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.
More than 100,000 new cancers of the female reproductive tract are diagnosed in the United States every year , 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 . The two respective types somewhat differ in their pathogenesis and clinical presentation     :
- Vulvar carcinoma - Squamous carcinoma of the epithelium is the most common type of vulvar carcinoma, followed by melanoma, adenocarcinoma, sarcoma, and Bartholin gland carcinoma  . 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 . Pruritus is considered to be the main symptom, while vulvar bleeding, discharge, local pain, and dysuria are less common findings . In some patients, a palpable mass may be detected, with a necrotic, ulcerating or warting appearance .
- 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 . 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 . Adenocarcinomas, melanomas, and metastatic tumors (from gynecologic and non-gynecologic origins) are other important types . 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 .
Entire Body System
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]
Physical findings: Individuals with SCC FGT may be asymptomatic but usually present with: • Localized pain; • Vaginal bleeding; • Abdominal bloating or a mass; or • Symptoms of metastasis disease to the liver, bone, lung, or regional lymph nodes. [secure.ssa.gov]
ClinicalTrials.gov Identifier: NCT00382330 Recruitment Status : Withdrawn First Posted : September 29, 2006 Last Update Posted : September 6, 2013 Sponsor: Information provided by (Responsible Party): Rutgers, The State University of New Jersey ( University [clinicaltrials.gov]
Once bowel sounds are auscultated and the patient passes flatus, then oral feeding is initiated; the TPN is withdrawn when oral intake is adequate. Intermittent, pneumatic calf compression is continued until the patient is fully ambulatory. [emedicine.medscape.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. 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)      . 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   . Finally, a biopsy of the tumor provides important information regarding the degree of cellular proliferation, after which a definite diagnosis can be made  .
- 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.