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Abstract

Vaginal cancer is a rare tumor which constitutes only 2 % of female genital tract cancers. There are some known causes such as age, HPV infection, social background, chronic conditions as well as unknown causes. The most common symptoms for vaginal cancer are: vaginal bleeding often postcoital, vaginal discharge, dysuria, pelvic pain and/or pelvic mass. The main volume of the theory regarding the treatment of vaginal cancer is based on radiotherapy and there are reports of surgical methods. Treatment selection factors include the extent of the primary disease (stage), histological type, location of recurrence, extent of the recurring disease, primary therapy, evidence of metastatic disease, performance status (PS), patient age and comorbidities. The reported overall 5-year survival rate for vaginal cancer is 44 %, which is poorer than that for both cervical and vulvar cancer.

In current oncology, survival rate is the primary target, but the analysis of the treatment complications and the quality of life is of crucial importance, particularly in cancers with indolent biology. It is difficult to establish strong, evidence-based recommendations as cancer of the vagina is such a rare disease. However, there are therapeutic options based on understanding the tumor biology and in individual treatment of the patient. Women with vaginal cancer should be managed in a cancer center within a multidisciplinary team (MDT) setting.

Keywords

Intensity Modulate Radiation Therapy Adenoid Cystic Carcinoma High Grade Squamous Intraepithelial Lesion National Cancer Data Base Invasive Squamous Cell Carcinoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Sedlis A, Robboy SJ (1987) Diseases of the vagina. In: Kurman RJ (ed) Blausterein’s pathology of the female genital tract, 3rd edn. Spinger, New York, pp 98–140Google Scholar
  2. 2.
    Plentl AA, Friedman EA (1971) Lymphatic system of the female genitalia. In: Plentl AA, Friedman EA (eds) The morphologic basis of oncologic diagnosis and therapy, vol 2. WB Saunders, Philadelphia, pp 51–74Google Scholar
  3. 3.
    Frumovitz M, Gayed IW, Jhingran A et al (2008) Lymphatic mapping and sentinel lymph node detection in women with vaginal cancer. Gynecol Oncol 108(3):478–481CrossRefPubMedGoogle Scholar
  4. 4.
    Kurman R, Ronnett B, Sherman M et al (2010) Tumors of the cervix, vagina and vulva, vol 13. ARP Press, WashingtonGoogle Scholar
  5. 5.
    Creasman WT, Phillips JL, Menck HR (1998) The national cancer database report on cancer of the vagina. Cancer 83(5):1033–1040CrossRefPubMedGoogle Scholar
  6. 6.
    Daling JR, Madeleine MM, Schwartz SM et al (2002) A population – based study of squamous cell vaginal cancer: HPV and cofactors. Gynecol Oncol 84(2):263–270CrossRefPubMedGoogle Scholar
  7. 7.
    Brinton LA, Nasca PC, Mallin K et al (1990) Case – control study of in situ and invasive carcinoma of the vagina. Gynecol Oncol 38(1):49–54CrossRefPubMedGoogle Scholar
  8. 8.
    Perez CA, Camel HM, Galakatos AE et al (1988) Definitive irradiation in carcinoma of the vagina: long-term evaluation and results. Int J Radiat Oncol Biol Phys 15:1283–1290CrossRefPubMedGoogle Scholar
  9. 9.
    Andersen ES (1989) Primary carcinoma of the vagina: a study of 29 cases. Gynecol Oncol 33(3):317–320CrossRefPubMedGoogle Scholar
  10. 10.
    Ball HG, Berman ML (1982) Management of primary vaginal carcinoma. Gynecol Oncol 14(2):154–163CrossRefPubMedGoogle Scholar
  11. 11.
    Chyle V, Zagars GK, Wheeler JA et al (1996) Definitive radiotherapy for carcinoma of the vagina: outcome and prognostic factors. Int J Radiat Oncol Biol Phys 35(5):891–905CrossRefPubMedGoogle Scholar
  12. 12.
    Gallup DG, Talledo OE, Shah KJ et al (1987) Invasive squamous cell carcinoma of the vagina: a 14-year study. Obstet Gynecol 69(5):782–785PubMedGoogle Scholar
  13. 13.
    Kirkbride P, Fyles A, Rawilings GA et al (1995) Carcinoma of the vagina – experience at the Princess Margaret Hospital (1974–1989). Gynecol Oncol 56(3):435–443CrossRefPubMedGoogle Scholar
  14. 14.
    Lenechan PM, Meffe F, Lickrish GM (1986) Vaginal intraepithelial neoplasia: biologic aspects and management. Obstet Gynecol 68(3):333–337CrossRefGoogle Scholar
  15. 15.
