Primary vaginal carcinoma
Updates to Article Attributes
Body
was changed:
Primary vaginal carcinoma, although being a rare overall, is still the 5th commonest gynaecological malignancy. A primary vaginal carcinoma is defined as a neoplasm that arises solely from the vagina with no involvement of the external os superiorly or the vulva inferiorly, the importance of this definition lying in the different clinical approaches in the treatment of cervical carcinoma and vulval carcinoma.
Epidemiology
It can account for 1 - 3 -3% of all gynaecologic malignancies. The typical age at presentation is at around the 6th to 7th decades of life.
Pathology
The tumour characteristically arises from the posterior wall of the upper third of the vagina. The common patterns of disease are:
- an ulcerating or fungating mass or
- an annular constricting lesion
Histological sub types
-
squamous cell carcinoma of the vagina: by far the commonest accounts for
~ 80 - 85~80-85% of primary vaginal malignancies:, presents in older individuals -
adenocarcinoma of the vagina:
~ 15~15% second commonest sub type:, presents in younger individuals -
primary vaginal melanoma
: -
vaginal sarcoma
:
Radiographic features
Pelvic MRI
Imaging features will somewhat depend on the histologcial type of malignancy.
Reported general signal characteristics in general include 6:
-
T1:
:iso intense to muscle -
T2:
:high signal intensity compared with muscle
Reported signal charactersitics for squamous cell carcinoma include 1:
-
T1:
: lowlow signal intensity -
T2:
:intermediate signal intensity
Staging
Treatment and prognosis
Prognosis is significantly dependent on stage. Carcinoma in situ and very early stage invasive carcinoma is often treated with surgery. However, the standard therapeutic intervention for patients with carcinoma of the vagina is radiation therapy. Advanced stages are often treated with radiography + chemotherapy (e.g. Cisplatin)
Differential diagnosis
For large lesions consider invasion of the vagina by:
Malignant involvement of the vagina from metastatic spread is much more common, and except for isolated reports of metastases from extragenital cancers, the most common cause of metastatic disease is direct local invasion from the female urogenital tract. Therefore some authors state the diagnosis of primary vaginal carcinoma should be diagnosed only if other gynecologic malignancies have been excluded.
Other differential considerations include:
-<p><strong>Primary vaginal carcinoma</strong>, although being a rare overall, is still the 5<sup>th </sup>commonest gynaecological malignancy. A primary vaginal carcinoma is defined as a neoplasm that arises solely from the <a href="/articles/vagina" title="Vagina">vagina</a> with no involvement of the external os superiorly or the vulva inferiorly, the importance of this definition lying in the different clinical approaches in the treatment of <a title="Cervical carcinoma" href="/articles/carcinoma-of-the-cervix">cervical carcinoma </a>and <a title="Vulval carcinoma" href="/articles/primary-vulval-cancer">vulval carcinoma</a>. </p><h4>Epidemiology</h4><p>It can account for 1 - 3 % of all gynaecologic malignancies. The typical age at presentation is at around the 6<sup>th</sup> to 7<sup>th</sup> decades of life.</p><h4>Pathology</h4><p>The tumour characteristically arises from the posterior wall of the upper third of the vagina. The common patterns of disease are </p><ul>-<li>an ulcerating or fungating mass or </li>-<li>an annular constricting lesion</li>- +<p><strong>Primary vaginal carcinoma</strong>, although being a rare overall, is still the 5<sup>th </sup>commonest gynaecological malignancy. A primary vaginal carcinoma is defined as a neoplasm that arises solely from the <a href="/articles/vagina">vagina</a> with no involvement of the external os superiorly or the vulva inferiorly, the importance of this definition lying in the different clinical approaches in the treatment of <a href="/articles/carcinoma-of-the-cervix">cervical carcinoma </a>and <a href="/articles/primary-vulval-cancer">vulval carcinoma</a>.</p><h4>Epidemiology</h4><p>It can account for 1-3% of all gynaecologic malignancies. The typical age at presentation is at around the 6<sup>th</sup> to 7<sup>th</sup> decades of life.</p><h4>Pathology</h4><p>The tumour characteristically arises from the posterior wall of the upper third of the vagina. The common patterns of disease are:</p><ul>
- +<li>an ulcerating or fungating mass or </li>
- +<li>an annular constricting lesion</li>
