vaginal metastases
Introduction
Introduction to vaginal metastatic tumors The vagina and ovaries are the most common sites of cancer metastasis in the female reproductive tract. The genital tract itself and other parts of the genital tract may be transferred to the vagina. Metastatic tumors are the most common in vaginal tumors, while primary vaginal cancers are relatively rare, and it is easy to misdiagnose metastatic cancer as a primary vaginal tumor, which brings certain difficulties to diagnosis and treatment. basic knowledge The proportion of illness: 0.04% - 0.08% Susceptible people: women Mode of infection: non-infectious Complications: non-specific vaginitis
Cause
Causes of vaginal metastatic tumors
(1) Causes of the disease
Tumors derived from pelvic and abdominal organs are mainly through surface implantation, direct infiltration, lymphatic and blood passages to the vagina, and metastases in other parts of the body are mainly through blood transfer. The following mainly introduces other parts of the common reproductive tract. The route and manner in which the tumor metastasizes to the vagina.
Cervical cancer metastasis to the vagina has surface dissemination, surface implantation and submucosal lymphatic spread 3 ways, cervical cancer cells infiltrated into the vaginal forehead and vaginal wall, the vaginal wall is infiltrated by cancer, can be vaginal mucosa alone or simultaneously , submucosal and muscular layer to the vagina, can also be retrogradely disseminated by means of the vaginal mucosa rich lymph, and isolated nodules appear on the vaginal wall away from the primary tumor.
Ovarian cancer can be transferred to the vagina through blood, lymphatic metastasis and direct invasion of vaginal or cancerous ascites. The uterus is transferred to the vagina. The vagina is rich in blood vessels and lymphatic vessels. The venous plexus of the female genital tract is connected with lymphatic circulation. Such ovarian venous tumor thrombus may be retrograde through the vine plexus to the vaginal venous plexus or through the bloodstream to the vagina, the para-aortic lymph node metastasis can be retrograde to the vaginal lymphatic network to cause vaginal metastasis, the metastatic cancer in the lower part of the vagina may be mainly derived Lymph node metastasis, pelvic floor tumors directly invade the vagina, often after ovarian cancer reduction, tumors often invade the vaginal stump.
Endometrial cancer cells are discharged into the uterine cavity through the implantation form, and can also be transferred to the vagina. Most of the metastasis is formed by the lymphatic pathway. After the endometrial cancer metastasizes and invades the cervix, the route of metastasis to the vagina is similar to cervical cancer. .
Gestational trophoblastic tumor cells invade the uterine vein. Because there is no venous valve in the vaginal vein, the uterine venous blood containing cancer cells can be retrogradely vaginal venous plexus, forming a tumor thrombus in the vaginal vein, and then developing a vaginal metastatic nodule.
(two) pathogenesis
The general morphology of vaginal metastasis varies with different tumor sources. When the surface of cervical cancer is spread, it can be paralyzed. When the tumor spreads through the submucosal lymphatics, it often causes diffuse hardening of the upper 1/2 vaginal mucosa. Often formed into the anterior wall of the vagina and the lower third of the isolated nodules, about half of the vaginal metastatic adenocarcinoma is exophytum-like, polypoid-like changes; 1/3 of the infiltrating into the vaginal wall, making the mucosal surface uneven and nodular, The texture is stiff; less common is the appearance of granulation tissue; at least it is a cystic mass, which is caused by ovarian cancer.
Vaginal metastatic trophoblastic tumors can be single and multiple, ranging in size from a few millimeters to a few centimeters. The erosive moles are dark red or purple blue, and a few nodules are grayish white, brittle, prone to bleeding, necrosis and Infection, the lesions can be seen in the grape, and the choriocarcinoma can be dark blue hemorrhagic nodules, spongy, soft texture, easy to hemorrhage, and clear boundary with surrounding tissues.
The microscopic histomorphological features of metastatic carcinoma are the same as those of the primary cancer.
Prevention
Vaginal metastatic tumor prevention
A) Develop good habits, stop smoking and limit alcohol. Eat some anti-cancer foods and alkaline foods with high alkalinity as appropriate to maintain a good mental state.
B) Actively treat primary cancer and avoid metastasis.
Complication
Vaginal metastatic tumor complications Complications Non-specific vaginitis
Co-infection, non-specific vaginitis, and some major bleeding.
Symptom
Vaginal metastatic tumor symptoms Common symptoms Increased vaginal discharge vaginal outflow yellow or... Vaginal bleeding nodules
About half of patients with vaginal metastatic tumors have no symptoms of vaginal metastasis at the time of follow-up. About half of the patients have vaginal bleeding and increased secretion. A small number of patients, especially gestational trophoblastic tumors, have vaginal metastasis due to vaginal metastasis. Major bleeding, co-infected people produce malodorous secretions.
Different time and location of metastatic lesions in different primary diseases, patients with aggressive hydatidiform moles from the termination of the last pregnancy to the discovery of vaginal metastases for less than 1 year, choriocarcinoma appeared later, most of them appeared within 1 year. 24% of patients found vaginal metastasis nodules within 1 to 3 years, metastatic nodules were mostly multiple, single nodules were more in the following segments, 82.4% of patients had metastases with other organs, and lung metastases were the most common. In patients with ovarian cancer complicated with vaginal metastasis, the average time for diagnosis and treatment of vaginal metastasis from ovarian cancer was 11.4 months. The metastatic segment was more in the upper vaginal segment, and 75% of patients had pelvic and abdominal cavity, lymph node and organ metastasis.
Endometrial adenocarcinoma The vaginal metastasis is located in the left and right sides of the lower vagina or isolated nodules below the urethra, located under the mucosa or mucosa.
Examine
Examination of vaginal metastatic tumors
Tumor marker examination, secretion examination.
Colposcopy.
Diagnosis
Diagnosis and differentiation of vaginal metastatic tumor
In the past, there was a history of diagnosis and treatment of cancer, or treatment of cancer, increased vaginal secretions or vaginal bleeding. Gynecological examination revealed typical cancerous nodules in the vagina. Local biopsy showed that the histomorphological structure was the same as that of the primary cancer. There is no evidence of primary vaginal cancer, patients are generally easy to obtain a diagnosis, but if vaginal metastasis is the first manifestation of other tumors, first of all to obtain a pathological biopsy results to determine adenocarcinoma or squamous cell carcinoma, and then purposefully search for the location of the primary tumor Generally, the location of the primary tumor can be found.
Attention to the differentiation of various primary vaginal cancer, metastatic cancer lacks the evolution of cancer of primary vaginal epithelial cancer, according to the International Federation of Obstetrics and Gynecology, continuous vaginal cancer with the cervix should be attributed to cervical cancer Vaginal cancer with continuous vulva should belong to vulvar cancer. Only when there is no cervical cancer or vulvar cancer, can it be diagnosed as primary vaginal cancer. Some urinary tumors such as renal cancer vaginal metastasis can be the earliest manifestation. In this case, the possibility of kidney cancer should be considered.
