eMedicine Specialties > Obstetrics and Gynecology > Gynecologic Surgery

Surgical Treatment of Vaginal Cancer: Follow-up

Author: Tarek Bardawil, MD, Assistant Professor, Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine
Coauthor(s): Alberto Manetta, MD, Professor, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Department of Internal Medicine, Division of Epidemiology, University of California at Irvine College of Medicine
Contributor Information and Disclosures

Updated: Dec 10, 2007

Outcome and Prognosis

The outcome of exenteration has improved significantly over time in terms of operative mortality and 5-year survival rates. In 1965, Brunschwig reported an operative mortality rate of 16% and a 5-year survival rate of 20%36 ; in 1989, Morley et al reported an operative mortality rate of 2% and a 5-year survival rate of 61%37 . In general, the operative mortality rate is less than 5%, and the 5-year survival rate is about 40%. Improved hemodynamic monitoring, nutritional support, and advances in surgical techniques and instruments contribute to the decrease in intraoperative mortality and morbidity. Anterior exenteration has a better survival rate than total exenteration, 30-60% versus 20-46%.

Clinical factors that affect survival

  • Length of time from initial radiation therapy to exenteration: Less than 1 year is a poor prognostic sign.
  • Size of the central mass (>3 cm)
  • Preoperative sidewall fixation as determined by clinical examination

Pathological factors that affect survival

  • Tumor extension: In 1989, Anthopoulos and colleagues reported that the most important risk factor for reduced survival was the extension of the tumor laterally into the surgical margins.38
  • Positive nodes: In 1989, Morley et al reported a 5-year survival rate of 70% for negative nodes versus 0% for positive nodes.37
  • Spread of tumor to adjacent organs

Age can affect the operative mortality rate but not the 5-year survival rate. In 1992, Matthews et al reported that patients older than 65 years had the same 5-year survival rate of 45% as patients younger than 65 years.22 The operative mortality rate of the older group was 11% versus 8.5% in the younger group.

Anthopoulos et al found that 84% of the patients were rehospitalized for complications that occurred more than 30 days after surgery; complications usually involved the gastrointestinal or urinary tract.38 Surgical intervention was required for 58% of patients with complications occurring 1 year after surgery, while 74% required surgery within the first year.

Organ reconstruction, including low rectal anastomosis, continent vesicostomy, and vaginal reconstruction, has significantly improved quality of life after pelvic exenteration. In 1997, Hawighorst-Knapstein and colleagues reported that patients with no ostomies have a much better quality of life and body image than patients with 2 ostomies.39 They also reported that women with vaginal reconstruction reported fewer problems related to quality of life and significantly fewer sexual problems. As compared to healthy women with sexual dysfunction, in 1983 Andersen et al reported that women with vaginal reconstruction have significant reductions in sexual activity and arousal in addition to greater sexual anxiety.31

Regarding outcome and prognosis, the main concern of the patient and physician is the possibility of recurrence of the primary disease.

Future and Controversies

Although primary vaginal carcinoma is a rare gynecologic malignancy, its impact on women's health should not be underestimated, especially when considering the demographic increase in elderly women. As more women survive past the age of 60 years, physicians need to consider the likelihood that more women will present with vaginal cancer.

Although screening is not indicated based on the low incidence of vaginal carcinoma, screening should be reconsidered in the near future because of evidence that links HPV infection to the pathogenesis of vaginal cancer.

In June 2006, the Advisory Commitee on Immunization Practices (ACIP) voted to recommend the first vaccine developed to prevent cervical cancer and other diseases caused by HPV type 6, 11, 16, and 18. The vaccine is almost 100% effective in preventing precancerous lesions of the cervix, vulva and vagina, and genital warts caused by the HPV 6, 11, 16, and 18. The FDA has approved Gardasil for girls and women ages 9-26.

Because the 5-year survival rate of treated early stage vaginal cancer is significantly higher than advanced stages, early detection is key to improving outcome. To improve outcome of primary vaginal carcinoma, oncology centers should receive more cases per month in order to plan randomized prospective studies. This would be possible if a few oncology centers are selected for referral of all newly diagnosed cases. This would increase the experience of any of these centers in treating primary vaginal carcinoma.

 


More on Surgical Treatment of Vaginal Cancer

Overview: Surgical Treatment of Vaginal Cancer
Workup: Surgical Treatment of Vaginal Cancer
Treatment: Surgical Treatment of Vaginal Cancer
Follow-up: Surgical Treatment of Vaginal Cancer
References
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Further Reading

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Keywords

cervical cancer, vulvar cancer, premalignant disease of the vagina, human papilloma virus, HPV, cervical carcinoma, herpes simplex virus, HSV, Trichomonas vaginalis, T vaginalis, human immunodeficiency virus, HIV, sexually transmitted diseases, STDs, melanoma, exenteration

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Contributor Information and Disclosures

Author

Tarek Bardawil, MD, Assistant Professor, Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine
Tarek Bardawil, MD is a member of the following medical societies: American Association of Gynecologic Laparoscopists and American College of Obstetricians and Gynecologists
Disclosure: Nothing to disclose.

Coauthor(s)

Alberto Manetta, MD, Professor, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Department of Internal Medicine, Division of Epidemiology, University of California at Irvine College of Medicine
Alberto Manetta, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Obstetricians and Gynecologists, American College of Surgeons, American Gynecological and Obstetrical Society, American Medical Association, and American Society of Clinical Oncology
Disclosure: Nothing to disclose.

Medical Editor

Serdar H Ural, MD, Associate Professor of Obstetrics and Gynecology and Radiology, Director, Division of Maternal Fetal Medicine, Medical Director, Labor and Delivery Suite, Penn State University College of Medicine
Serdar H Ural, MD is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, Association of Professors of Gynecology and Obstetrics, and Society for Maternal-Fetal Medicine
Disclosure: GSK Honoraria Speaking and teaching; Ortho Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Associate Professor, Coordinator, Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

 
 
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