Primary vaginal cancer is considered a relatively rare form of malignancy. It accounts for 1 to 3% of all tumors of the female reproductive system. The Oncology Clinic of the Yusupov Hospital has created all the necessary conditions for the treatment of patients who have been diagnosed with a malignant tumor in the vagina:
- European level of room comfort;
- Highly qualified oncologists and gynecologists;
- Equipping with the latest equipment from leading global manufacturers;
- The use of modern antitumor drugs for chemotherapy, which are highly effective and have a minimal range of side effects;
- Individual approach to the choice of surgical intervention and radiation therapy regimen;
- Attentive attitude of medical personnel to the intimate problems of patients.
For vaginal cancer, the prognosis depends on the stage of the disease, the adequacy of the treatment, the presence of concomitant pathology, and the general condition of the patient. Five-year survival rates are, according to summary data from FIGO (International Federation of Obstetrics and Gynecology), for the first stage - 61.5%, the second - 33.7%, the third - 25.5%, the fourth - 8.9%. These figures in the Russian Federation are 81.4%, 40.0%, 24.8% and 8.8%. Considering that 25–30% of patients are diagnosed with stages III–IV of the disease upon initial treatment, treatment results remain disappointing. For this reason, in patients who come to the Yusupov Hospital with complaints of discomfort, pain or vaginal discharge, gynecologists first of all rule out a tumor in the vagina.
Benign tumors of the vagina
Benign tumors of the vagina are volumetric formations of the vaginal tube that develop from the structures of connective tissue, epithelium, and blood vessels. The course of benign vaginal tumors is often asymptomatic. As the tumor increases in size, it can cause foreign body sensations, discomfort during sexual intercourse, and problems with urination and defecation. Vaginal tumors are diagnosed by gynecologists at the Yusupov Hospital during a gynecological examination, colposcopy, and transvaginal ultrasound.
The following benign tumors localized in the vagina are distinguished:
- Fibroma;
- Lipoma;
- Cyst;
- Hemangioma.
The need for surgical treatment of benign vaginal tumors is dictated by the possibility of their suppuration, necrosis and malignant degeneration. Gynecologists perform organ-preserving operations. During surgery, the tumor is removed, leaving the female reproductive organ. After surgery, the symptoms of the disease disappear, and the tumor rarely recurs.
Treatment
Conservative therapy
The tactics of conservative treatment are determined by the etiology of the disease. Foreign bodies are removed with a finger, a clamp, tweezers or by rinsing. Patients with colpitis undergo local measures: douching with anti-inflammatory and emollient solutions, administration of antimicrobial tablets and vaginal suppositories, tampons with sea buckthorn oil. Correct endocrine and immune disorders. In the initial stages of prolapse, the following measures are performed:
- Strengthening muscles
. Complexes according to Atabekov and Kegel exercises are recommended. Regular training provides good results with a decrease in muscle tone and creates certain positive dynamics even in the presence of anatomical defects. - Hormone replacement therapy
. Indicated for patients with post-castration syndrome and menopause symptoms. Helps increase muscle tone and strengthen ligaments. Phytoestrogenic and estrogen-containing agents are used. - Correction of associated disorders
. For enterocele and rectocele, a special diet is indicated to prevent constipation. For mechanical support of the genitals, pessaries are used as a temporary measure. Long-term fixation with supporting devices is undesirable, since it can contribute to further prolapse, but it is forced to be used if there are contraindications to surgery.
The listed methods can be supplemented with physiotherapeutic procedures. If the pelvic floor muscles are weak, electrical myostimulation, laser therapy and other methods are prescribed. Treatment regimens for malignant neoplasms include polychemotherapy, intracavitary brachytherapy, and external beam radiation therapy.
Surgery
Taking into account the characteristics of the pathology, the following operations are performed:
- Benign space-occupying formations
: surgical removal of neoplasia and vaginal polyps, minimally invasive interventions (plasma coagulation, electrocoagulation, radio wave and laser methods), excision of cysts. - Malignant neoplasia
: removal of the uterus and appendages, various options for extended hysterectomy, including cystectomy or vulvectomy. - Vaginal prolapse
: vaginopexy, colporrhaphy, installation of mesh implants, sling interventions, colpocleisis. - Foreign bodies
: removal in the operating room if vaginal trauma is suspected, vaginoplasty in case of scar formation and severe mechanical damage.
