Human papillomaviruses (HPV) cause several types of diseases, most notably sexual transmitted infections, warts, and some cancers. The high grade strains, HPV-16 and HPV-18, are associated with the pathogenesis of vaginal cancer.
The most common subtype of vaginal cancer is squamous cell carcinoma. Primary SCC is rare, thus it often occurs secondary to cervical SCC. Other types include clear cell adenocarcinoma and sarcoma botryoides. Please refer to the Picmonic on Vaginal Cancer Subtypes for more information.
Vaginal bleeding can occur in vaginal cancer. It typically presents as vaginal ulcerations with contact bleeding. Other symptoms include urinary frequency and malodorous discharge.
Leukoplakia can be seen in vaginal cancer. It presents as a firmly adhered, well demarcated white plaque on the vaginal mucosa.
A colposcopy involves direct visualization of the cervix and vagina. This is performed if cytology results from a Pap smear are abnormal with a clearly visible lesion during the pelvic exam. A biopsy can then be performed in order to determine the histopathology.
Radiotherapy, particularly via brachytherapy, can be sufficient in patients with stage I vaginal cancer. Radiotherapy also has a role in Stage II-IV but outcomes are not as favorable. Early induction of menopause is a considerable risk for reproductive age women undergoing radiotherapy.
For stage I disease, several surgical approaches are available from pelvic lymphadenectomy to radical hysterectomy. For advanced and metastatic disease, surgery may not lead to any significant improvements in survival outcomes over chemoradiation.
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