Female genital cancers are an important cause of death in women. Numerous types of vaginal and vulvar cancers are seen in clinical practice, with main symptoms being vaginal bleeding, discharge, pruritus, local pain, and the presence of a mass. The diagnosis and identification of the exact tumor type rest on clinical criteria, findings obtained from imaging studies, and a properly obtained biopsy.
Presentation
More than 100,000 new cancers of the female reproductive tract are diagnosed in the United States every year [1], suggesting its rather important place in the overall mortality from malignant diseases in women. Vulvar and vaginal cancers account for approximately 10% of all gynecological neoplasias and are not as common as uterine or ovarian cancer [1]. The two respective types somewhat differ in their pathogenesis and clinical presentation [2] [3] [4] [5] [6]:
- Vulvar carcinoma - Squamous carcinoma of the epithelium is the most common type of vulvar carcinoma, followed by melanoma, adenocarcinoma, sarcoma, and Bartholin gland carcinoma [5] [6]. Studies hypothesize that human papillomavirus (HPV) infection plays an important role in its development in younger populations, whereas cellular atypia, mainly as a result of advanced age might also be a possible risk factor [3]. Pruritus is considered to be the main symptom, while vulvar bleeding, discharge, local pain, and dysuria are less common findings [3]. In some patients, a palpable mass may be detected, with a necrotic, ulcerating or warting appearance [3].
- Vaginal carcinoma - Similarly to vulvar carcinoma, squamous cell carcinoma comprises the vast majority of cancers stemming from the vagina, and are primarily seen in postmenopausal women [4]. Involvement of HPV in the pathogenesis is also established, and a significant number of women already suffer from a malignant disease arising from the vulva or the cervix [4]. Adenocarcinomas, melanomas, and metastatic tumors (from gynecologic and non-gynecologic origins) are other important types [4]. The clinical presentation includes painless vaginal bleeding and discharge, pelvic pain, a palpable mass, and urinary tract-related symptoms, but up to a quarter of patients may be asymptomatic [4].
Entire Body System
- Swelling
Other symptoms of vaginal cancer include: Abnormal vaginal discharge Difficulty or pain when urinating Pain during sexual intercourse Pain in the pelvic area (the lower part of the abdomen between the hip bones) Pain in the back or legs Swelling in the [cancer.net]
Some women may develop a mass, swelling or lump over the vulva. This is usually over the labia or near it. There may be pain and discomfort in the vulva especially on urination or during sexual intercourse. [news-medical.net]
If you are referred to a gynaecologist, you may have: external and internal examinations to look for any unusual vaginal lumps or swellings a colposcopy – an examination where a special instrument (colposcope) that acts like a magnifying glass is used [eveappeal.org.uk]
The lymph glands in the groin may swell. Problems with bowel motions and passing urine may indicate the cancer has spread into the bowel or bladder. [betterhealth.vic.gov.au]
A lump or swelling in the vulva. A mole on the vulva that changes shape or colour. Note : all these symptoms can be caused by other conditions which are not cancer. If you have any of these symptoms then you should see your doctor. [patient.info]
- Surgical Procedure
Skin grafting is a surgical procedure in which skin is moved from one part of the body to another. [medifitbiologicals.com]
In its early stages, it can be treated with surgical procedures which spare the genitals, i.e. surgical conization and vaginal radical trachelectomy with laparoscopic lymphadenectomy The advantages of these procedures have been observed in our experience [ncbi.nlm.nih.gov]
In some cases, these abnormalities are relatively minor, requiring only small-scale surgical interventions. For example, in cases where a patient’s hymen has not opened properly, there are straightforward surgical procedures to correct the problem. [bapras.org.uk]
This surgical procedure involves the removal of the tumor along with some normal tissues around it to make sure that all malignant cells are removed. Laser surgery. [cancerwall.com]
- Pathologist
Biopsy: The removal of cells or tissues from the vagina and cervix so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a Pap smear shows abnormal cells in the vagina, a biopsy may be done during a colposcopy. [medifitbiologicals.com]
* This multidisciplinary team includes gynecologic oncologists (surgeons), radiation oncologists, medical oncologists, pathologists, radiologists, general practitioners in oncology, nurses, radiation therapists, counsellors and nutritionists. [www2.gov.bc.ca]
Biopsy: The removal of cells or tissues from the vagina and cervix so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a Pap test shows abnormal cells in the vagina, a biopsy may be done during a colposcopy. [medicinenet.com]
In cases when the patients do not have or fail to provide information regarding a history of malignancy, this may pose a major diagnostic challenge to the gynecologist and pathologist. [spandidos-publications.com]
Ears