    Leung S, Sexton M (1993) Radical radiation therapy for carcinoma of the vagina – impact of treatment modalities on outcome: peter maccallum cancer institute experience 1970–1990. Int J Radiat Oncol Biol Phys 25(3):413–418CrossRefPubMedGoogle Scholar
  16. 16.
    Spirtos NM, Doshi DS et al (1989) Radiation therapy for primary squamous cell carcinoma of the vagina: Stanford University experience. Gynecol Oncol 35(1):20–26CrossRefPubMedGoogle Scholar
  17. 17.
    Stock RG, Chen AS, Seski J (1995) A 30-year experience in the management of primary carcinoma of the vagina: analysis of prognostic factors and treatment modalities. Gynecol Oncol 56(1):45–52CrossRefPubMedGoogle Scholar
  18. 18.
    Stock RG, Mychalczak B, Armstrong JG et al (1992) The importance of brachytherapy technique in the management of primary carcinoma of the vagina. Int J Radiat Oncol Biol Phys 24(4):747–753CrossRefPubMedGoogle Scholar
  19. 19.
    Urbanski K, Kojis Z, Reinfuss M et al (1996) Primary invasive vaginal carcinoma treated with radiotherapy: analysis of prognostic factors. Gynecol Oncol 60(1):16–21CrossRefPubMedGoogle Scholar
  20. 20.
    Verloop J, van Leeuwen F, Helmerhorst T et al (2010) Cancer risk in DES daughters. Cancer Causes Control 21(7):999–1007CrossRefPubMedCentralPubMedGoogle Scholar
  21. 21.
    Goodman A, Schorge J, Greene M (2011) The long – term effects or in utero exposures – the DES story. N Engl J Med 364:2028–2084Google Scholar
  22. 22.
    Davis KP, Stanhope CR et al (1991) Invasive vaginal carcinoma: analysis of early – stage disease. Gynecol Oncol 42(2):131–136CrossRefPubMedGoogle Scholar
  23. 23.
    Hellman K, Lundell M, Silfversward C et al (2006) Clinical and histopathologic factors related to prognosis in primary squamous cell carcinoma of the vagina. Int J Gynecol Cancer 16(3):1201–1211CrossRefPubMedGoogle Scholar
  24. 24.
    Mauer HM, Beltangady M, Gehan EA (1988) The intergroup RMS study I.A. Final report. Cancer 61:209–220CrossRefGoogle Scholar
  25. 25.
    FIGO Committee on Gynecology (2009) Current FIGO staging for cancer of the vagina, fallopian tube, ovary, and gestational trophoblastic neoplasia. Int J Gynecol Obstet 105(1):3–4CrossRefGoogle Scholar
  26. 26.
    American Joint Committee on Cancer (AJCC) (2010) Vagina. In: Edge SB, Byrd DR, Compton CC et al (eds) AJCC cancer staging manual, 7th edn. Springer, New York, pp 469–472Google Scholar
  27. 27.
    Frank SJ, Jhingran A, Levenback C et al (2005) Definitive radiation therapy for squamous cell carcinoma of the vagina. Int J Radiat Oncol Biol Phys 62(1):138–147CrossRefPubMedGoogle Scholar
  28. 28.
    Taylor MB, Dugar N, Davidson SE et al (2007) Magnetic resonance imaging of primary vaginal carcinoma. Clin Radiol 62(6):549–555CrossRefPubMedGoogle Scholar
  29. 29.
    Lamoreaux WT, Grigsby PW, Dehdashti F et al (2005) FDG-PET evaluation of vaginal carcinoma. Int J Radiat Oncol Biol Phys 62(3):733–737CrossRefPubMedGoogle Scholar
  30. 30.
    Zaino R, Nucci M, Kurman R (2011) Disease of the vagina. In: EL Kurman R, Ronnett B (eds) Blaustein’s pathology of the female genital tract, 6th edn. Springer, New York, pp 105–154CrossRefGoogle Scholar
  31. 31.
    Brunner A, Grimm C, Polterauer S et al (2011) The prognostic value of human papillomavirus in patients with vaginal cancer. Int J Gynecol Cancer 21:923–929CrossRefPubMedGoogle Scholar
  32. 32.
    Fuste V, del Pino M, Perez A et al (2010) Primary squamous cell carcinoma of the vagina: human papillomavirus detection, p16INK4A overexpression and clinicopathological correlations. Histopathology 57:907–916CrossRefPubMedGoogle Scholar
  33. 33.
    Frank S, Deavers M, Jhingran A et al (2007) Primary adenocarcinoma of the vagina not associated with diethylstilbestrol (DES) exposure. Gynecol Oncol 105:470–474CrossRefPubMedGoogle Scholar
  34. 34.
