Cancer of the Vagina

CANCER OF THE VAGINA

Cancer of the vagina usually results from metastasized choriocar-cinoma or from cancer of the cervix or adjacent organs (eg, uterus, vulva, bladder, or rectum). Primary cancer of the vagina is squa-mous in origin.

Risk factors include previous cervical cancer, in utero exposure to diethylstilbestrol (DES), previous vaginal or vulvar cancer, pre-vious radiation therapy, history of HPV, or pessary use. Any pa-tient with previous cervical cancer should be examined regularly for vaginal lesions.

Before 1970, vaginal cancer occurred primarily in postmeno-pausal women. In the 1970s, it was shown that maternal inges-tion of DES affected female offspring who were exposed in utero. Benign genital tract abnormalities have occurred in some of these young women. Vaginal adenosis (abnormal tissue growth) may also occur. The risk for clear cell tumor related to DES exposure is 0.14 to 1.4 in 1,000 women. Colposcopy is indicated for all women exposed to this medication in utero. If colposcopic exam-ination discloses adenosis or a significant cervical lesion, follow-up is essential.

Vaginal pessaries, used to support prolapsed tissues, have been associated with vaginal cancer only if the devices were not cared for properly (ie, regularly cleaned and the vagina examined by a health care professional) because pessaries can be a source of chronic irritation.

Patients often do not have symptoms but may report slight bleeding after intercourse, spontaneous bleeding, vaginal discharge, pain, and urinary or rectal symptoms (or both). Diagno-sis is often by Pap smear of the vagina.

Medical Management

Treatment of early lesions may be local excision or administra-tion of a chemotherapeutic cream (ie, 5-fluorouracil applied with a tampon or a diaphragm). Cotton balls placed at the introitus lessen spillage, which otherwise can result in perineal irritation. Laser therapy is a common treatment option in early vaginal and vulvar cancer. Radiation, another treatment option, is delivered by external beam to the pelvis, by vaginal intracavitary radiation using a tandem and colpostats, or by interstitial vaginal implants using an obturator and vaginal template. For a tumor located in the lower third of the vagina, radical node dissection is followed by radiation.

Encouraging close follow-up by health care providers is the prime focus of nursing interventions with women who were ex-posed to DES in utero. Because DES was used only from the 1940s to the 1970s, the incidence will decrease with each subse-quent year. Emotional support for mothers and daughters is es-sential. For young women who have had vaginal reconstructive surgery, specific vagina-dilating procedures may be initiated and taught. Water-soluble lubricants are helpful in reducing painful intercourse (dyspareunia). If a lesion requiring treatment devel-ops, all aspects and effects of radiation therapy, chemotherapy, or surgery need to be explored on an individual basis.