Makindo Medical Notes

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.