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Vaginal Cancer

Chapter 17 – Gynaecological Cancer in the Senior Patient

Primary vaginal cancers represent only 2% of female genital tract malignancies. It is mainly a disease of women > 60 years of age. Women treated for anogenital precancerous lesions or cancer in the past are considered to be at high risk for vaginal cancer. The 2008 FIGO staging system is used.

Stage 0

Stage 0 represents a carcinoma in situ. The five-year survival is 100%. The preferred treatment is surgical excision of the lesion.

Stage I

In stage I the disease is limited to the vagina wall. The five-year survival in 70%.

The preferred treatment is an excision of the lesion (so-called partial or complete vaginectomy) and lymph node dissection.

  • If the lesion is in the upper one-third of the vagina, pelvic lymphadenectomy should be performed.
  • If the lesion is located in the lower one-third part, an inguinal lymphadectomy should be performed.
  • If the lesions are located in the middle, both inguinal and pelvic lymphadnectomy should be performed.

Sentinel node biopsy will be helpful in determining which nodes should be removed,  but  at  present  there  are  no  data  supporting  the  use  of  this procedure and, because of the rareness of the disease, it is unlikely that there will be any data to support the use of sentinel node biopsy in vaginal cancer.

Concomitant chemoradiation can be used as an alternative to surgery.

Stage II

In stage II the carcinoma involves the subvaginal tissue but has not extended to the pelvic wall. The five-year survival is 50%. The treatment is similar to that for stage I disease.

Stage III

In stage III the carcinoma has extended to the pelvic wall. The five-year survival is 20%. If possible, surgery can be considered; however, the preferable treatment in this stage is concomitant chemoradiation.

Stage IV

In stage IV the carcinoma has extended beyond the true pelvis or has involved the mucosa of the bladder or rectum; bullous oedema, as such, does not permit a patient to be allotted to stage IV.

Stage IV can be divided into the following:

  • IVA: Tumour invades bladder and/or rectal mucosa and/or direct extension beyond the true pelvis. Treatment: In localised disease, a pelvic exenteration is a surgical option with a cure rate of about 50%.
  • IVB: Spread to distant organs. Treatment: Palliative chemotherapy can be considered.

The prognosis of stage IV disease is poor, with a five-year survival of <10%. However, in case of a rectovaginal or vesicovaginal fistula with distant disease, one should also consider exenteration or derivation surgery to improve quality of life.

Adjuvant concomitant chemoradiation is recommended in case of lymph nodes or surgical margin involvement.

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