Background

Question 1

Vaginal cancer typically presents in what age group?

Answer 1

70% of primary vaginal malignancies are detected in women ≥60 yo.

Question 2

What 3 lifestyle risk factors are associated with increased incidence of vaginal cancer? How common is HPV detected?

Answer 2

Increased risk of vaginal cancer is associated with the # of lifetime sexual partners, early onset of intercourse, and current smoking.

HPV DNA is detected in 64%–91% of invasive vaginal cancers.

Question 3

What % of cancers involving the vagina are not primary vaginal cancers?

Answer 3

∼75% of malignancies involving the vagina originate at other sites.

Question 4

What is the most common histology for vaginal cancer? What are 5 other rare vaginal cancer histologies?

Answer 4

Squamous cell carcinoma is the most common primary vaginal histology. Melanoma, sarcoma, lymphoma, adenocarcinoma, and clear cell adenocarcinoma are much more rare.

Question 5

Increased risk for clear cell adenocarcinoma is linked with what exposure?

Answer 5

In utero exposure to the synthetic estrogen diethylstilbestrol (DES) is linked with an increased risk for clear cell adenocarcinoma.

Question 6

What type of vaginal sarcoma is most common in adults? In children?

Answer 6

Adults: leiomyosarcoma

Children (≤6 yo): embryonal RMS (i.e., sarcoma botryoides)

Question 7

If an elderly woman has had a hysterectomy d/t early-stage cervical cancer, is it reasonable to continue PAP smear screening of the vaginal vault?

Answer 7

Yes. Though the value of continued screening is not proven, PAP smears of the vaginal vault in elderly women who have had hysterectomy for invasive/preinvasive cervical cancer seems reasonable given the increased risk for vaginal cancer.

Question 8

What is the nodal drainage of the upper two-thirds of the vagina? Of the lower one-third of the vagina?

Answer 8

The upper two-thirds of the vagina drain to the obturator, internal, external, and common iliac nodes. The lower one-third of the vagina may drain to the inguinofemoral nodes.

Question 9

What are 4 common presenting Sx of vaginal cancer? What 2 additional Sx may suggest locally advanced Dz?

Answer 9

Vaginal cancer may present with bleeding, discharge, pruritus, and dyspareunia. Pain or change in bowel/bladder habits may suggest locally advanced Dz.

Question 10

Where in the vagina is vaginal cancer most often located?

Answer 10

Vaginal cancer is most often found in the post wall, sup one-third of the vagina (the speculum must be rotated to ensure exam of this region).