- Hearing Impairment
[…] health professionals: www.immunizebc.ca/healthcare-professionals/hpv BC Centre for Disease Control, www.bccdc.ca Public Agency of Canada, www.phac-aspc.gc.ca HealthlinkBC, www.healthlinkbc.ca or by telephone (toll free in BC) 8-1-1 or 7-1-1 (for the hearing [www2.gov.bc.ca]
Skin
- Ulcer
In some patients, a palpable mass may be detected, with a necrotic, ulcerating or warting appearance. [symptoma.com]
Squamous cell carcinoma Red, pink or white nodule or nodules or plaques May have a wart-like and/or raw surface if ulcerated Affected area of vulva may appear white and feel rough About 50% of women complain of itching or pain Other symptoms include painful [dermnetnz.org]
These include: A lump or ulceration on the vulva Itching or irritation Bleeding or discharge Vaginal cancers are more commonly asymptomatic, and are found on routine gynecologic examinations or may result in an abnormal Pap smear. [cedars-sinai.edu]
Contact your doctor if you have a rash that doesn't go away itching or pain that doesn't go away abnormal growths, bumps, or ulcers any changes in the skin of the vulva. Itchiness, abdominal pain, or fever can signal infection instead of cancer. [drugs.com]
Question I have a sore area near the opening of my vagina like an ulcer, and it itches a lot. Could it be cancer? It could be a number of things, and it could be something serious, like an STD. You should see a doctor immediately. [wikihow.com]
- Pruritus
Numerous types of vaginal and vulvar cancers are seen in clinical practice, with main symptoms being vaginal bleeding, discharge, pruritus, local pain, and the presence of a mass. [symptoma.com]
The classic symptom is vulvar itching (pruritus), reported in almost 90% of the women with vulvar cancer. There can also be associated pain, pain with intercourse, bleeding, vaginal discharge, and/or painful urination (dysuria). [oncolink.org]
Psychiatrical
- Fear
[…] that their partners had lost interest in them sexually", "sensing that others were biased against us as women without a uterus or ovaries", "hiding the fact that they had uterine or ovarian cancer in their relationships with others", "being overcome by fear [ci.nii.ac.jp]
Fear of recurrence, the financial impact of treatment, employment issues and coping strategies are other common emotional and practical challenges experienced by vulvar cancer survivors. [oncolink.org]
[…] down for video A new survey by the charity The Eve Appeal, today revealed one in five women are too embarrassed to discuss the symptoms of the five gynaecological cancers - womb (pictured), ovarian, cervical, vulval and vaginal, with their doctors, fearing [dailymail.co.uk]
Workup
The prognosis of vulvar and vaginal cancers directly depends on the stage, and given the fact that an early local spread is observed for both tumors, a prompt diagnosis is of critical importance. The workup of female genital cancers involves a multistep process, starting with a thorough patient history and a meticulous physical examination, with an emphasis on the duration of symptoms and their progression and a detailed genital examination, respectively. Once sufficient clinical criteria exist for further evaluation, imaging studies must be employed. Various procedures have been described, including ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and fluorodeoxyglucose-positron emission tomography (FDG-PET) [2] [3] [7] [8] [9] [10]. In order to establish the tumor stage, it is important to assess the extent of tumor spread into local, but also distant tissues. MRI is considered to be a superior method for evaluation of local tumor invasion due to its higher sensitivity for discriminating soft-tissue structures, whereas both CT and MRI, but also FDG-PET might be performed if a nodal or metastatic spread is suspected [2] [4] [9]. Finally, a biopsy of the tumor provides important information regarding the degree of cellular proliferation, after which a definite diagnosis can be made [4] [6].
Treatment
Pregnancy after breast cancer treatment has been shown to develop properly and both, pregnancy and breastfeeding have no influence on cancer relapse. [ncbi.nlm.nih.gov]
When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Clinical trials are taking place in many parts of the country. [medifitbiologicals.com]
The first half of the seminar looked at the treatment of FGS cancers with Dr Vikash Chatrani informing the audience about the ever-prevalent benign tumours called fibroids and the best practice for treatment and counseling the patient. [bnr.org.bb]
180.1;180.8; 183.0; 183.2; 183.3; 183.5; 183.8; 183.9;184.4; 184.8; 184.9 TREATMENT There is no standard treatment for SCC FGT. [secure.ssa.gov]
Prognosis
Management and prognosis The prognosis of patients with gastric cancer with metastasis to the ovaries has been reported to be poorer compared with that of other primary tumors ( 3, 14, 23 ). [spandidos-publications.com]
Prognosis The prognosis of vaginal cancer includes factors such as the stage of cancer, tumor size, age, general health condition, recurrence and location of the tumor. [cancerwall.com]
The prognosis of vulvar and vaginal cancers directly depends on the stage, and given the fact that an early local spread is observed for both tumors, a prompt diagnosis is of critical importance. [symptoma.com]
