••• Chapter 48^ Vulvar and Vaginal Carcinoma^473
❍ What is the stage of a vaginal cancer that has extended onto the pelvic sidewall?
Stage III.
❍ What is typical treatment of a bulky stage I or II vaginal cancer?
External radiation 4000 to 5000 cGy followed by (in some centers) vaginal ovoids and an intrauterine tandem
(Fletcher-Suite). These are used to deliver a surface dose of up to 6000 cGy in 72 hours or 8000 cGy in two
applications of 48 hours each separated by 2 weeks, depending on initial thickness and regression of the lesion.
Many centers now administer high-dose radiation (HDR) brachytherapy on an outpatient schedule.
❍ In addition to standard radiation therapy, which additional treatments should be considered for a vaginal
tumor occurring in the distal third of the vagina?
Since these tumors frequently metastasize to the inguinal nodes, these nodes are best treated by radical inguinal
dissection before radiation therapy.
❍ In clear cell adenocarcinoma of the vagina, what is the precursor lesion found?
Adenosis.
❍ What has clear cell carcinoma of the vagina and cervix been thought to be associated with?
Diethylstilbestrol (DES) exposure in utero. Sixty-five percent of clear cell carcinomas of the vagina and cervix have
evidence of in utero exposure to DES; however, data does not substantiate that DES intrauterine exposure is a
carcinogenic event. It has been shown to be teratogenic with increased adenosis and other uterine anomalies.
❍ What is the treatment of clear cell adenocarcinoma confined to the upper vagina and/or cervix?
Radical hysterectomy with upper vaginectomy and pelvic lymphadenectomy with retention of the ovaries.
❍ What is the overall survival rate of clear cell adenocarcinoma of the vagina/cervix?
80%. This is better than 65% crude survival rate for squamous cell cancer of the cervix and much higher than
35% to 40% survival rate reported for squamous cell cancer of the vagina.
❍ Can primary adenocarcinoma of the vagina occur without intrauterine exposure to DES?
Yes. In both pre- and postmenopausal women.
❍ What is the treatment of malignant melanoma of the vagina?
Surgical excision (radical excision with nodal dissection). Radiation and chemotherapy have not been found to be
effective in the upper two-third of the vagina. An exenterative procedure must be used.
❍ What is the overall survival rate of patients with vaginal melanomas?
15%.
❍ What is the peak age at presentation of a DES exposure-related clear cell adenocarcinoma of the vagina or
cervix?
19 years old.