Estrogen, vaginal cancer, and vaginal development.
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Adenocarcinoma↗
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Second primary cancers after vulvar and vaginal cancers.
OBJECTIVE: Our objective was to examine the occurrence of second primary cancers after vaginal and vulvar cancers. STUDY DESIGN: Women in whom cancers of the vagina (in situ, n=461; invasive, n=888) and vulva (in situ, n=2898; invasive, n=2685) were diagnosed between 1973 and 1988 were identified from nine population-based cancer registries. Subjects were followed through 1989 for the development of a subsequent primary cancer. RESULTS: We found increased risks of all second cancers combined among women with cancer of the vulva (observed/expected in situ = 1.5; observed/expected invasive = 1.3) and vagina observed/expected invasive = 1.2). Most of the excess second cancers were smoking related (e.g., cancers of the lung, buccal cavity and pharynx, esophagus, nasal cavity and larynx) or related to infection with human papillomavirus (e.g., cervix, vulva, vagina, and anus). CONCLUSION: These associations indicate that the follow-up care of women with cancers of the vulva and vagina should involve efforts to promote smoking cessation. The data are also consistent with a common sexually related cause for cancers of the cervix, vulva, vagina, and anus.
Cohort Studies↗
High-dose-rate brachytherapy in primary stage I and II vaginal cancer.
Thirteen patients with primary vaginal cancer were treated with external beam irradiation and high-dose-rate brachytherapy. Median age was 65 years old. Five tumors were stage I, 4 stage IIA, and 4 stage IIB. Twelve tumors were squamous and 11 were moderately or poorly differentiated. Median tumor diameter was 4 cm. Patients were treated with external beam irradiation (4500 cGy) and high-dose-rate brachytherapy (2000-2800 cGy in three to four fractions). All 13 patients had a complete response. Local control was achieved in 12 patients (92%) at a median follow-up of 2.6 years. No acute or chronic intestinal or bladder grade 3 or 4 toxicity was observed. Moderate to severe vaginal stenosis occurred in 6 patients (46%). Treatment of stage I and II primary vaginal cancer with external beam irradiation and high-dose-rate brachytherapy appears to produce a high response rate, local control, and survival with minimal complications.
Adult↗
Is hysterectomy a risk factor for vaginal cancer?
Several recent case series have called attention to a possible association between previous hysterectomy and the subsequent development of vaginal cancer. To study this relationship, we compared 49 patients with vaginal cancer with 49 controls matched for age, race, and prior cervical dysplasia or neoplasia. Patients and controls were alike in terms of exposure to estrogens. Twenty-four patients (49%) had had prior hysterectomies, of which 13 (27%) were for benign disease. Similarly, 24 controls had a history of a hysterectomy. The matched-pairs odds ratio relating prior hysterectomy to vaginal cancer was 1.00 based on these data, with a 95% confidence interval of 0.47 to 2.12. In the subsample of women without a history of cervical disease, a similar odds ratio appeared. Although the study sample size did not permit exclusion of a twofold increase in risk, the statistical power to detect an actual odds ratio of 2.5 is 76%. At this level of statistical power, our data suggest that hysterectomy has a low probability of being a risk factor for vaginal cancer when age and cervical disease are controlled for. In the absence of such a relationship, screening for vaginal cancer does not appear to be necessary for women who have had a hysterectomy for benign disease.
Adult↗
The role of brachytherapy in the treatment of stage III vaginal cancer. A report of 3 cases.