Causes of vaginal cancer
Scientists still do not have a consensus on the cause of vaginal cancer and how the disease develops. Since the vulva, vagina and cervix develop from the urogenital sinus, it is assumed that the causes and mechanism of development of malignant neoplasms are the same. This tumor cannot be identified absolutely, since vaginal carcinoma is 30–40 times less common than cervical cancer, and the average age of patients with cervical cancer is 10–15 years younger than with malignant vaginal tumors.
One of the leading causes of the development of a malignant tumor of the vagina is considered to be a viral infection that is sexually transmitted. Genital condylomas of the vagina, the viral nature of which is absolutely proven, are a precancerous process. The leading role in the occurrence of squamous cell carcinoma of the vagina is played by the human papillomavirus. The HPV-16 and HPV-18 viruses are responsible for the occurrence of 70% of cancers of the vagina, cervix and anal canal and 30–40% of malignant tumors of the vulva, penis, mouth and oropharynx.
For the progression of human papillomavirus infection to cancer, a number of factors must be present:
- Long-term use of hormonal contraceptives;
- Sexual activity;
- Smoking tobacco;
- Infection with chlamydia trachomatis and herpes simplex virus type 2.
A certain role in the occurrence of vaginal cancer is assigned to burdened heredity and impaired immunological defense. Clear cell adenocarcinomas of the vagina occur in women whose mothers used 17 beta-estradiol and diethylstilbestrol to treat various complications of pregnancy, threatening miscarriages. The development of vaginal tumors may be associated with neoplasms in other localizations. Most often, malignant neoplasms of the vagina are detected after treatment for cervical cancer. In some patients with vaginal carcinoma, radiation therapy was performed the day before for other locations of the cancerous tumor.
Why is bartholinitis dangerous during pregnancy?
Any disease of an infectious-inflammatory nature that appears during pregnancy negatively affects the growth and development of the unborn child. Pathologies that are accompanied by suppuration and intoxication pose a particular danger to the fetus. Bartholinitis in pregnant women is just such a disease, so even with minor symptoms it is necessary to consult a specialist and begin treatment as early as possible. Treatment of an infectious disease is carried out with antibiotics. The doctor determines the treatment regimen individually, taking into account the patient’s position. Sometimes conservative treatment does not bring results, then surgical removal of the abscess is performed under local anesthesia, which does not harm the health of the expectant mother and child.
Types of malignant tumors of the vagina
Histologically, most vaginal tumors are represented by squamous cell carcinoma of varying degrees of differentiation. 2–3.5% of all malignant tumors of the vagina are adenocarcinomas and sarcomas. Vaginal melanomas are even less common. Most vaginal neoplasms deterministically undergo a sequential development cycle, which includes dysplasia, preinvasive and invasive forms. A precancerous condition of vaginal cancer is dysplasia. It, depending on the severity of pathological changes in the surface layer of stratified squamous epithelium, can be mild, moderate and severe. There is no specific macroscopic picture of dysplasia and preinvasive cancer. They may look like leukoplakia or erythroplakia, develop against the background of a visually unchanged vaginal mucosa or in condylomas.
Preinvasive cancer is most often localized in the upper third of the vagina. The tumor is characterized by multicentric growth. Considering the fact that preinvasive cancer is detected on average 10–12 years earlier than invasive cancer, gynecologists at the Yusupov Hospital carry out early diagnosis of the disease at the initial stage of the pathological process. Consistent cytological examination, colposcopy and biopsy provide a reliable diagnosis. To determine the boundaries of the lesion, use Lugol's solution or 3% acetic acid solution.
The histological structure of invasive cancer is represented by three main forms:
- Squamous cell keratinizing;
- Non-keratinizing;
- Poorly differentiated.
In patients with vaginal cancer, squamous cell neoplasms predominate. Keratinizing and non-keratinizing forms of cancer are observed with equal frequency. Poorly differentiated cancer occurs in 10.8% of patients, and vaginal adenocarcinoma – in 2.3%. The exophytic form of growth occurs 2 times more often than the endophytic one.
Vaginal tumors predominantly spread through the lymphogenous route. Neoplasms located in the upper third of the vagina metastasize to the iliac and obturator lymph nodes. Tumors of the lower part of the vagina spread to the inguinal-femoral lymph nodes, and cancer of the middle third of the vagina metastasizes in all directions.
Vaginal adenocarcinomas are more common in young women aged 17–21 years. Their histological structure is very diverse. The following types of vaginal adenocarcinoma are distinguished:
- Mesonephroid (clear cell);
- Endometrioid;
- Adenoid cystic tumor;
- Dimorphic glandular squamous cell carcinoma.
Vaginal melanomas are most often located in the lower third of the vagina. The tumor is characterized by an aggressive course, early hematogenous metastasis, rapid relapses after treatment and resistance to chemotherapy.
