Factors to be considered in planning therapy for vaginal cancer are:

• Stage, size, and location of the lesion.
• Presence or absence of the uterus.
• Whether there has been prior pelvic radiation therapy.

In a large series of women studied retrospectively for 30 years, 50% had undergone hysterectomy prior to the diagnosis of vaginal cancer.[1] In this posthysterectomy group, 31 of 50 (62%) women developed cancers limited to the upper third of the vagina. In women who had not previously undergone hysterectomy, upper vaginal lesions were found in only 17 of 50 (34%) women. The lymphatics may drain to pelvic or inguinal nodes or both, depending on tumor location, and consideration should be given to these areas in treatment planning. The proximity of the vagina to the bladder or rectum limits treatment options and increases complications involving these organs. For patients with carcinoma of the vagina in its early stages, standard treatment applied by gynecologic oncologists or radiation oncologists is highly effective. For patients with stages III and IVA disease, radiation therapy alone is standard. For patients with stage IVB disease, current therapy is inadequate, and no established anticancer drugs can be considered standard treatment. Considering the rarity of such patients, they should be considered candidates for clinical trials using anticancer drugs and/or radiosensitizers to attempt to improve survival or local control.

Information about ongoing clinical trials is available from the NCI Web site.

References:

1. Stock RG, Chen AS, Seski J: 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, 1995.