Squamous cell carcinoma of the vagina | |
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Female reproductive anatomy with layers of the vaginal wall shown | |
Specialty | Oncology, Gynecology |
Symptoms | irregular vaginal bleeding, lump in the vagina, pain in vaginal area, pain with intercourse, pain with urination, constipation |
Types | keratinizing, nonkeratinizing, basaloid, warty |
Risk factors | HPV infection, smoking, early age at first sexual intercourse, multiple sex partners, age over 60 |
Diagnostic method | pelvic exam, biopsy |
Squamous cell carcinoma of the vagina is a potentially invasive type of cancer that forms in the tissues of the vagina. Though uncommonly diagnosed, squamous cell cancer of the vagina (SCCV) is the most common type of vaginal cancer, accounting for 80-90% of cases as well as 2% of all gynecological cancers. SCCV forms in squamous cells, which are the thin, flat cells lining the vagina. SCCV initially spreads superficially within the vaginal wall and can slowly spread to invade other vaginal tissues. Because of its slow growth, this cancer may cause no symptoms, or it may present with signs like irregular bleeding, pain, or a vaginal mass. This carcinoma can metastasize to the lungs or less frequently to the liver, bone, or other sites. SCCV has many risk factors in common with cervical cancer and is similarly strongly associated with infection with oncogenic strains of human papillomavirus (HPV). Diagnosis of SCCV is done by pelvic exam and biopsy of the tissue. Treatment and prognosis will depend on the stage, location, and characteristics of the cancer. [1] [2] [3]
SCCV may not cause any signs or symptoms in its early stages. The most common symptom people experience due to SCCV is vaginal bleeding, often in women who have already gone through menopause and no longer have monthly periods or after sexual intercourse. A mass or lump in the vagina may also be noticed and can cause pain during sexual intercourse. If the disease has grown or spread from the vagina, it can lead to pain in the pelvic area, pain when urinating, and/or constipation. [1] [2]
SCCV is often found alongside human papillomavirus (HPV) infection, similar to cervical cancer. Because of this association, risk factors for HPV infection also increase risk of SCCV. These factors include early age at first sexual intercourse, multiple sex partners, and smoking. SCCV is also becomes more common as age increases, with the average age of individuals affected being around 60 years old. Other factors that have been found to increase risk of SCCV include history of malignant cervical cancer, alcohol consumption, and low socioeconomic status. [1] [2] [4]
Diagnosis of SCCV is made by histologic appearance of a biopsy from the vagina and lack of history of a gynecological cancer that may have recurred and spread into the vagina. In order to diagnose SCCV, a doctor must perform a complete assessment of medical history and a physical examination. A pelvic exam with a speculum is needed in order to fully visualize the vagina and look for any irregularities or masses, which would then be biopsied. This also allows the doctor to exclude more benign causes of symptoms associated with SCCV. A bimanual exam is also often done to evaluate for other pelvic masses, and a rectovaginal exam may be performed to assess for spread of the cancer to the rectum. Other diagnostic procedures that can be used to evaluate for SCCV include a Pap smear, colposcopy, and vaginal cytology. Once diagnosed, chest x-ray and skeletal radiology are done to determine staging of the cancer. CT scan (CAT scan), MRI (magnetic resonance imaging),and PET scan (positron emission tomography scan) may be done as well to help plan treatment. [1] [2]
Treatment will vary depending on staging, where the cancer is located, whether the patient has a uterus or has had a hysterectomy to have it removed, and whether the patient has previously received radiation treatment to the pelvis. Diagnostic imaging is used to determine staging and plan treatment. Treatment generally consists of radiation therapy, either administered via external beam radiotherapy or brachytherapy. Chemotherapy can also be used along with radiation therapy, particularly with later stage cases. Surgical treatment of SCCV is uncommon but may be utilized for early stage cases that can feasibly be fully removed in an operation. After treatment is completed, surveillance for recurrence of SCCV should be done at least yearly. If the cancer does return, surgery may be curative and is regularly used. In recurrent disease, chemotherapy is often ineffective, so palliative care may be recommended if surgery cannot be completed. [1] [2] [5]
