Malignant tumors of the vagina. Classification and approach to treatment

Recurrence of gynecologic malignancy at the vaginal vault after hysterectomy

OBJECTIVE

Vaginal vault recurrences of genital tract malignancy are not uncommon, and may be the first sign of recurrent disease. This paper reviews the experience at Columbia Presbyterian Medical Center.

METHODS

The tumor lists from 1993 to 1996 of the Division of Ob/Gyn Pathology at Columbia Presbyterian Medical Center were reviewed, and correlated with retrospective chart review.

RESULTS

Of 36 cases, 13 were from uterine primaries, seven were cervical in origin, eight were ovarian primaries, and in eight cases, the exact primary was not known at the time of biopsy. For the cases where the primary diagnosis and disease free interval were known, the time interval from hysterectomy to vault recurrence ranged from 1.5 months to 84 months, with a mean of 25.6 months.

CONCLUSION

Vaginal vault recurrences are often the site of recurrent female genital tract malignancies. Patients treated for gynecological cancer must have regular pelvic examinations including cytologic examination as part of their oncologic surveillance.

The management of vaginal melanoma

Between 1964 and 1987 ten patients with vaginal melanoma were treated at The University of Michigan Hospital. Five of the six patients who underwent radical surgery had adequate information concerning the first site of relapse, and in four of these five, pelvic sites or locoregional lymph nodes were the first sites of recurrent disease. One of these patients developed a 17-cm pelvic recurrence, which responded with a 75% reduction in size 3 months after completion of radiotherapy given in high individual fractions (400 cGy X 11). Three patients were managed with local resection, and all developed recurrent locoregional disease. One patient presented with metastatic disease. We conclude that locoregional control of vaginal melanoma is difficult to achieve with surgery alone. We hypothesize that preoperative radiotherapy to the pelvis (500 cGy X 6 given 3 days a week to the whole pelvis with subsequent consideration for a vaginal boost field) may improve the poor rate of locoregional control of vaginal melanoma that is seen when surgery alone is used.

The role of surgery in the management of carcinoma of the vagina

Treatment for vaginal carcinoma should be individualized. Surgery is an option to be considered in an attempt to improve both survival and the quality of life following therapy. Most patients with superficial Stage I vaginal carcinoma can be managed surgically. In patients with central non-metastatic Stage IV disease exenterative surgery should be considered, as well as in patients with central recurrence following radiotherapy. In suitable patients the results of surgery are good, and using modern techniques the incidence of complications is acceptably low.