Vaginal Cancer FRCR CO2A Flashcards
what factors determine treatment of vaginal cancer?
- tumor site
- tumor size and
- stage
- involvement of adjacent anatomical structures
what are the majority of tumors affecting vagina?
from adjacent structures i.e cervix and vulva
only 23% of tumors arise from vagina itself
What’s the Lymphatic drainage of vagina?
upper 2/3rd: pelvic nodes
lower 1/3rd: inguinal nodesq
what are the RFs for vaginal cancer?
- old age
- HPV 16 and 18
- smoking
- chronic vaginal trauma (procidentia)
- DES exposure in utero
what’s the common histology of vaginal cancer?
sq cell carc (80%)
AC
How does Vaginal cancer spread locally?
locally to paravaginal tissue and pelvic side walls and rectum and anus and bladder, urethra and ureter
what’s the s/s vaginal cancer?
bleeding (MC), postmenopausal or post coital
Discharge
Dysuria
Pain/dyspareunia
or fistula
How is vaginal cancer diagnosed?
EUA, Biopsy ‘
what investigations are done in vaginal cancer?
cystoscopy
proctoscopy
rule out pregnancy in premenopausal ladies
CT / MRI for local disease extension
CT chest or CxR
what are the regional LNs for vaginal cancer?
Pelvic for upper 2/3: ext, int and common iliac
Inguinal and femoral for lower 1/3rd
How is stage I vaginal cancer defined and treated?
limited to vaginal wall
Rx: BT alone for smaller and superficial lesion
RT (EBRT and BT)
Surgery and/or RT
How are st II and III vaginal cancer defined and treated?
II: involved subvaginal tissue but not extended to pelvic side walls
III: extends to pelvic side walls
Rx
RT (EBRT and BT)
RT alone
surgery and/or post op RT
How is st IVA vaginal cancer defined and treated?
IVA: invades bladder / rectal mucosa and or direct extension beyond the true pelvis
Rx
RT (EBRT and BT)
RT alone
surgery and/or post op RT
How is st IV B defined and treated (vaginal cancer)?
spread to distant organs
pall RT, ChT and BSC
when can surgery be considered for vaginal cancer?
stage I and small st II tumors (radical hysterectomy and vaginectomy)
when is post op RT indicated in Vaginal Cancer?
margin +
LN +
How is RT delivered for vaginal carcinoma?
two phases:
phase I : EBRT to pelvis
Phase II: boost depending on location of tumor
Apical tumors: Intracavitory if < 0.5 cm thick, interstitital if ? 0.5 cm
Mid vaginal:
Interstitital BT for small anter and lat tumors and EBRT for postr or larger tumors
Distal tumors: INterstitial or EBRT for larger tumors
what about conc cisplatin for vaginal carcinoma Rx?
No evidence of benefit, but cisplatin is used
extrapolation from other cancers
What is beam arrangement of RT for vaginal cancer?
upper: 4 field
lower: AP and PA
what RT dose is usually given for Vaginal Carcinoma?
EBRT 50.4 Gy/ 28# followed by boost with HDR (21 Gy/ 3#) or LDR (20/25 Gy in single fraction)
when is external beam boost done in vaginal carcinoma RT treatment?
larger, postr or deeply infiltrating tumor
dose : 18 to 24 Gy in 10 to 12 fractions
what are S/Es of RT for vaginal cancer?
rectal ulceration, proctitis, urethral stricture, necrosis, small bowel obstruction
late: VVF and RVF or stricture urethra
when is recurrence risk high in vaginal cancer post Rx?
first 2 years
how is F/U done in vaginal cancer post Rx?
1st year: 3 monthly
2nd year: 4 monthly
3rd and 4th year: 6 monthly
then annually
What’s the predominant site of relapse in vaginal carcinoma post Rx?
Locoregional
How is rec treated in vaginal cancer ?
prev RT done, pelvic exenteration
prev Sx: RT radical
what are poor Prognostic Factors in vaginal cancer?
lower vagina
Adenocarcinoma
increased tumor bulk and
higher stage
what are favorable prognostic factors for vaginal carcinoma?
- young age < 60 yrs
- early stage
- HPV +
what RT dose is a/w improved survival in vaginal carcinoma?
70 Gy
What are 5 yr OS in vaginal Carcionma?
I: 75%
II: 60%
III: 35%
IVA: 20%
IVB: 0%
what are systemic treatment for IV B vaginal cancer? (NCCN) 2025
PD-L1–positive tumors
Pembrolizumab + cisplatin/paclitaxel
± bevacizumab
Pembrolizumab + carboplatin/paclitaxel
± bevacizumab
Cisplatin/paclitaxel/bevacizumab
Carboplatin/paclitaxel/bevacizumab