-<li>-<a title="squamous cell carcinoma of the vagina" href="/articles/squamous-cell-carcinoma-of-the-vagina">squamous cell carcinoma of the vagina</a> : by far the commonest accounts for ~ 80 - 85% of primary vaginal malignancies : presents in older individuals</li>-<li>-<a title="adenocarcinoma of the vagina" href="/articles/adenocarcinoma-of-the-vagina">adenocarcinoma of the vagina</a> : ~ 15 % second commonest sub type : presents in younger individuals</li>-<li>-<a title="primary vaginal melanoma" href="/articles/primary-vaginal-melanoma">primary vaginal melanoma</a> :</li>-<li>-<a title="vaginal sarcoma" href="/articles/vaginal-sarcoma">vaginal sarcoma</a> :</li>-</ul><h4>Radiographic features</h4><h5>Pelvic MRI</h5><p>Imaging features will somewhat depend on the histologcial type of malignancy. </p><p>Reported general signal characteristics in general include <sup>6</sup></p><ul>-<li>-<strong>T1</strong> : iso intense to muscle</li>-<li>-<strong>T2</strong> : high signal intensity compared with muscle</li>-</ul><p>Reported signal charactersitics for squamous cell carcinoma include <sup>1</sup></p><ul>-<li>-<strong>T1</strong> : low signal intensity</li>-<li>-<strong>T2</strong> : intermediate signal intensity</li>-</ul><h4>Staging </h4><p><strong>See -</strong> <a title="vaginal cancer staging" href="/articles/vaginal-cancer-staging">vaginal cancer staging</a></p><h4>Treatment and prognosis</h4><p>Prognosis is significantly dependent on stage. Carcinoma in situ and very early stage invasive carcinoma is often treated with surgery. However, the standard therapeutic intervention for patients with carcinoma of the vagina is radiation therapy. Advanced stages are often treated with radiography + chemotherapy (e.g. Cisplatin)</p><h4>Differential diagnosis</h4><p>For large lesions consider invasion of the vagina by</p><ul>-<li><a title="Cervical carcinoma" href="/articles/carcinoma-of-the-cervix">cervical carcinoma</a></li>-<li><a title="Rectal carcinoma" href="/articles/rectal-cancer">rectal carcinoma</a></li>-<li><a title="Uterine cancers" href="/articles/malignant-neoplasms-involving-the-uterus">uterine carcinoma</a></li>-</ul><p>Malignant involvement of the vagina from metastatic spread is much more common, and except for isolated reports of metastases from extragenital cancers, the most common cause of metastatic disease is direct local invasion from the female urogenital tract. Therefore some authors state the diagnosis of primary vaginal carcinoma should be diagnosed only if other gynecologic malignancies have been excluded. </p><p>Other differential considerations include</p><ul><li><a title="vaginal lymphoma" href="/articles/vaginal-lymphoma">vaginal lymphoma</a></li></ul>- +<li>
- +<a href="/articles/squamous-cell-carcinoma-of-the-vagina">squamous cell carcinoma of the vagina</a>: by far the commonest accounts for ~80-85% of primary vaginal malignancies, presents in older individuals</li>
- +<li>
- +<a href="/articles/adenocarcinoma-of-the-vagina">adenocarcinoma of the vagina</a>: ~15% second commonest sub type, presents in younger individuals</li>
- +<li><a href="/articles/primary-vaginal-melanoma">primary vaginal melanoma</a></li>
- +<li><a href="/articles/vaginal-sarcoma">vaginal sarcoma</a></li>
- +</ul><h4>Radiographic features</h4><h5>Pelvic MRI</h5><p>Imaging features will somewhat depend on the histologcial type of malignancy. </p><p>Reported general signal characteristics in general include <sup>6</sup>:</p><ul>
- +<li>
- +<strong>T1:</strong> iso intense to muscle</li>
- +<li>
- +<strong>T2:</strong> high signal intensity compared with muscle</li>
- +</ul><p>Reported signal charactersitics for squamous cell carcinoma include <sup>1</sup>:</p><ul>
- +<li>
- +<strong>T1:</strong> low signal intensity</li>
- +<li>
- +<strong>T2:</strong> intermediate signal intensity</li>
- +</ul><h4>Staging </h4><p><strong>See:</strong> <a href="/articles/vaginal-cancer-staging">vaginal cancer staging</a></p><h4>Treatment and prognosis</h4><p>Prognosis is significantly dependent on stage. Carcinoma in situ and very early stage invasive carcinoma is often treated with surgery. However, the standard therapeutic intervention for patients with carcinoma of the vagina is radiation therapy. Advanced stages are often treated with radiography + chemotherapy (e.g. Cisplatin)</p><h4>Differential diagnosis</h4><p>For large lesions consider invasion of the vagina by:</p><ul>
- +<li><a href="/articles/carcinoma-of-the-cervix">cervical carcinoma</a></li>
- +<li><a href="/articles/rectal-cancer">rectal carcinoma</a></li>
- +<li><a href="/articles/malignant-neoplasms-involving-the-uterus">uterine carcinoma</a></li>
- +</ul><p>Malignant involvement of the vagina from metastatic spread is much more common, and except for isolated reports of metastases from extragenital cancers, the most common cause of metastatic disease is direct local invasion from the female urogenital tract. Therefore some authors state the diagnosis of primary vaginal carcinoma should be diagnosed only if other gynecologic malignancies have been excluded.</p><p>Other differential considerations include:</p><ul><li><a href="/articles/vaginal-lymphoma">vaginal lymphoma</a></li></ul>
Images Changes:
Image 1 MRI (T2) ( update )
Caption
was changed:
Case 1: squamous cell carcinoma
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