Vaginal malignancy

Introduction

Introduction to vaginal malignancies Vaginal malignancies are often secondary, can spread directly from cervical cancer, or from endometrial cancer, ovarian cancer and choriocarcinoma, and bladder, urethra or rectal cancer can often be transferred to the vagina. Primary vaginal malignancies are rare, accounting for about 1% of female genital malignancies. Mainly squamous cell carcinoma, macular epithelial cancer, other such as adenocarcinoma, sarcoma and malignant melanoma are rare, no young woman obstetrician in medical practice, only seen a few patients, due to vaginal secondary Sexual cancer is more common, and the possibility of secondary vaginal cancer should be considered and excluded before the diagnosis of primary tumor. Vaginal malignant tumors may have no obvious symptoms in the early stage, or only vaginal secretions and contact bleeding. With the development of the disease course, vaginal cancerous lesions increase, necrosis, vaginal discharge odor, painless vaginal bleeding, when When the tumor spreads to surrounding organs and tissues, the corresponding symptoms may appear. basic knowledge The proportion of illness: 0.002%-0.005% Susceptible people: women Mode of infection: non-infectious Complications: hematuria constipation

Cause

Causes of vaginal malignancies

Cause

Human papilloma virus (35%):

It may be partly related to HPV and vaginal mucosal developmental abnormalities, known as vaginal intraepithelial neoplasia, HPV infection! Vaginal intraepithelial neoplasia! Invasive cancer, this process has been reported, but the exact possibility is still unclear.

Estrogen (30%):

Young women with vaginal clear cell carcinoma are associated with their mothers taking estrogen during pregnancy, the risk is 1%, and women who are exposed to the first 12 weeks of pregnancy are at the highest risk. There are no obvious symptoms in the early stage of vaginal malignancy.

Pathological change

Since primary vaginal cancer most often occurs in the posterior iliac crest, it may be associated with chronic irritation. In short, its exact cause and precursor conditions remain unclear. There are three general types of pathology: 1 cauliflower type, such as delayed treatment, cauliflower-like mass can fill the entire vagina. It usually occurs in the upper third of the vaginal wall, and the cancer cells are highly differentiated. They are exogenous and rarely infiltrate inward. 2 infiltrative or ulcerated, cancer formation ulcers, mainly found in the anterior wall of the vagina, often quickly infiltrated around the vagina. 3 mucosal type, slow development, can be confined to the mucosal layer for a long time, for vaginal carcinoma in situ. However, vaginal carcinoma in situ is more associated with or secondary to cervical cancer in situ, or peripheral changes in cervical invasive cancer. Histologically, primary vaginal cancer is almost always squamous cell carcinoma, rarely adenocarcinoma.

Prevention

Vaginal malignancy prevention

Malignant tumors may have no obvious symptoms in the early stage, or only vaginal secretions and contact bleeding. Attention should be paid to regular medical examinations and examinations.

1. Actively treat diseases such as vaginal leukoplakia, chronic inflammation and ulcers.

2. Anyone with irregular vaginal bleeding, abnormal leucorrhea, early diagnosis and active treatment.

Complication

Vaginal malignancy complications Complications, hematuria, constipation

When the tumor invades the bladder, frequent urination, dysuria, difficulty in defecation, hematuria; when the cancer invades the rectum, anal bulge may occur, difficulty in defecation, pain during defecation, constipation.

Symptom

Symptoms of vaginal malignancy Common symptoms Vaginal secretions increase difficulty in bowel movements Rectal pain Anal bulge constipation

symptom

Vaginal malignant tumors may have no obvious symptoms in the early stage, or only vaginal secretions and contact bleeding. With the development of the disease course, vaginal cancerous lesions increase, necrosis, vaginal discharge odor, painless vaginal bleeding, when When the tumor spreads to surrounding organs and tissues, the corresponding symptoms may occur. Involving the urinary tract or bladder may cause frequent urination, urgency, hematuria and dysuria; involving the rectum may cause difficulty in defecation and may be urgent after the vaginal vaginal ligament, ligament, ligament Invasion may cause lumbosacral pain, etc. If vaginal leiomyomas are the most common vaginal rectal pain, about half of the cases have this symptom.

Sign

Vaginal cancer occurs in the posterior wall of the upper third of the vagina and the anterior wall of the lower third. The vaginal epithelial tumor or the early invasive cancer lesion can only be erosive. The invasive tumor is mostly exogenous, with papillary shape. Or cauliflower type is common, there are ulcer type, flat submucosal type or vaginal infiltration type, early vaginal lesions are more limited, more vaginal, vaginal, main ligament and patellar ligament infiltration, bladder or urethra, vagina or rectal vaginal fistula, as well as groin, pelvic, metastasis of the supraclavicular lymph nodes, and even distant metastasis.