What is the prognosis? The outlook (prognosis) is best in those who are diagnosed when the cancer of the vulva (vulval cancer) is at an early stage. Surgical removal of a small vulval cancer gives a good chance of cure. [patient.info]
He went on to share on the signs, prognosis, and surgical as well as non-surgical interventions of malignant tumours. [bnr.org.bb]
Etiology
Rosenberg SA (eds): AIDS: Etiology, Diagnosis. Treatment, and Prevention. الصفحة 190 - Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med. الصفحة 193 - Henson D, Tarone R. [books.google.com]
As soon as the etiologic association was recognized, use of unopposed estrogens declined dramatically, and incidence rates also began to decline. This effect seems to have been delayed by about four years in Canada. [bmcwomenshealth.biomedcentral.com]
This suggests that a single etiologic factor is unlikely. [emedicine.medscape.com]
Etiology of vulvar cancer will impact on treatment options and therapy outcome: Two major pathways of vulvar cancer. Gynecologic Oncology. Oct 2013; 131(1):246-247. Viswanathan C, Kirschner K, Truong M, Balachandran A, Devine C, Bhosale P. [oncolink.org]
Noncontiguous spread of hematological, lymphatic or Fallopian tube etiology usually results in diffuse uterine enlargement with complete loss of the junctional zone on MRI ( 50, 51 ). [spandidos-publications.com]
Epidemiology
Diagnostic criteria and microbial and epidemiologic associations. Am J Med. Seite 193 - Henson D, Tarone R. An epidemiologic study of cancer of the cervix, vagina, and vulva based on the Third National Cancer Survey in the United States. [books.google.de]
Diagnostic criteria and microbial and epidemiologic associations. Am J Med. الصفحة 193 - Henson D, Tarone R. An epidemiologic study of cancer of the cervix, vagina, and vulva based on the Third National Cancer Survey in the United States. [books.google.com]
Other epidemiologic and risk factor information was found in published surveillance and research reports. [bmcwomenshealth.biomedcentral.com]
タイトル Tobacco smoking and cancer: a brief review of recent epidemiological evidence. 雑誌 Lung Cancer 45 Suppl 2:S3-9 (2004) DOI: 10.1016/j.lungcan.2004.07.998 文献 PMID: 12612656 (marker) 著者 Baldwin P, Laskey R, Coleman N. [genome.jp]
Epidemiological studies in various regions of Pakistan are required to study the pattern of female genital tract malignancies. Thus a true picture of genital cancer in Pakistan will emerge. References 1. Jafarey, N.A. and Zaidi, S.H.M. [jpma.org.pk]
Pathophysiology
FEMALE GENITAL TRACT CANCERS PATHOPHYSIOLOGY Malignant diseases of the vagina are either primary vaginal cancers or metastatic cancers from adjacent or distant organs. [medifitbiologicals.com]
Adenocarcinoma can arise from the Bartholin gland and present with a painful lump. [19] Causes [ edit ] Two main pathophysiological pathways are currently understood to contribute to development of vulvar cancer - human papillomavirus (HPV) infection [en.wikipedia.org]
Prevention
However, the overall effectiveness of preventing against cervical cancer has not been demonstrated. [www2.gov.bc.ca]
I call it Immunizer - just a simple exercise, but The Complete Colds/Flus/AIDS/STD/HPV/HBV/HCV/West Nile/Yosemite/Cancers Prevention - normally done for a minute a day for kids and adults as the full prevention of the major plagues of civilization. [books.google.com]
Dr Broome described current and future methods of HPV prevention and gave an update on the Barbados HPV vaccination programme. [bnr.org.bb]
HPV vaccination can prevent cancer: HPV vaccines can prevent infection with disease-causing HPV types, preventing many HPV-related cancers and cases of genital warts. [cancer.gov]
Having the Cervical Screening Test every 5 years (which has replaced the Pap smear) is essential for all women who have ever been sexually active to help prevent cervical cancer. [healthdirect.gov.au]
References
- Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7-30.
- Gardner CS, Sunil J, Klopp AH, et al. Primary vaginal cancer: role of MRI in diagnosis, staging and treatment. Br J Radiol. 2015;88(1052):20150033.
- Alkatout I, Schubert M, Garbrecht N, et al. Vulvar cancer: epidemiology, clinical presentation, and management options. Int J Womens Health. 2015;7:305-313.
- Parikh JH, Barton DP, Ind TE, Sohaib SA. MR imaging features of vaginal malignancies. Radiographics. 2008;28(1):49-63.
- Herr D, Juhasz-Boess I, Solomayer EF. Therapy for Primary Vulvar Carcinoma. Geburtshilfe Frauenheilkd. 2014;74(3):271-275.
- Hill-Daniel J, Roett MA. Genital Cancers in Women: Vulvar Cancer. FP Essent. 2015;438:31-43; quiz 44-8.
- Lamoreaux WT, Grigsby PW, Dehdashti F, et al. FDG-PET evaluation of vaginal carcinoma. Int J Radiat Oncol Biol Phys. 2005;62(3):733-737.
- Taylor MB, Dugar N, Davidson SE, Carrington BM. Magnetic resonance imaging of primary vaginal carcinoma. Clin Radiol. 2007;62(6):549-555.
- Lee LJ, Jhingran A, Kidd E, et al. Acr appropriateness Criteria management of vaginal cancer. Oncology (Williston Park). 2013;27(11):1166-1173.
- Sohaib SA, Richards PS, Ind T, et al. MR imaging of carcinoma of the vulva. AJR Am J Roentgenol. 2002;178(2):373–377.