472 Obstetrics and Gynecology Board Review •••
❍ What is the cause of most vaginal tumors/cancer seen?
Secondary carcinoma from extension of a cervical cancer; primary probably account for the greatest number of
so-called vaginal cancers.
❍ What is the histologic distribution of primary vaginal cancers?
- Squamous 85%
- Adenocarcinoma 6%
- Melanoma 3%
- Sarcoma 3%
- Misc. 3%
❍ Where is the most frequent location of a primary vaginal carcinoma lesion?
The predominance of lesions is in the upper third and posterior wall of the vagina.
❍ Have causes of chronic irritation of the vaginal wall, that is, use of a vaginal pessary, prolapse of the vaginal
wall, syphilis, leukoplakia, been proven to be a cause of vaginal cancer?
No. The cause of squamous cell carcinoma of the vagina is unknown.
❍ What is the most frequent presenting symptom of vaginal cancer?
Vaginal discharge, often bloody, is the most frequent symptom in most series. The signs and symptoms of invasive
vaginal cancer are similar to that of cervical cancer.
❍ Are the course and destination of lymphatic channels from different areas in the vagina predictable and
consistent?
No. All lymph nodes in the pelvis may at one time or another serve as a primary site or regional drainage for
vaginal lymph and its contents.
❍ How is vaginal cancer staged?
Clinically similar to cervical cancer. All patients should have a physical examination, chest film, IVP, cystoscopy,
and proctoscopy. Optional studies include lymph angiogram and barium enema.
❍ When should a barium enema be definitely included in patients with vaginal cancer?
In patients with a history of recurrent diverticulitis since it may be important in planning radiation therapy.
❍ What is the primary mode of therapy for vaginal cancer?
Radiation therapy.
❍ What is the typical radiation treatment plan for larger stage I vaginal cancers and above?
4000 to 5000 cGy whole pelvis external radiation with an interstitial implant delivery approximately 3000cGy
locally.