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25 - Vagina

Published online by Cambridge University Press:  23 December 2009

Louise Hanna
Affiliation:
Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK
Malcolm Adams
Affiliation:
Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK
Louise Hanna
Affiliation:
Velindre Hospital, Cardiff
Tom Crosby
Affiliation:
Velindre Hospital, Cardiff
Fergus Macbeth
Affiliation:
Velindre Hospital, Cardiff
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Summary

Introduction

Primary carcinoma of the vagina is a rare condition that mainly affects older women. One of the main risk factors is persistent human papilloma virus (HPV) infection. Treatments are individualised, and treatment decisions are based on factors that include the site, size and stage of the tumour, and which adjacent structures are involved.

Tumours affecting the vagina

The most common malignant tumours affecting the vagina are tumours that have spread from adjacent structures (cervix and vulva). Table 25.1 shows the range of tumours that can affect the vagina (adapted from WHO Classification, 2003).

Anatomy

The vagina is a muscular tube about 8 cm long, and it extends upwards and backwards from the vulva to the uterus. The apex of the vagina, into which the cervix projects, is divided into four fornices: anterior, posterior, and two lateral.

The relations of the vagina from superior to inferior are as follows:

  • Anterior – bladder, urethra.

  • Posterior – pouch of Douglas, rectum, perineal body (separates lower vagina from anus).

  • Lateral – ureter, pelvic floor and perineal muscles.

The lymphatic drainage from the upper two-thirds is to the pelvic nodes, and from the lower third to the inguinal nodes.

Incidence and epidemiology

Vaginal cancer is rare; the annual disease incidence in the UK is 0.7 in 100,000 women. Approximately 180 new cases are diagnosed per year in England (National Statistics, 2005), and vaginal cancer accounts for approximately 1 to 2% of all gynaecological malignancy. The mortality-to-incidence ratio is 0.53 (National Statistics, 2005).

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Publisher: Cambridge University Press
Print publication year: 2008

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References

Chyle, V., Zagars, G. K., Wheeler, J. A.et al. (1996). Definitive radiotherapy for carcinoma of the vagina: outcome and prognostic factors. Int. J. Radiat. Oncol. Biol. Phys., 35, 891–905.CrossRefGoogle ScholarPubMed
Dalrymple, J. L., Russell, A. H., Lee, S. W.et al. (2004). Chemoradiation for primary invasive squamous carcinoma of the vagina. Int. J. Gynecol. Cancer, 14, 110–7.CrossRefGoogle ScholarPubMed
Frank, S. J., Jhingran, A., Levenback, C.et al. (2005). Definitive radiation therapy for squamous cell carcinoma of the vagina. Int. J. Radiat. Oncol. Biol. Phys., 62, 138–47.CrossRefGoogle ScholarPubMed
Mock, U., Kucera, H., Fellner, C.et al. (2003). High-dose-rate (high dose rate) brachytherapy with or without external beam radiotherapy in the treatment of primary vaginal carcinoma: long-term results and side effects. Int. J. Radiat. Oncol. Biol. Phys., 56, 950–7.CrossRefGoogle ScholarPubMed
Nanavati, P. J., Fanning, J., Hilgers, R. D.et al. (1993). High-dose-rate brachytherapy in primary stage I and II vaginal cancer. Gynecol. Oncol., 51, 67–71.CrossRefGoogle Scholar
National Statistics (2005). In Cancer Statistics and Registrations, Series MB1 no. 34, London: Office for National Statistics.
Perez, C. A., Grigsby, P. W., Garipagaoglu, M.et al. (1999). Factors affecting long-term outcome of irradiation in carcinoma of the vagina. Int. J. Radiat. Oncol. Biol. Phys., 44, 37–45.CrossRefGoogle ScholarPubMed
Tjalma, W. A. A., Monaghan, J. M., Lopes, Barros A.et al. (2001). The role of surgery in invasive squamous carcinoma of the vagina. Gynecol. Oncol., 81, 360–5.CrossRefGoogle ScholarPubMed
International Union Against Cancer. (2002). In tumour nodes metastases Classification of Malignant Tumours, ed. Sobin, L. H. and Ch., Wittekind, 6th edn. New York, Wiley-Liss, pp. 150–3.Google Scholar
World Health Organisation classification. (2003). In World Health Organization Classification of Tumours: Pathology and Genetics of Tumours of the Breast and Female Genital Organs, ed. Tavassoli, A. and Devilee, P.. Lyon: IARC Press, Chap. 6.Google Scholar

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  • Vagina
    • By Louise Hanna, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK, Malcolm Adams, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK
  • Edited by Louise Hanna, Tom Crosby, Fergus Macbeth
  • Book: Practical Clinical Oncology
  • Online publication: 23 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545375.026
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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Vagina
    • By Louise Hanna, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK, Malcolm Adams, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK
  • Edited by Louise Hanna, Tom Crosby, Fergus Macbeth
  • Book: Practical Clinical Oncology
  • Online publication: 23 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545375.026
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Vagina
    • By Louise Hanna, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK, Malcolm Adams, Consultant, Clinical Oncologist, Velindre Cancer Centre, Velindre Hospital, Whitchurch, Cardiff, UK
  • Edited by Louise Hanna, Tom Crosby, Fergus Macbeth
  • Book: Practical Clinical Oncology
  • Online publication: 23 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545375.026
Available formats
×