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PubMed2002

Vaginal cancer.

Carcinoma of the vagina is an uncommon gynecologic cancer in the United States and throughout the world. Carcinoma in situ of the vagina and very early stage invasive carcinoma of the vagina may be treated with surgery. However, the standard therapeutic intervention for patients with carcinoma of the vagina is radiation therapy. In early stage vaginal carcinoma, radiation therapy is chosen for definitive treatment to preserve the anatomy and function of the vagina. In more advanced stages of vaginal carcinoma, radiation therapy is chosen as the standard treatment to avoid exenterative surgery, preserve anatomy and function, and to treat known or presumed lymph node metastasis. No randomized studies comparing irradiation alone versus irradiation and chemotherapy have been performed for patients with advanced carcinoma of the vagina. The standard therapy for patients with advanced cervical carcinoma is irradiation and concurrent cisplatin-based chemotherapy. Because the etiology and epidemiology of vaginal carcinoma appears identical to those of patients with invasive cervical carcinoma, patients with advanced vaginal carcinoma should be treated with irradiation and concurrent cisplatin-based chemotherapy.

Antineoplastic Agents↗
PubMed1993

Interstitial radiotherapy for early stage vaginal cancer. A new method of tumor localization.

Carcinoma of the vagina is optimally treated primarily with teletherapy, followed by interstitial needle brachytherapy. Following teletherapy, identification of the original tumor site is frequently difficult. We describe a method of marking the tumor with an india ink "tattoo" at initial presentation, followed by placement of a purse-string suture and titanium hemoclips at the time of brachytherapy. A stable marker is created so that the location of the original vaginal tumor can be easily identified on dosimetric films.

Adult↗
PubMed2000

Tamoxifen induces endometrial and vaginal cancer in rats in the absence of endometrial hyperplasia.

Tamoxifen was administered orally to neonatal rats on days 2-5 after birth and the subsequent effects on the uterus were characterized, morphometrically, over the following 12 months. Tamoxifen inhibited development of the uterus and glands in the endometrium, indicating a classical oestrogen antagonist action. Between 24 and 35 months after tamoxifen treatment there was a significant increase in the incidence (26%) of uterine adenocarcinomas and a 9% incidence of squamous cell carcinomas of the vagina/cervix in the absence of any oestrogen agonist effect in the uterus. This demonstrates that an oestrogen agonist effect is not an absolute requirement for the carcinogenic effect of tamoxifen in the reproductive tract of the rat. The unopposed oestrogen agonist effect of tamoxifen on the endometrium may not be the only factor involved in the development of endometrial cancers. It is possible that tamoxifen causes these tumours via a genotoxic mechanism similar to that seen in rat liver. However, using (32)P-post-labelling we failed to find evidence of tamoxifen-induced DNA adducts in the uterus. Tamoxifen may affect hormonal imprinting of oestrogen receptor responses in stem cells of the uterus, causing reproductive tract cancers to arise at a later time, in the same way as has been proposed for diethylstilbestrol. If these rodent data extrapolate to humans, then women who are taking tamoxifen as a chemopreventative may have an increased risk of vaginal/cervical cancer, as well as endometrial cancer.

Animals↗
PubMed1984

[Effect of brachytherapy and teletherapy on treatment results in primary vaginal cancer].