    Staats P, Clement P, Young R (2007) Primary endometrioid adenocarcinoma of the vagina: a clinicopathologic study of 18 cases. Am J Surg Pathol 31:1490–1501CrossRefPubMedGoogle Scholar
  35. 35.
    Saitoh M, Hayasaka T, Ohmichi M et al (2005) Primary mucinous adenocarcinoma of the vagina: possibility of differentiating from metastatic adenocarcinomas. Pathol Int 55:372–375CrossRefPubMedGoogle Scholar
  36. 36.
    McCurdy M, Zouain N (2009) Sucessful treatment of primary vaginal papillary serous adenocarcinoma using chemoradiation followed by brachytherapy. Case Rep Oncol 2:97–102CrossRefPubMedCentralPubMedGoogle Scholar
  37. 37.
    Ditto A, Martinelli F, Carcangiu M et al (2007) Incidental diagnosis of primary vaginal adenocarcinoma of intestinal type: a case report and review of the literature. Int J Gynecol Pathol 26:490–493CrossRefPubMedGoogle Scholar
  38. 38.
    Bague S, Rodriguez IM, Prat J (2004) Malignant mesonephric tumors of the female genital tract: a clinicopathologic study of 9 cases. Am J Surg Pathol 28(5):601–607CrossRefPubMedGoogle Scholar
  39. 39.
    Woida F, Ribeiro-Silva A (2007) Adenoid cystic carcinoma of the Bartholin gland. Arch Pathol Lab Med 131:796–798PubMedGoogle Scholar
  40. 40.
    Gardner G, Reidy-Lgunes D, Gehrig P (2011) Neuroendocrine tumors of the gynecologic track: a Society of Gynecologic Oncology (SGO) clinical document. Gynecol Oncol 122:190–198CrossRefPubMedGoogle Scholar
  41. 41.
    Akl M, Naidu S, McCullough A et al (2010) Vaginal paraganglioma presenting as a pelvic mass. Surgery 147:169–171CrossRefPubMedGoogle Scholar
  42. 42.
    Sedenik M, Yan Z, Khalbuss W et al (2007) Malignant mixed mullerian tumor of the vagina: case report with review of literature, immunohistochemical study, and evaluation for human papillomavirus. Hum Pathol 38:1282–1288CrossRefGoogle Scholar
  43. 43.
    Ghaemmaghami F, Zarchi M, Ghasemi M (2008) Lower genital tract rhabdomyosarcoma: case series and literature review. Arch Gynecol Obstet 278:65–69CrossRefPubMedGoogle Scholar
  44. 44.
    Walterhouse D, Meza J, Breneman J et al (2011) Local control and outcome in children with localized vaginal rhabdomyosarcoma: a report from the Soft Tissue Sarcoma Committee of the Children’s Oncology Group. Pediatr Blood Cancer 57:76–83CrossRefPubMedCentralPubMedGoogle Scholar
  45. 45.
    Lee H, Jang K, Park H et al (2008) Angiomyofibroblastoma of the vagina in a breast cancer patients. Pathology (Phila) 40(5):534–536Google Scholar
  46. 46.
    Margo G, Caltabiano R, Kacerovska D et al (2012) Vulvovaginal myofibroblastoma: expanding the morphological and immunohistochemical spectrum: a clinopathologic study of 10 cases. Hum Pathol 43:243–253CrossRefGoogle Scholar
  47. 47.
    Frumovitz M, Etchepareborda M, Sun C et al (2010) Primary malignant melanoma of the vagina. Obstet Gynecol 116:1358–1365CrossRefPubMedGoogle Scholar
  48. 48.
    Terenziani M, Spreafico F, Collini P et al (2007) Endodermal sinus tumor of the vagina. Pegiatr Bloob Cancer 48:577–578CrossRefGoogle Scholar
  49. 49.
    Gangopadhyay M, Raha K, Sinha S et al (2009) Endodermal sinus tumor of the vagina in children: a report of two cases. Indian J Pathol Microbiol 52:403–404CrossRefPubMedGoogle Scholar
  50. 50.
    Lagoo A, Robboy SJ (2005) Lymphoma of the female genital tract: current status. Int J Gynecol Pathol 25:1–21CrossRefGoogle Scholar
  51. 51.
    Berchuck A, Rodriguez G, Kamel A et al (1990) Expression of epidermal growth factor receptor and HER-2/neu in normal and neoplastic cervix, vulva, and vagina. Obstet Gynecol 76(3 Pt.1):381–387PubMedGoogle Scholar
  52. 52.
    Pingley S, Shrivastava SK, Sarin R et al (2000) Primary carcinoma of the vagina: tata memorial hospital experience. Int J Radiat Oncol Biol Phys 46(1):101–108CrossRefPubMedGoogle Scholar
  53. 53.
