Related Subjects:
|Causes of abnormal Vaginal bleeding
|Vaginal Carcinoma
|Cervical cancer
|Antepartum haemorrhage
|Trauma: Traumatic Brain Head Injury (TBI)
|Post Menopausal Bleeding
|Postpartum haemorrhage
🌸 Vaginal carcinoma is a rare gynaecological malignancy, accounting for only 1–2% of cases.
It usually affects older women 👵 and is most commonly squamous cell carcinoma arising in the upper third of the vagina.
⚙️ Aetiology
- Most often squamous cell carcinoma (SCC, ~90%).
- 🦠 Associated with high-risk HPV infection.
- Risk factors: prior cervical cancer, radiotherapy, immunosuppression.
🔬 Pathology
- Premalignant: Vaginal intraepithelial neoplasia (VAIN).
- Squamous Cell Carcinoma 🩸: ~90% of cases, upper 1/3 vagina.
- Adenocarcinoma 💊: ~5%, includes clear cell adenocarcinoma linked to in utero DES exposure (<18 wks gestation).
- Rare types: Vaginal melanoma 🎨, sarcoma.
🩺 Clinical Features
- 🩸 Post-menopausal bleeding, irregular PV discharge.
- Dyspareunia (pain during sex).
- Vaginal mass, urinary frequency/dysuria.
- Local invasion → bowel changes, rectal symptoms.
- Lymphatic spread → palpable lymph nodes.
🔎 Investigations
- 🩺 Pelvic exam: Speculum + bimanual to assess lesion.
- 🔬 Biopsy: Gold standard for diagnosis.
- 🔭 Colposcopy: To visualise lesion and guide biopsy.
- 🖥️ Imaging: CT/MRI/PET for staging, local invasion, nodal/distant spread.
💡 Exam Pearl:
- Squamous = most common (upper vagina).
- Clear cell adenocarcinoma = think DES exposure in utero 💊.
- Postmenopausal bleeding 🩸 → always investigate for malignancy.
🛠️ Management
- 🔪 Surgery: Options vary by stage → local excision, vaginectomy, pelvic exenteration for advanced disease.
- ☢️ Radiotherapy: Often preferred if surgery not feasible or for older/frail patients.
- 💊 Chemotherapy: Sometimes used with radiotherapy or for advanced disease.
📚 Case Example
👵 A 68-year-old woman presents with postmenopausal bleeding 🩸 and watery vaginal discharge.
Exam: Friable lesion in upper vaginal wall.
Biopsy: Squamous cell carcinoma.
Staging MRI shows localised disease.
✅ Diagnosis: Vaginal squamous cell carcinoma.
🛠️ Management: Radical surgery vs radiotherapy depending on surgical fitness.