From 1971 to 1977 99 cases of primary carcinoma of the vagina were treated at the Radiotherapy Department of the I. University Clinic for Gynecology and Obstetrics in Vienna. Radiotherapy was adapted individually as far as possible due to the different localisations and extensions of this tumor and to the vicinity of bladder and rectum, two very radiation-sensitive organs. Basically a three-phased scheme of treatment was intended: primarily a focal irradiation of the tumor by plaque-application, then combined intra-uterine and intra-vaginal radium insertion, followed by a vaginal cylinder. Thus the vaginal tissue is charged with about 32 Gy in a depth of 0,5 cm, the tumor itself with about 100 Gy. Percutaneous telecobalt irradiation was applied additionally following the method prescribed for carcinoma of the cervix uteri. A vulvo-perineal irradiation field was applied supplementarily , if the tumor was localised in the lower third of the vagina. 5-year overall remission rate amounted to 32% for the years 1971 to 1977; hence it was somewhat lower than for the total time observed (1950 to 1977), which was 39,8%. This could be explained by the sharp increase of very old patients and of progressed stages. For separate stages, the following 5-year healing rates were observed: stage I: 78%; stage II: 48%; stage III: 24% and stage IV: 19%. Recto-vaginal or vesico-vaginal fistulas occurred in 8% of the cases; less severe complications, such as cystitis or proctitis, were found in 41 and 43%, respectively. The effect of percutaneous telecobalt irradiation on the healing rate was marked in progressed cases, especially. Only 1 patient of 15 (7%), who were not treated by teletherapy, reached 5-year remission , as compared to 14 of 52 (27%), who received teletherapy. Stages I and II did not show a comparable difference. Intrauterine brachytherapy was of more importance for remission rate in early stages: 11 of 16 (69%) patients with stages I and II, who were treated with intrauterine curietherapy, survived 5 years or more; of those who did not have intrauterine insertion, only 6 of 15 (40%) reached 5-year remission . For stages III and IV, intrauterine curietherapy did not markedly change the healing rate.

Adult↗
PubMed2001

Lactobacilli-mediated control of vaginal cancer through specific reactive oxygen species interaction.

Klebanoff et al. proposed that hydrogen peroxide-producing lactobacilli and peroxidase in the vagina of healthy women might be responsible for the prevention of vaginosis and also might exert an antitumor effect (1). Based on recent evidence on superoxide anion generation by transformed cells (2,3) and on the potential of myeloperoxidase for selective apoptosis induction in transformed cells (4), a model for specific reactive oxygen species interaction during lactobacilli-mediated tumor control in the vagina is presented here. We propose that peroxidase, which converts hydrogen peroxide into hypochlorous acid, is responsible for creating a microbicidal vaginal milieu by maintaining a balanced, non-toxic, steady state level of the microbicides H(2)O(2)and HOCI. In case individual superoxide anion-producing transformed cells eventually appear in the mucosa they will be driven into apoptosis by interaction of HOCI with superoxide anions which leads to the generation of hydroxyl radicals. Hence selective apoptosis induction in transformed cells represents the key element of lactobacilli-mediated antitumor defense. Since papilloma virus infected cells are resistant to this pathway of apoptosis induction, they are plausible candidates for circumvention of lactobacilli-mediated control of oncogenesis.

Apoptosis↗
PubMed2006

[A look beyond urology: vaginal cancer].

Primary carcinomas of the vagina are very rare. Nevertheless, they need to be included in differential diagnoses when carrying out a urological examination of the pelvic floor and the vagina in patients with micturition problems, also in younger patients: we report a case of a 35-year-old woman with a primary carcinoma of the vagina and present a review of the literature.

Adenocarcinoma↗
PubMed1988

Cervical and vaginal cancer detection at a regional diethylstilbestrol (DES) screening clinic.

From 1979 to 1986, 500 women were enrolled in a New York State regional diethylstilbestrol (DES) clinic for the early detection of DES-associated adenocarcinoma of the cervix or vagina. Only 66 DES-exposed females were seen at Roswell Park Memorial Institute in the 6-year period prior to the establishment of the DES screening clinic. Most (40%) learned of the DES screening clinic through television public service announcements. Documentation by physician, pharmacy, or hospital records of intrauterine DES exposure was possible in only 15.2% of the cases. Because of a mean age of 24 years of the DES-exposed patients, most physician, pharmacy, and hospital records were not readily available from that time period. In 5.2% of the patients enrolled in the DES clinic, review documented that the mother had not taken DES or other synthetic estrogen analogs. Among the 474 evaluable DES patients, gross vaginal or cervical abnormalities were present in 13.5% and DES-associated adenosis was seen in 16.0%. Sixteen (3.4%) developed squamous dysplasia, one developed squamous in situ carcinoma of the cervix, and one developed invasive squamous cell carcinoma of the cervix. During the 6-year period of the DES screening clinic, no patient developed DES-associated adenocarcinoma of the cervix or vagina. The utility of such specialized clinics is discussed.