Advanced vaginal cancer has a grim prognosis: management is complicated. It may include surgery which needs to be exenterative if cure is intended, and/or radiation therapy (RT), the dose of which is limited by the radiosensitivity of adjacent structures. We report on 3 cases, in each of which the tumor was located in different anatomic sites, and we demonstrate how therapy was tailored to each situation. All 3 patients had Stage III, squamous cell carcinoma of the vagina. They received external beam irradiation (EBI) 4000-5000 cGy to the pelvis. This is the maximal tolerable dose by most pelvic organs, but is not curative. Therefore brachytherapy was combined with EBI. In one patient brachytherapy was given intraoperatively, following extensive removal of residual tumor in the pelvis. Two patients are alive and free of disease three and six and a half years later, and one patient died of disease five years following therapy. For eradication of advanced vaginal cancer, treatment includes the combination of EBI and brachytherapy with or without debulking surgery, the role of which was not previously described in this setting. Treatment strategy should be adapted to the anatomic location of the tumor, its intravaginal extension and the age of the patient.
Adult↗
Vaginal cancer: an iatrogenic disease?
Presently we are witnessing two unique occurrences in the field of public health: the first demonstration of transplacental carcinogenesis in humans and the first drug-induced cancer epidemic in women under age 30. This article examines the current status of the vaginal cancer epidemic and possible reasons for the failure of governmental health agencies to recall and test the generation of females who were exposed to diethylstilbestrol (DES) in utero. Epidemiologic evidence indicates that the large majority of "DES daughters" may develop adenosis. The carcinogenicity of other estrogens in wide use is examined. It is pointed out that, although vaginal cancer in daughters exposed to DES in utero provided the clinical evidence to secure a Food and Drug Administration ban on DES as an additive to cattle feed, the FDA approved a new use of DES as a "morning-after pill" contraceptive even though the contraceptive contains 833,000 times the amount of DES banned for human consumption in beef. The lack of standards of informed consent in the testing of the morning-after pill on university women and the additional risk this presents to DES daughters are discussed. The sociopolitical and economic contributing factors to the vaginal cancer epidemic and the extent to which the scientific direction of medical care is influenced by economic factors are examined. Public health measures which might prevent the occurrence of such man-made epidemics in the future are recommended.
Abortion, Spontaneous↗
[Primary vaginal cancer in adults. Apropos of 72 cases treated at the Fondation Curie from 1956 to 1968].
Primary vaginal cancer are infrequent and amount to 2 or 3 per cent of the gynecological cancers. Their diagnosis is difficult, because many other cancers metastasize in the vagina. The primary vaginal cancer arise mostly after climateric. Adjuvant causes would be a total hysterectomy in the past, prolapsus, prolonged use a pessary or a previous irradiation. The squamous-cell carcinomas, by far the most frequent (91%), are mostly situated in the upper third of the vagina on the anterior and posterior walls. Surgery, being difficult and mutilating is rarely indicated. So the treatment is mainly radiotherapic: external irradiation and intracavitary curietherapy. The radiation techniques are a little different according to the site of the lesion in the lower third or not. The upper lesion can be treated like a cervix cancer. The lower ones are more difficult to handle; for curietherapy, one must use molded apparatus, loaded with Iridium wire, adapted to each special case. The therapeutic results are rather poor:43 per cent for the 5-year cure rate and 36 per cent for the 10-year cure rate: less than for the cervix uteri. The upper lesions have a better prognosis than the lower ones. Results should be improved with an earlier diagnosis, a more accurate radiotherapy and a more precise dosimetry. The non-squamous-cell cancers (adenocarcinomas, sarcomas, mallignant melanomas) are generally rather radio-resistant. They are rare and their prognosis is very poor.
Adult↗
DNA analysis cervical and vaginal cancer cells during radiotherapy by rapid high-resolution cytometry.
The DNA content of the nuclei of cancer cells of 12 cases of cervical cancer and 2 cases of vaginal cancer, treated with radiotherapy, were studied in 50 specimens. Specimens were taken from each case before radiotherapy and at the totals of 1,000 rad, 2,000 rad, 3,000 rad and 4,500 rad (or 5,000 rad). All specimens were stained by the Papanicolaou method and were analyzed by rapid high-resolution cytometry. Total optical density, mean nuclear area and the 5N-exceeding rate (5NER) increased gradually following irradiation. Cancer cells disappeared in good response cases before 3,000 rad. Eight smears with a 5NER under 100 at the dose of 3,000 rad or more seemed to be poor response cases. Low 5NER and low mean nuclear areas were observed in both patients who died with persistent disease after radiotherapy, as well as in one case treated with chemotherapy for persistent disease after radiotherapy.