Paths of spread of the tumor process (metastasis)
1 – direct path (implantation or “per continuitatem”). The tumor grows into nearby organs and tissues - the rectum, bladder, pelvic wall, pelvic bones.
2 – lymphatic pathway to the pelvic and then para-aortic lymph nodes. The region of lymph node involvement depends on the location of the primary tumor. If there is a tumor in the lower third of the vagina, the first to spread are the inguinal lymph nodes.
3 - hematogenous (through blood vessels) - to distant organs (lungs, liver and bones).
Symptoms of vaginal cancer
With vaginal cancer, a woman complains of pain and leucorrhoea. Bloody vaginal discharge due to cancer is observed in 58–67% of patients. In 5–13% of patients the disease is asymptomatic. Quite often, the course of the disease is characterized by a combination of several symptoms. In 16% of patients, gynecologists find a cancerous tumor in the vagina by chance during a routine examination.
The clinical picture of vaginal cancer is quite polymorphic. This determines certain features and difficulties of diagnosis. They are detected when analyzing symptoms at various stages of the disease. If the frequency of bloody or mucous discharge from the vagina that is white or yellowish in color does not depend on the stage of the pathological process, then the proportion of pain syndrome increases significantly according to the degree of spread of the neoplasm. The presence of pain in a patient with a vaginal tumor indicates that the cancer process has spread beyond the organ. Most often, carcinoma is accidentally detected in the early stages of tumor development.
With a careful gynecological examination, diagnosing vaginal cancer is not difficult. During a speculum examination, gynecologists carefully examine the vaginal vaults, not forgetting that most malignant neoplasms of the vagina, especially in the early stages of development, are localized in its upper third. Tumors of the vagina belong to the “visual” localization. A reliable diagnosis is provided by cytological examination, colposcopy and biopsy. These diagnostic procedures are performed sequentially.
Where can I get a biopsy of a vaginal tumor in Moscow? At the Oncology Clinic of the Yusupov Hospital, doctors professionally perform targeted biopsies of suspicious areas and send the material for histological examination. It allows you to confirm or exclude a malignant tumor with high accuracy (up to 95%). To clarify the extent of spread of the tumor process in the Yusupov Hospital, the following diagnostic methods are used:
- Ultrasound examination of the pelvic and abdominal organs;
- Cystoscopy;
- Sigmoidoscopy;
- Radioisotope renography;
- Chest X-ray;
- Isotopic study of skeletal bones.
High-tech examination methods, which include magnetic resonance, computed tomography and positron emission tomography using the radiopharmaceutical drug fluorodeoxyglucose, are very informative, but, given their cost, are not mandatory. In vaginal cancer, magnetic resonance imaging is useful in diagnosing regional lymph node metastases, but MRI characteristics of the primary vaginal tumor are nonspecific.
To plan treatment and follow-up of patients at the Yusupov Hospital, a comprehensive diagnosis of human papillomavirus (HPV) infection is carried out using the following methods:
- Cytological - allows you to identify specific cells that are characteristic of HPV infection;
- Extended colposcopy after treating the vaginal mucosa with a solution of acetic acid;
- Molecular - determination of HPV DNA in the cells and tissues of the genital organs (polymerase chain reaction).
Using a comprehensive step-by-step approach to diagnosing vaginal cancer allows gynecologists at the Yusupov Hospital to quickly establish an accurate diagnosis and develop a treatment regimen. All cases of vaginal tumors that are difficult to diagnose and treat are discussed at a meeting of the Expert Council with the participation of professors and doctors of the highest category.
Antibacterial therapy
If the disease is advanced and cannot be treated sparingly with the use of bactericidal ointments and solutions, then the doctor decides to use antibacterial drugs. The treatment regimen is determined individually, taking into account the duration of pregnancy, the stage of progression of bartholinitis, the presence of associated complications, and the type of pathogen that provoked the inflammation.
To destroy a bacterial infection, the following drugs are often prescribed:
- "Amoxiclav";
- "Augumentin".
The course of therapy and dosage are individual. Also safe for the fetus are drugs belonging to the group of cephalosporins:
- "Ceftriaxone" in the form of injections;
- "Cefexin" for oral administration.
If inflammation of the Bartholin glands occurs with complications, the pregnant woman is prescribed the antibiotic Sumamed. The course of therapy is carried out under the strict supervision of a specialist. The doctor monitors the condition of the unborn child, as well as the effectiveness of the drug used, and adjusts the regimen if necessary.
