Vaginal Tumor

Vaginal tumors are divided into benign and malignant. Benign vaginal tumors include fibroma, leiomyoma, hemangioma, lipoma, neuroma, myxoma and papilloma, named by their histologic origin; they usually cause no obvious symptoms. Vaginal malignant tumor = malignant lesion arising in vaginal-wall tissue; primary or secondary. Secondary tumors mostly metastasize from cervical, vulvar, endometrial or rectal cancer; primary vaginal malignancy is rare, accounting for about 2% of gynecologic malignancies.

Common Symptoms

Intermenstrual bleeding; irregular vaginal bleeding; bloody vaginal discharge

Causes and Pathogenesis

Etiology of primary vaginal tumors: 1. Chronic irritation: primary vaginal squamous carcinoma usually arises in the posterior fornix, possibly related to long-term pessary use in uterine-prolapse patients, vaginal leukoplakia or local inflammation. 2. Pelvic radiotherapy: over 20% of primary vaginal cancer patients have a history of pelvic radiotherapy. Generally vaginal dysplasia or cancer can occur 10-40 years after cervical radiotherapy; women under 40 with pelvic radiotherapy history have higher vaginal-cancer incidence. 3. Viral infection: HPV, especially types 16 and 18, may be an initiator of vaginal malignancy. 4. Immunosuppression: congenital or acquired/iatrogenic immunosuppressed patients have higher cancer incidence; vaginal cancer is no exception. 5. Estrogen deficiency: vaginal squamous carcinoma favors elderly women, possibly related to low postmenopausal estrogen causing vaginal mucosal epithelial atrophy — creating favorable conditions for carcinogens. 6. Recently, vaginal clear-cell adenocarcinoma is thought related to endogenous/exogenous estrogen. 7. Vaginal endodermal-sinus tumor is hypothesized to result from lack of embryonic tissue conductors during germ-cell migration, causing germ-cell misplacement into upper vagina. Spread and metastasis of vaginal malignancy: vaginal mucosa is extremely rich in lymphatics and blood vessels, submucosal connective tissue is loose — leading to mainly lymphatic spread and direct invasion of adjacent organs/tissues. 1. Lymphatic spread: upper 1/3 of vagina drains to pelvic nodes, lower 1/3 to inguinal nodes, middle 1/3 to both. Thus lymphatic spread depends on lesion location. 2. Direct invasion: anterior-wall lesion may involve urethra and bladder; posterior-wall lesion may involve rectum or pararectal tissue; lateral lesions often infiltrate paravaginal tissue; upper/lower 1/3 lesions may involve cervix/vulva respectively. 3. Hematogenous spread: usually in advanced cases.

Treatment

Surgery, interventional therapy

Preventive Measures

1. Actively treat diseases such as vaginal leukoplakia, chronic inflammation and ulcers. 2. Any irregular vaginal bleeding or abnormal discharge should be diagnosed and treated early. 3. After vaginal-cancer treatment, follow up every 3-6 months with cytology; any recurrent bleeding or abnormal discharge should prompt immediate visit.

Department to Visit

It is recommended to visit the Gynecology department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.