Adult↗
Combined therapy as an alternative to exenteration for locally advanced vulvo-vaginal cancer: rationale and results.
Locally advanced vulvo-vaginal cancer is a difficult therapeutic problem complicated by the fact that it is an uncommon clinical entity. Surgery for the vulvar (external genital) phase of this disease presentation was combined with radiotherapy for the internal genital phase (with adequate overlap of fields to protect surgical margins). The rationale is that this approach treats the cancer and its dual regional spread patterns, while at the same time preserves the bladder and/or rectum, and should be associated with less morbidity and mortality than exenterative surgery, especially in this predominantly geriatric patient population. During the period from 1968-1980, 33 cancers have been treated. There were 26 primary and seven recurrent cases. The apparent advantages of this combined therapeutic approach over exenterative surgery include bladder and/or rectal preservation, low primary mortality, low treatment morbidity, and good results in cancer control.
Adult↗
Vaginal cancer: the role of infectious and environmental factors.
Primary cancers of the vagina are rare. They comprise 1% to 2% of all gynecologic malignancies and occur predominantly in older women. The diagnosis of primary carcinoma of the vagina requires that the cervix and vulva be intact and that no clinical evidence of other primary tumors exist. Approximately 90% of all vaginal tumors are squamous cell in type on histologic examination. Adenocarcinoma, which is much less common (2% to 4%), is seen primarily in younger women with in utero exposure to diethylstilbestrol. In addition to exposure to diethylstilbestrol, other environmental factors have been associated with the development of vaginal tumors, including chronic irritation from pessaries, previous hysterectomy for benign disease, immunosuppression therapy, cervical irradiation, and endometriosis. Infectious causes seem to play an even more pernicious role in vaginal cancer. The two agents most often implicated are herpes simplex virus and human papillomavirus. These viruses appear to serve as cofactors in the inducement of various genital cancers, working together or with environmental agents such as diethylstilbestrol and host-related genetic abnormalities. The prognosis of vaginal cancer depends on the stage of the disease, with an overall 5-year survival rate of 80% to 90% for early stages.
Adenocarcinoma↗
Promoting effect of croton oil on the induction of cervical and vaginal cancers with herpes simplex virus types 1 and 2 in mice.
Hybrid Swiss virgin mice (Kuan-min strain) were challenged intravaginally with uv-inactivated herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2) twice a week for 16 times and subsequently with croton oil or control medium twice a week for 27 times. After a period of 180 days the exposure to HSV-2 plus control medium induced premalignant and malignant lesions of the cervix and vagina in 50.0% of the mice. The exposure to HSV-2 plus croton oil induced similar lesions in 78.2% of the mice. The exposure to HSV-1 combined with either control medium or croton oil induced lesions in 37.2 and 58.3% of the mice, respectively. No malignant lesions were found in the control mice. These results reveal that (1) HSV-1 and HSV-2 have a similar oncogenic potential, and (2) croton oil can promote the induction of cervical and vaginal cancers with HSV-1 and HSV-2. Additionally, these results suggest that the virus-induced carcinogenesis of cervix and vagina might be similar to the classical two-stage carcinogenesis model. This animal model seems to be more suitable for studying the prevention and treatment of cervical and vaginal cancers because the period of this experiment is significantly shorter than that of experiments reported by other investigators and the frequency of the malignant lesion is significantly higher than or similar to that of the same lesion reported in other experiments.
Animals↗
Cervical and vaginal cancer associated with pessary use.
