Cancer of Vagina

CANCER OF VAGINA
BY
PROF. BILQIS AFRIDI
CANCER OF VAGINA
•1 – 2% of all Gynaecological Malignancies
•85 % Epidermoid
other - Adenocarcinoma
Sarcoma
Melanoma
•Pathology mostly Epidermoid
May be
- Intra epithelial (ca in situ)
- Invasive

CANCER OF VAGINA (cont…)
•Intra epithelial Ca
Isolated
Multifocal
•Increased incidence of ca in situ vagina in patients with ca in situ vulva

•2 – 3% of patient will get ca vagina after treated for ca in situ Cx.
CANCER OF VAGINA (cont…)
•Upper 1/3 of vagina is more vulnerable to dev . Of Dysplasia and ca in situ.

•Patients with odeno carcinoma vagina must be investigated for odenocarcinoma.

•Candylomata of vagina shall be biopsied because of its associated with ca in situ and dysplasia .


CANCER OF VAGINA (cont…)
•Clear cell adenocarcinoma is associated with DES administration during early Pregnancy to the mother.
• Incidence: 1.4/1000 in exposed foetus .

•Invasive Epidermoid cancer of vagina occurs in postmenopausal women usually above 55 yrs (6th or 7th decode)
CLICINCIAL FEATURES
•Mean age 55 years for invasive
•45 for ca in situ
•Intraepithelial is usually asypmptomatic
•No racial predisposition
•Lesion may be ulcerative or exophytic invasive.
•Bleeding p/v or bloody dischange
CLICINCIAL FEATURES (cont..)
•Pruritus vulvae with advanced disease.
•Pain & leg oedema in advanced disease.
•Involvement of bladder and rectum V VF and RVF
•Metastasis to inguinal lymph nodes & lungs
•Palpation may reveal submucosal nodules not visible on exam.
STAGING OF CA VAGINA
•Stage I- Confined to vaginal wall
•Stage II- Involves Subvaginal tissues
•Stage III- Extension to pelvic wall
•Stage IV- Extension beyond pelvis
or has involved mucosa of bladder
or rectum .
•Stage IV- (a) mucosa of bladder or rectum
(b) distant metastasis
SPREAD
•Direct invasion
Bladder
Rectum
•Lymph node – metastasis depends on size & location of tumour

•Lower 1/3 – metastasis like tumour of vulva.
Cont…
•Middle 1/3 – metastasis
- inguinal lymph node
- deep pelvic lymph node

•Upper 1/3 – metastasis like ca Cx.

TREATMENT
•Ca in situ – Upper 1/3 TAH and Upper
1/3 cuff of vagina

•Co2 Laser - treatment of choice for Ca in situ

•Intra vaginal application of 5 – fluorouracil

•Intra cavitary radium 6000 – 7000 rads over 72 hrs.
TREATMENT OF INVASIVE Ca VAGINA
•Depends on location and staging .
•Therapy is complicated because of approximity of bladder and rectum
•Upper 1/3 small stage I & II , can be treated with radical abd. Hystrectomy & partial vaginectomy & pelvic Lymphadenectomy .
•middle & lower 1/3 – usually with radiotherapy.
• Stage III & IV -radio therapy
THANK YOU