Squamous cell carcinoma of the vagina

A type of cancer affecting the vaginal epithelium

Classification
External resources

Squamous cell carcinoma of the vagina is a type of vaginal cancer that originates from the squamous cells lining the vaginal epithelium. It is the most common form of vaginal cancer, accounting for approximately 85% of all cases. This malignancy primarily affects postmenopausal women, with a peak incidence in the seventh decade of life.

Pathophysiology

Diagram showing the layers of the vaginal wall

Squamous cell carcinoma of the vagina arises from the squamous epithelial cells that line the vaginal wall. These cells undergo malignant transformation due to various risk factors, leading to uncontrolled growth and invasion of surrounding tissues. The progression from normal epithelium to carcinoma typically involves a series of precancerous changes known as vaginal intraepithelial neoplasia (VAIN).

Risk Factors

Several risk factors have been associated with the development of squamous cell carcinoma of the vagina:

• Human papillomavirus (HPV) infection, particularly high-risk strains such as HPV 16 and 18.
• History of cervical cancer or cervical intraepithelial neoplasia.
• Previous radiation therapy to the pelvic region.
• Immunosuppression, such as in patients with HIV/AIDS or those on immunosuppressive medications.
• Smoking, which has been linked to an increased risk of various squamous cell carcinomas.

Clinical Presentation

Patients with squamous cell carcinoma of the vagina may present with a variety of symptoms, including:

• Abnormal vaginal bleeding, particularly postmenopausal bleeding.
• Vaginal discharge that may be watery, bloody, or malodorous.
• Pelvic pain or discomfort.
• A palpable mass or lesion in the vagina.

Diagnosis

The diagnosis of squamous cell carcinoma of the vagina is typically made through a combination of:

• Pelvic examination to identify any visible lesions or masses.
• Biopsy of suspicious areas to obtain tissue for histopathological examination.
• Imaging studies such as MRI or CT scan to assess the extent of disease and involvement of adjacent structures.

Staging

The staging of vaginal cancer is based on the FIGO staging system, which considers the size of the tumor, the extent of local invasion, and the presence of distant metastases. Staging is crucial for determining the appropriate treatment strategy and prognosis.

Treatment

The treatment of squamous cell carcinoma of the vagina depends on the stage of the disease and may include:

• Surgery, such as vaginectomy or pelvic exenteration, for localized disease.
• Radiation therapy, often used in combination with surgery or as a primary treatment for inoperable tumors.
• Chemotherapy, typically reserved for advanced or metastatic disease.

Prognosis

The prognosis for patients with squamous cell carcinoma of the vagina varies based on the stage at diagnosis. Early-stage disease has a relatively favorable prognosis, with five-year survival rates exceeding 70%. However, advanced-stage disease is associated with a poorer prognosis due to the likelihood of metastasis and local recurrence.

Prevention

Preventive measures for squamous cell carcinoma of the vagina include:

• Vaccination against HPV to reduce the risk of infection with high-risk strains.
• Regular gynecological examinations and Pap smears to detect precancerous changes early.
• Smoking cessation to decrease the risk of squamous cell carcinomas.

Related pages

• Vaginal cancer
• Human papillomavirus
• Cervical cancer
• Vaginal intraepithelial neoplasia