From 1967 to 1990, 96 previously untreated patients with cervicovaginal cancer associated with a history of vaginal pessary use to control uterovaginal prolapse were referred to eight radiation therapy departments in France. Sixty-eight patients had cervical cancer, and 28 had vaginal cancer. The mean interval between pessary insertion and cancer diagnosis was 18 years, with a range of 1 to 41 years. Most patients received radiation therapy and brachytherapy. Few (5%) had Grade 3 treatment side effects. The overall 5-year relative survival rate was 54%; nonsurvival was related to locoregional recurrence. Because almost all tumors occurred at the site of pessary insertion, foreign body chronic inflammation in association with viral infection may be the cause of the tumors.
Aged↗
[Surgical treatment of cervical and vaginal cancer by means of the synchronized extraperitoneal-vaginal radical operation and the neovagina technic using the peritoneum].
In the period from 1976 to 1986 we operated 350 cases by the technique of combined extraperitoneal-vaginal radical synchronized hysterectomy in cases of uterus and vagina cancer. We analyzed 236 cases and compared them with the control group operated by the technique of Wertheim and modifications. There is a considerable difference in operative and post-operative complications. There are less complications in the examined group of patients operated by the technique of combined synchronized extraperitoneal-vaginal radical operation. We introduced the technique of partial neovagina formation at the place of the resected one, by means of the anterior and posterior plica peritoneum by which we are able to preserve the normal length of the vagina. By the means of this technique we operated 21 patients; out of that 15 were with cancer of the uterus cervix, 6 with vagina cancer, and in 3 of them, a complete vaginectomy was performed, and a complete neovagina made.
Adult↗
Serum squamous cell carcinoma antigen levels in patients with invasive squamous vulvar and vaginal cancer: a preliminary report.
Pretreatment serum squamous cell carcinoma antigen (SCC) levels were obtained in 12 patients with invasive vulvar and 5 patients with invasive vaginal squamous cancer. Only 4 of 12 (33%) patients with vulvar cancer and 1 of 5 (20%) patients with vaginal cancer, usually those with more advanced disease, had elevated serum SCC levels at the time of diagnosis.
Aged↗
[Vaginal cancer in a woman with a family history of ovarian cancer].
The proband was referred to familial ovarian cancer surveillance because two of her sisters died of carcinoma of the ovary. Her third sister succumbed of cervical cancer and her brother had acute myeloblastic leukaemia. Her second brother is alive and healthy. None of her parents and their sibs suffered of malignant disease. The offspring of the proband's sibs are young and appear to be normal. During surveillance she developed a stage I vaginal cancer. Following preoperative brachytherapy she underwent a radical hysterectomy and bilateral salpingoophorectomy with pelvic lymphadenectomy, and she is free of disease during 2 years of follow-up. The authors are not aware of any similar case.
Carcinoma, Squamous Cell↗
[Clinical course and radiotherapy of primary vaginal cancer (362 cases)].
362 cases of primary vaginal carcinoma were treated at the Irradiation Department of the University Clinic for Obstetrics and Gynaecology, Vienna, from 1950 to 1977. As method of choice an individually dosed, fractioned and protracted radium-telecobalt therapy was employed. An overall 5-years' survival rate of 39.8% could be achieved, a value which is above the average reported in world literature. Comparing the last period analysed in the present study (1971 to 1977) with another period 20 years earlier (1951-1956), the following differences can be observed: the fraction of stages III and IV rose markedly from 57.2% to 68.7%; associated with this change was an increase of the percentage of older patients (greater than 60a) from 53.6% to 70.7%. These two developments had an impact on the survival rate: in the total population, it was 39.8% as compared to 32% for the period from 1971 to 1977. The 5-year-survival rate in stage I (n = 60) was 75%, in stage II (n = 95) 45.3%, in stage III (n = 145) 30.3% and in stage IV (n = 62) 19.3%. The incidence of rectovaginal or vesico-vaginal fistulas amounted to 8%. The importance of gynaecological screening for old age patients is emphasized being the only possibility for reducing the high percentage of progressed stages.
Adult↗
Transplacental induction of vaginal cancer by synthetic estrogens.
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Abortion, Threatened↗
Stilbestrol and vaginal cancer in young women.
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Adenocarcinoma↗