Examine

Examination of vaginal malignancies

1. Gynecological examination: It can be seen that the vaginal wall has nodules, which are cauliflower-like, ulcer or local hardening. The advanced cancerous tumor is filled with vaginal cavity, and a large amount of odor secretion is discharged, and contact bleeding.

2. Tissue biopsy: and vaginal cytology examination. Any suspicious tissue on the vaginal wall requires biopsy to be qualitative. For cases without obvious lesions, vaginal cytology is feasible, and the positive rate can be from 10% to 40%.

3. Diagnostic curettage: understanding the presence of a tumor in the endometrium of the cervix.

4. Endoscopy: All patients with a late stage of the disease need to undergo urethra-cytoplasmoscopy, rectal-sigmoidoscopy to exclude cancerous organs from invading these organs.

5. Imaging examination: All patients need to perform this examination before treatment, including B-ultrasound, CT, MRI, intravenous pyelography and chest X-ray examination to understand the relevant organs.

6. Serum immunological examination: Preoperative CEA, AT-4 and CA125 examinations are helpful for post-treatment prognosis assessment and follow-up monitoring.

Diagnosis

Diagnosis and diagnosis of vaginal malignant tumor

diagnosis

(1) Clinical diagnosis

1. Increased vaginal discharge, watery or bloody or odorous.

2. Irregular bleeding in the vagina, contact bleeding.

3. The vaginal wall has nodules, which are cauliflower-like, ulcerated or partially hardened.

4. When the tumor invades the nerves or bones, there is pain in the lower abdomen and lumbosacral region.

5. When the tumor invades the bladder, frequent urination, dysuria, difficulty in defecation, and hematuria occur.

6. When the cancer invades the rectum, anal swelling may occur, difficulty in defecation, pain during defecation, and constipation.

7. Biopsy, cytology can confirm the diagnosis.

(two) pathological diagnosis

Pathological diagnosis can be used to determine the nature of the tumor to estimate the prognosis and to develop a treatment plan.

(3) Clinical stage

The clinical stage of primary vaginal cancer is mainly based on the following staging criteria of the International Federation of Obstetricians and Gynecologists (FIGO).

Stage O: The tumor is confined to the epithelial layer (intraepithelial tumor).

Stage I: The cancer is limited to the vaginal wall.

Stage II: The cancerous lesion spreads to the subvaginal tissue but does not reach the pelvic wall.

Stage IIa: Infiltration under the vagina, not reaching the palace.

Stage IIb: Infiltration of the palace side did not pass through the basin wall.

Stage III: The cancerous lesion extends to the pelvic wall.

Stage IV: The extent of cancer is beyond the true pelvic cavity or invading the bladder or rectal mucosa, but bladder edema should not be included in this period.

Stage IVa: Cancer invades adjacent organs.

Stage IVb: The cancer is transferred to a distant organ.

Differential diagnosis

1. Vaginal epithelial atrophy: epithelial atrophy caused by estrogen deficiency in elderly women, vaginal cytology may be suspected of cancer; histological examination due to the entire epithelium can be composed of basal cells or subbasal cells and the epithelial top cells lack glycogen, The iodine test is positive, but similar to the vaginal intraepithelial tumor, but such patients can use the estrogen ointment in the vagina for 2 weeks, then vaginal cytology or histological examination, can return to normal vaginal epithelium.

2. Vaginal condyloma: It is difficult to visually distinguish such lesions from squamous squamous cell carcinoma, and it depends on histological examination.

3. Vaginal inflammation: Vaginitis and early vaginal cancer are sometimes difficult to distinguish on the naked eye, especially when the cancer is multi-center or diffuse, it needs to be examined by histology.

4. Endometrial adenocarcinoma vaginal metastasis: more than the left and right sides of the vagina or the lower urethra, isolated nodules, located in the mucosa or submucosa, tumor nodules can ulcerate, bleeding and infection, may be accompanied by uterus Large, uterine cavity diagnosis is positive.

5. Paraurethral adenocarcinoma: more involved in the vestibule of the vagina, there may be frequent urination, dysuria or dysuria.

6. Vestibular large adenoma: more involving the lower side of the vagina, the location of the mass is deeper.

7. Vaginal endometriosis: rare, often occurs in the ankle, its nodules increase with the increase in the number of menstrual cycles, surrounded by inflammatory infiltrates, often combined with pelvic endometriosis, often dysmenorrhea Or sexual intercourse pain, vaginal endometriosis when cancer occurs, the transition pattern between normal endometrium and endometrial adenocarcinoma must be seen in the tissue.

8. Vaginal metastasis of malignant trophoblastic tumors: often purple-blue nodules under the mucosa, which can lead to major bleeding, abortion, normal or hydatidiform history, uterus usually increased, or ovarian flavin cysts. Positive urine test or abnormal increase in blood -HCG.

9. Vestibular large gland malignant tumors: vaginal leiomyosarcoma, which is close to the vaginal canal wall, is sometimes difficult to distinguish from vestibular glandular malignant tumors and can be identified by histopathological examination.

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