The prognosis for individuals with SCCV is dependent on the stage at time of diagnosis, with lower stages having more favorable outcomes. Tumor size is also a significant factor affecting prognosis, with smaller tumors being better. Location in the vagina, histology, history of hysterectomy, and age may be influential factors, but the data for these variables is inconsistent. [2] [3]
Of all cases of gynecologic cancers, SCCV makes up less than 2% of cases, affecting less than 1 in 100,000 women despite making up 80-90% of all vaginal cancers. Approximately 3,000 new cases of SCCV are diagnosed every year in the United States. The average age at diagnosis is around 60, with SCCV becoming more common as age increases, but it can be found in adolescents and young adults as well. Black women are more likely to develop SCCV than white women, whereas Asian/Pacific Islander women are less likely to develop SCCV. SCCV appears to be more common in women who have had a hysterectomy as well as those who experience pelvic organ prolapse. [2] [3] [6]
The Papanicolaou test is a method of cervical screening used to detect potentially precancerous and cancerous processes in the cervix or, more rarely, anus. Abnormal findings are often followed up by more sensitive diagnostic procedures and, if warranted, interventions that aim to prevent progression to cervical cancer. The test was independently invented in the 1920s by the Greek physician Georgios Papanikolaou and named after him. A simplified version of the test was introduced by the Canadian obstetrician Anna Marion Hilliard in 1957.
Cervical cancer is a cancer arising from the cervix or in the any layer of the wall of the cervix. It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body. Early on, typically no symptoms are seen. Later symptoms may include abnormal vaginal bleeding, pelvic pain or pain during sexual intercourse. While bleeding after sex may not be serious, it may also indicate the presence of cervical cancer.
Hysterectomy is the surgical removal of the uterus and cervix. Supracervical hysterectomy refers to removal of the uterus while the cervix is spared. These procedures may also involve removal of the ovaries (oophorectomy), fallopian tubes (salpingectomy), and other surrounding structures. The term “partial” or “total” hysterectomy are lay-terms that incorrectly describe the addition or omission of oophorectomy at the time of hysterectomy. These procedures are usually performed by a gynecologist. Removal of the uterus renders the patient unable to bear children and has surgical risks as well as long-term effects, so the surgery is normally recommended only when other treatment options are not available or have failed. It is the second most commonly performed gynecological surgical procedure, after cesarean section, in the United States. Nearly 68 percent were performed for conditions such as endometriosis, irregular bleeding, and uterine fibroids. It is expected that the frequency of hysterectomies for non-malignant indications will continue to fall given the development of alternative treatment options.
Uterine cancer, also known as womb cancer, includes two types of cancer that develop from the tissues of the uterus. Endometrial cancer forms from the lining of the uterus, and uterine sarcoma forms from the muscles or support tissue of the uterus. Endometrial cancer accounts for approximately 90% of all uterine cancers in the United States. Symptoms of endometrial cancer include changes in vaginal bleeding or pain in the pelvis. Symptoms of uterine sarcoma include unusual vaginal bleeding or a mass in the vagina.
Endometrial cancer is a cancer that arises from the endometrium. It is the result of the abnormal growth of cells that have the ability to invade or spread to other parts of the body. The first sign is most often vaginal bleeding not associated with a menstrual period. Other symptoms include pain with urination, pain during sexual intercourse, or pelvic pain. Endometrial cancer occurs most commonly after menopause.
Ovarian cancer is a cancerous tumor of an ovary. It may originate from the ovary itself or more commonly from communicating nearby structures such as fallopian tubes or the inner lining of the abdomen. The ovary is made up of three different cell types including epithelial cells, germ cells, and stromal cells. When these cells become abnormal, they have the ability to divide and form tumors. These cells can also invade or spread to other parts of the body. When this process begins, there may be no or only vague symptoms. Symptoms become more noticeable as the cancer progresses. These symptoms may include bloating, vaginal bleeding, pelvic pain, abdominal swelling, constipation, and loss of appetite, among others. Common areas to which the cancer may spread include the lining of the abdomen, lymph nodes, lungs, and liver.
