Vaginal cancer

Question 1

Is vaginal cell cancer common?

Answer 1

• no
• accounts for 1% of all new cancer cases

Question 2

Which age group are most commonly affected by vaginal cancer?

1 - 45-55
2 - 55-65
3 - 65-75
4 - 85-89

Answer 2

4 - 85-89

Question 3

Which cell type do vaginal cancers typically originate from?

1 - cuboidal cells
2 - germ cells
3 - squamous cells
4 - columnar cells

Answer 3

3 - squamous cells

Question 4

Are squamous cell carcinomas of the vagina more common in the anterior or posterior vagina?

Answer 4

• posterior

Question 5

In addition to squamous cell vaginal cancer, there is clear cell cancer which originate from the glands of the vagina. Which drug has been strongly linked with causing clear cell cancer in the vagina?

1 - Combined oral contraception
2 - Diethylstilbestrol, a synthetic estrogen
3 - Progesterone only pill
4 - Intrauterine device

Answer 5

2 - Diethylstilbestrol, a synthetic estrogen

Question 6

What is the most common infection that has been linked with causing squamous cell carcinoma?

1 - chlamydia
2 - human papillomavirus (HPV)
3 - gonorrhoea
4 - HIV

Answer 6

2 - human papillomavirus (HPV)
- 16 and 18 specifically

Question 7

All of the following are risk factors for vaginal cancer, bur what is the main risk factor?

1 - history of vulval intraepithelial neoplasia
2 - age
3 - history of lichen sclerosis
4 - history of radiotherapy and chemotherapy
5 - history of any other malignancy
Immunosuppression
6 - Diethylstilbestrol (DES) exposure during pregnancy
7 - history of HPV infection
8 smoking

Answer 7

2 - age
- closely followed by HPV

Question 8

Which of the following may a patient with vaginal cancer NOT typically NOT present with?

1 - vaginal bleeding/discharge
2 - dyspareunia
3 - weight loss
4 - abdominal pain/distension
5 - lethargy

Answer 8

4 - abdominal pain/distension
- more common in ovarian cancer

Question 9

What are typically the first line tests that should be done in an attempt to confirm a diagnosis of vaginal cancer?

1 - chest X-ray
2 - CT / PET
3 - MRI
4 - coloposcopy + vaginal biopsy

Answer 9

4 - coloposcopy + vaginal biopsy
- cytology will provide a definitive diagnosis
- all other tests are assessments of metastasis

Question 10

If a patient presents with vaginal bleeding/discharge, dyspareunia, weight loss and lethargy we need to come up with a list of differentials. Which of the following are suitable differentials?

1 = Primary/Secondary vaginal cancer
2 - Cervical cancer
3 - Rectal cancer
4 - Vaginal cyst
5 - Vaginal lymphoma
6 - Pelvic inflammatory disease
7 - all of the above

Answer 10

7 - all of the above

• patients who have previously had endometrial or cervical cancer are at an increased risk of vaginal cancer

Question 11

Which of the following is stage 1 of the FIGO classification for vaginal cancer?

1 - the disease involves the subvaginal tissue, but not the pelvic wall.
2 - the disease either extends beyond the true pelvis or involves the bladder or rectal mucosa
3 - the disease is limited to the vaginal wall mucosa.
4 - the disease extends to pelvic wall.

Answer 11

3 - the disease is limited to the vaginal wall mucosa.

Question 12

Which of the following is stage 2 of the FIGO classification for vaginal cancer?

1 - the disease involves the subvaginal tissue, but not the pelvic wall.
2 - the disease either extends beyond the true pelvis or involves the bladder or rectal mucosa
3 - the disease is limited to the vaginal wall mucosa.
4 - the disease extends to pelvic wall.

Answer 12

1 - the disease involves the subvaginal tissue, but not the pelvic wall.

Question 13

Which of the following is stage 3 of the FIGO classification for vaginal cancer?

1 - the disease involves the subvaginal tissue, but not the pelvic wall.
2 - the disease either extends beyond the true pelvis or involves the bladder or rectal mucosa
3 - the disease is limited to the vaginal wall mucosa.
4 - the disease extends to pelvic wall.

Answer 13

4 - the disease extends to pelvic wall.

Question 14

Which of the following is stage 4 of the FIGO classification for vaginal cancer?

1 - the disease involves the subvaginal tissue, but not the pelvic wall.
2 - the disease either extends beyond the true pelvis or involves the bladder or rectal mucosa
3 - the disease is limited to the vaginal wall mucosa.
4 - the disease extends to pelvic wall.

Answer 14

2 - the disease either extends beyond the true pelvis or involves the bladder or rectal mucosa

Question 15

Which 2 of the following treatments are effective in early stages of vaginal cancer?

1 - radiotherapy
2 - surgery
3 - chemotherapy
4 - all of the above combined

Answer 15

1 - radiotherapy
2 - surgery

• all can be combined where required though