Vaginal cancer natural history

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Syed Musadiq Ali M.B.B.S.[2]

Depending on the extent of the tumor at the time of diagnosis, the prognosis of vaginal cancer may vary. However, the prognosis is generally regarded as good.The 5-year survival rate can also depend on the type of vaginal cancer. For squamous cell carcinoma of the vagina, the 5-year survival rate is 54%. For adenocarcinoma of the vagina, the rate is about 60%. Symptoms are related to local extension of disease, urinary symptoms (eg, frequency, dysuria, hematuria), or gastrointestinal complaints (eg, tenesmus, constipation, melena)

• Vaginal bleeding is the most common clinical presentation of vaginal cancer. Many women are asymptomatic.
• Vaginal bleeding associated with vaginal cancer is typically postcoital or postmenopausal.
• A watery, blood-tinged, or malodorous vaginal discharge may also be present^[1].
• A vaginal mass may also be noted by the patient.
• Symptoms are related to local extension of disease, urinary symptoms (eg, frequency, dysuria, hematuria), or gastrointestinal complaints (eg, tenesmus, constipation, melena)^[2].
• Pelvic pain from extension of disease beyond the vagina is present in 5 percent of patients.
• 20 percent of women are asymptomatic at time of diagnosis [17-19].
• These vaginal cancers may be detected as a result of cytologic screening for cervical cancer or may be an incidental finding of a vaginal mass on pelvic examination.

• Infection
• VTE
• Haemorrhage
• Vesicovaginal fistula
• Bladder dysfunction
• Fever
• lymphocyst formation
• Short Vagina

• Vaginal dryness^[3]
• Vaginal stenosis
• Radiation cystitis
• Radiation proctitis
• Loss of ovarian function

• Data from a United States National Cancer Database showed an increased risk of mortality in women with vaginal cancer with stage II or greater disease and/or tumor size >4 cm (five-year survival 65 versus 84 percent in tumors ≤4 cm)^[4].
• Mortality was 51 percent higher in women with melanoma compared with squamous vaginal cancer.
• Patient prognosis depends primarily on the stage of disease, but survival is reduced among those who are older than 60 years, are symptomatic at the time of diagnosis.
• In addition, the length of vaginal wall involvement has been found to be associated with survival and stage of disease in vaginal Squamous cell cancer(SCC) patients.
• Non–DES-associated adenocarcinomas generally have a worse prognosis than Squamous cell cancer(SCC) tumors, but DES-associated clear cell tumors have a relatively good prognosis^[5].