Anal cancer is a cancer which arises from the anus, the distal opening of the gastrointestinal tract. Symptoms may include bleeding from the anus or a lump near the anus. Other symptoms may include pain, itchiness, or discharge from the anus. A change in bowel movements may also occur.
Cervical intraepithelial neoplasia (CIN), also known as cervical dysplasia, is the abnormal growth of cells on the surface of the cervix that could potentially lead to cervical cancer. More specifically, CIN refers to the potentially precancerous transformation of cells of the cervix.
Vulvar cancer is a cancer of the vulva, the outer portion of the female genitals. It most commonly affects the labia majora. Less often, the labia minora, clitoris, or Bartholin's glands are affected. Symptoms include a lump, itchiness, changes in the skin, or bleeding from the vulva.
Vaginal cancer is an extraordinarily rare form of cancer that develops in the tissue of the vagina. Primary vaginal cancer originates from the vaginal tissue – most frequently squamous cell carcinoma, but primary vaginal adenocarcinoma, sarcoma, and melanoma have also been reported – while secondary vaginal cancer involves the metastasis of a cancer that originated in a different part of the body. Secondary vaginal cancer is more common. Signs of vaginal cancer may include abnormal vaginal bleeding, dysuria, tenesmus, or pelvic pain, though as many as 20% of women diagnosed with vaginal cancer are asymptomatic at the time of diagnosis. Vaginal cancer occurs more frequently in women over age 50, and the mean age of diagnosis of vaginal cancer is 60 years. It often can be cured if found and treated in early stages. Surgery alone or surgery combined with pelvic radiation is typically used to treat vaginal cancer.
Gynecologic oncology is a specialized field of medicine that focuses on cancers of the female reproductive system, including ovarian cancer, uterine cancer, vaginal cancer, cervical cancer, and vulvar cancer. As specialists, they have extensive training in the diagnosis and treatment of these cancers.
Gynecologic cancer is a type of cancer that affects the female reproductive system, including ovarian cancer, uterine cancer, vaginal cancer, cervical cancer, and vulvar cancer.
Neuroendocrine carcinoma of the cervix is best defined separately:Neuroendocrine: Of, relating to, or involving the interaction between the nervous system and the hormones of the endocrine glands.Carcinoma: An invasive malignant tumor derived from epithelial tissue that tends to metastasize to other areas of the body.
Cervical cancer staging is the assessment of cervical cancer to determine the extent of the spread of cancer beyond the cervix. This is important for determining how serious the cancer is and to create the best treatment plan.
Postcoital bleeding (PCB) is non-menstrual vaginal bleeding that occurs during or after sexual intercourse. Though some causes are with associated pain, it is typically painless and frequently associated with intermenstrual bleeding.
Carcinoma of the tonsil is a type of squamous cell carcinoma. The tonsil is the most common site of squamous cell carcinoma in the oropharynx. It comprises 23.1% of all malignancies of the oropharynx. The tumors frequently present at advanced stages, and around 70% of patients present with metastasis to the cervical lymph nodes. . The most reported complaints include sore throat, otalgia or dysphagia. Some patients may complain of feeling the presence of a lump in the throat. Approximately 20% patients present with a node in the neck as the only symptom.
Squamous-cell carcinoma (SCC), also known as epidermoid carcinoma, comprises a number of different types of cancer that begin in squamous cells. These cells form on the surface of the skin, on the lining of hollow organs in the body, and on the lining of the respiratory and digestive tracts.
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Ovarian squamous cell carcinoma (oSCC) or squamous ovarian carcinoma (SOC) is a rare tumor that accounts for 1% of ovarian cancers. Included in the World Health Organization's classification of ovarian cancer, it mainly affects women above 45 years of age. Survival depends on how advanced the disease is and how different or similar the individual cancer cells are.