Adenocarcinoma↗
PubMed1990

Histologic disappearance of locally advanced vaginal cancer after combination chemotherapy.

Clinically and histologically complete disappearance of local tumor and pelvic sidewall involvement was achieved in a patient with primary advanced squamous cell carcinoma of the vagina administered combination chemotherapy prior to operation. Radical hysterectomy, total vaginectomy, bilateral salpingo-oophorectomy, bilateral pelvic lymphadenectomy, and paraaortic lymph node biopsy were performed after seven courses of combination chemotherapy with vinblastine, bleomycin, and cis-platinum. This encouraging result warrants further investigation of combination chemotherapy in other patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1996

[Clinical and radiobiologic evaluation of radiation dosage in radiotherapy of vaginal cancer].

The investigation has been concerned with the results of combined (distant + contact) treatment and contact low-, medium-, and high-dosage radiotherapy alone in 133 patients with primary tumors of the vagina (VT). Time-dose-fractionation (TDF), cumulative radiation effect (CRE) and linear-quadratic (LQ) ("extrapolated dose of response") models were employed to evaluate the response of normal tissue. There was no correlation between survival in VT patients treated with radiation only and the tolerance limits for connective tissue estimated using TDF, CRE and LQ models being exceeded. The incidence of late-onset radiation injuries rose significantly by 20% (p < 0.05) when the TDF- and CRE-based limits of tolerance were exceeded. The LQ model had no similar predictive value. The TDF model proved more convenient in radiobiological assessment of different patterns of total focal dose fractionation, selection of similarly effective modalities as well as in prediction of late-onset radiation injury.

Dose-Response Relationship, Radiation↗
PubMed1989

[Vaginal cancer: primary invasive squamous cell carcinoma in adults].

Retrospective study of 80 cases treated at the Institute Curie from 1969 to 1982. This cancer is rare; it is generally seen in old women, mostly arising in the upper third. The treatment is exclusive radiation therapy in almost all the cases, through four pelvic fields up to a dose of 45/50 Gy. A boost dose is added with a perineal field, or curietherapy. Immediate tolerance is rather good and late severe complications are rare (6%). The 5-year survival rate is 52%. The prognostic factors, according to the Cox model, are: the clinical T stage (5-year survival rate of 66% in T1-T2 stages, and 30% in T3-T4 stages), the patient's age (5-year survival rate of 65% for the patients less than 70 years of age, 40% for the older ones), complete tumor regression 3 months after the end of the treatment (5-year survival rate of 71% for those patients, and only 12 months of median survival for the others who are all dead at 36 months).

Adult↗
PubMed2003

Cost-effectiveness of pap smear screening for vaginal cancer after total hysterectomy for benign disease.

OBJECTIVE: To examine the cost effectiveness of Papanicolaou screening for cancer after total hysterectomy for benign disease. MATERIALS AND METHODS: Decision analysis including Markov modeling applied to women aged 40 or older with a history of total hysterectomy for benign disease. We derived expected discounted costs and life expectancy. RESULTS: Maximum gain in life expectancy between no screening and any screening strategy was approximately 3 weeks. Cost effectiveness in dollars per life-year gained was > or =$143,875 more than no screening for strategies starting at age 50, and over $12 million for aged 40 or more screening strategy. None of the sensitivity analyses caused the incremental cost effectiveness of any strategy to come to less than $100,000 per life year gained compared with no screening. CONCLUSIONS: Despite significant costs for any strategy, Pap smear screening after total hysterectomy for benign disease provides essentially no gain in life expectancy. In absence of risks for genital cancer, such screening is not cost effective.

Journal Article↗