    Tjalma WA, Monaghan JM, de Barros Lopes A et al (2001) The role of surgery in invasive squamous carcinoma of the vagina. Gynecol Oncol 81(3):360–365CrossRefPubMedGoogle Scholar
  54. 54.
    Soper JT, Secord AA, Havrilesky LJ et al (2007) Comparison of gracilis and rectus abdominis myocutaneous flap neovaginal reconstruction performed during radical pelvic surgery: flap-specific morbidity. Int J Gymecol Cancer 17(1):298–303CrossRefGoogle Scholar
  55. 55.
    Boronow RC, Hickman BT, Reagan MT et al (1987) Combined therapy as an alternative to exenteration for locally advanced vulvovaginal cancer. II. Results, complications and dosimetric and surgical considerations. Am J Clin Oncol 10(2):171–181CrossRefPubMedGoogle Scholar
  56. 56.
    Tavassoli FA, Norris HJ (1979) Smooth muscle tumors of the vagina. Obstet Gynecol 53(6):689–693PubMedGoogle Scholar
  57. 57.
    Perez CA, Korba A, Sharma S (1977) Dosimetric considerations in irradiation of carcinoma of the vagina. Int J Radiat Oncol Biol Phys 2(7–8):639–649CrossRefPubMedGoogle Scholar
  58. 58.
    Perez CA, Grigsby PW, Garipagaoglu M et al (1999) Factors affecting long – term outcome of irradiation in carcinoma of the vagina. Int J Radiat Oncol Biol Phys 44(1):37–45CrossRefPubMedGoogle Scholar
  59. 59.
    Moran MS, Castrucci WA, Ahmad M et al (2010) Clinical utility of the modified segmental boost technique for treatment of the pelvis and inguinal nodes. Int J Radiat Oncol Biol Phys 76(4):1026–1036CrossRefPubMedGoogle Scholar
  60. 60.
    Menkarios C, Azria D, Laliberte B et al (2007) Optimal organ-sparing intensity-modulated radiation therapy (IMRT) regiment for the treatment of locally advanced anal cancer carcinoma: a comparison of conventional and IMRT plans. Radiat Oncol 2:41CrossRefPubMedCentralPubMedGoogle Scholar
  61. 61.
    Milano MT, Jani AB, Farrey KJ et al (2005) Intensity-modulated radiation therapy (IMRT) in the treatment of anal cancer: toxicity and clinical outcome. Int J Radiat Oncol Biol Phys 63(2):354–361CrossRefPubMedGoogle Scholar
  62. 62.
    Roberts WS, Hoffman MS, Kavanagh JJ et al (1991) Further experience with radiation therapy and concomitant intravenous chemotherapy in advanced carcinoma of the lower female genital tract. Gynacol Oncol 43(3):233–236CrossRefGoogle Scholar
  63. 63.
    Tabata T, Takeshima N, Nishida H et al (2002) Treatment failure in vaginal cancer. Gynecol Oncol 84(2):309–314CrossRefPubMedGoogle Scholar
  64. 64.
    Wharton JT, Rutledge FN, Gallager HS et al (1975) Treatment of clear cell adenocarcinoma in young females. Obstet Gynecol 45(4):365–368PubMedGoogle Scholar
  65. 65.
    Brand E, Fu YS, Lagasse LD et al (1989) Vulvovaginal melanoma: report of seven cases and literature review. Gynecol Oncol 33(1):54–60CrossRefPubMedGoogle Scholar
  66. 66.
    Peters WA 3rd, Kumar NB, Andersen WA et al (1985) Primary sarcoma of the adult vagina: a clinicopathologic study. Obstet Gynecol 65(5):699–704PubMedGoogle Scholar
  67. 67.
    Das Gupta T, D’Urso J (1964) Melanoma of the female genitalia. Surg Gynecol Obstet 119:1074–1078Google Scholar
  68. 68.
    Thigpen JT, Blessing JA, Homesley HD et al (1986) Phase II trial of cisplatin in advance or recurrent cancer of the vagina: a Gynecologic Oncology Group Study. Gynecol Oncol 23(1):101–104CrossRefPubMedGoogle Scholar
  69. 69.
    Muss HB, Bundy B, DiSaia PJ et al (1985) Treatment of recurrent or advanced uterine sarcoma. A randomized trial of doxorubicin versus doxorubicin and cyclophosphamide (a phase III trial of the Gynecologic Oncology Group). Cancer 55(8):1648–1653CrossRefPubMedGoogle Scholar
  70. 70.
    Harris NL, Scully RE (1984) Malignant lymphoma and granulocytic sarcoma of the uterus and vagina. A clinicopathologic analysis of 27 cases. Cancer 53(11):2530–2545CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Department of Medical OncologyUniversity of LarissaLarissaGreece

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