Vaginal cancer surgery
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Overview
The surgical approach for vaginal cancer requires a radical hysterectomy, upper vaginectomy, and bilateral pelvic lymphadenectomy. If a hysterectomy has been performed previously, then radical vaginectomy and bilateral lymphadenectomies should be done to complete the surgical therapy. Patients with stage I vaginal cancer appear to have the best outcomes when treated surgically. Early-stage disease had a mean five-year survival rate of 77 percent, which was far better than those with later-stage disease, regardless of whether or not adjuvant RT was administered.
Surgical therapy
- Surgical excision is the mainstay of vaginal cancer treatment. This approach permits histologic diagnosis, a significant advantage over other treatments since invasive foci have been detected in up to 10 to 28 percent of specimens[1].
- Surgical approaches include local excision, partial vaginectomy, and, rarely, total vaginectomy for extensive and persistent disease.
- Most excisions are performed transvaginally, although at times an open or minimally invasive abdominal approach is necessary.
- Presurgical administration of topical therapy may reduce lesion size, allow loosening of epithelial-stromal adherence, and enable cancer cells to be stripped from the underlying tissue during local excision[2].
- Partial vaginectomy is required when VaIN is buried in posthysterectomy suture recesses, as these lesions are frequently inaccessible to other forms of treatment.
References
- ↑ Ireland D, Monaghan JM (October 1988). "The management of the patient with abnormal vaginal cytology following hysterectomy". Br J Obstet Gynaecol. 95 (10): 973–5. PMID 3191050.
- ↑ Sillman FH, Fruchter RG, Chen YS, Camilien L, Sedlis A, McTigue E (January 1997). "Vaginal intraepithelial neoplasia: risk factors for persistence, recurrence, and invasion and its management". Am. J. Obstet. Gynecol. 176 (1 Pt 1): 93–9. PMID 9024096.