Vaginal cancer surgery
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Syed Musadiq Ali M.B.B.S.[2]
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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][2].
- Surgical approaches include local excision, partial vaginectomy, and, rarely, total vaginectomy for extensive and persistent disease[3].
- Most excisions are performed transvaginally, although at times an open or minimally invasive abdominal approach is necessary[4].
- 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[5].
- Partial vaginectomy is required when VaIN is buried in posthysterectomy suture recesses, as these lesions are frequently inaccessible to other forms of treatment[6].
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.
- ↑ Stock RG, Chen AS, Seski J (January 1995). "A 30-year experience in the management of primary carcinoma of the vagina: analysis of prognostic factors and treatment modalities". Gynecol. Oncol. 56 (1): 45–52. doi:10.1006/gyno.1995.1008. PMID 7821847.
- ↑ Hacker NF, Eifel PJ, van der Velden J (October 2012). "Cancer of the vagina". Int J Gynaecol Obstet. 119 Suppl 2: S97–9. doi:10.1016/S0020-7292(12)60022-8. PMID 22999510.
- ↑ Shah CA, Goff BA, Lowe K, Peters WA, Li CI (May 2009). "Factors affecting risk of mortality in women with vaginal cancer". Obstet Gynecol. 113 (5): 1038–45. doi:10.1097/AOG.0b013e31819fe844. PMC 2746762. PMID 19384118.
- ↑ 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.
- ↑ Tjalma WA, Monaghan JM, de Barros Lopes A, Naik R, Nordin AJ, Weyler JJ (June 2001). "The role of surgery in invasive squamous carcinoma of the vagina". Gynecol. Oncol. 81 (3): 360–5. doi:10.1006/gyno.2001.6171. PMID 11371123.