradiated externally, and the dose of periuterine tissue was 45-50Gy / 5-6 weeks. Lower tumors should be irradiated. An irradiation field parallel to the inguinal ligament 8 × 12CM 14CM can be used, and 6 8MV X-rays can be given to Dm40Gy / 4 weeks, and then Dm20Gy / 2 weeks can be irradiated with electron rays. For patients with more advanced vaginal cancer, intracavity irradiation is difficult, and external irradiation can be performed first. The tumor dose is DT45 50Gy, and intracavity irradiation is supplemented according to the regression of the tumor.

2. Surgical treatment

Early surgery for patients with primary vaginal cancer is optional. Vaginal carcinoma in situ can be partially removed, partial or total vaginal resection, and vaginal angioplasty. In early patients with invading tumors in the upper vagina, extensive hysterectomy and partial vaginal resection and pelvic lymph node dissection can be performed. The vaginal resection margin should be 2 to 3 cm below the cancer margin. Early vaginal lesions, vaginal and vulvar resection and inguinal lymph node dissection are feasible. Tumors in the middle of the vagina should be selected for inguinal or pelvic lymphadenectomy in addition to a total hysterectomy based on the extent of the lesion and the location of the lymph nodes. For extensive and deep lesions, a complete vagina including rectal or bladder resection (organ removal) is required, but the operation is complicated and the complications are high.

3. chemotherapy

Vaginal cancer is not effective with chemotherapy alone. Common drugs are cisplatin (PDD), pingyangmycin (BLM), mitomycin (MMC), 5-fluorouracil (5-FU), ifosfamide (IFO), and paclitaxel (PTX) and so on. Combined chemotherapy regimens include: PVB, PIB, TP, PDD + MMC, PDD + 5FU + CTX, etc. In addition to intravenous systemic administration, interventional chemotherapy is also used clinically.

Prognosis of vaginal cancer

The 5-year survival rate is related to staging. Poor prognostic factors include the location and length of vaginal involvement, the type and grade of primary tumor pathology, and treatment options.