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Wake Forest Baptist Approach Gynecologic Oncology Gynecologic Oncologists provide comprehensive treatment for all gynecologic malignancies, advanced pelvic surgery for benign and malignant conditions as well as complete evaluation and treatment of pre-invasive changes of cervix, vagina and vulva.  Multidisciplinary management is provided through close cooperation with radiation oncology, surgical oncology, medical oncology and pathology.  Active clinical research protocols are available for the management of cervical, endometrial, ovarian and vulvar malignancies, and include phase I, II and III trials from the Comprehensive Cancer Center, Gynecologic Oncology Group, Radiation Therapy Oncology Group, Department of Defense, and the pharmaceutical industry.  Studies focus both on the newest and most aggressive approaches for gynecologic cancers, as well as quality-of-life. Genetic counseling is available for women at risk for familial ovarian cancer syndromes. Brachytherapy Brachytherapy, which literally means “short therapy”, involves the implantation of radioactive sources in or near a tumor, a procedure which typically involves the collaboration of a surgical oncologist and radiation oncologist.  A full range of brachytherapy treatment options are available for treating cancers of the prostate, breast cervix, uterus, vagina, head and neck, soft tissues, brain, and eye.  In fact, with the availability of both high dose rate (HDR) and low dose rate (LDR) brachytherapy technology and expertise, virtually any area of the body can be implanted if appropriate.  Brachytherapy is often used as a “boost” in conjunction with external beam radiation, particularly for locally advanced cancers.   Vaginal tumors Female reproductive anatomy Uterus Normal uterine anatomy (cut section) Definition: A vaginal tumor is an abnormal growth of tissue in the vagina, a female reproductive organ. Alternative Names: Vaginal cancer; Cancer - vagina; Tumor - vaginal Causes, incidence, and risk factors: Most cancerous vaginal tumors occur when another cancer, such as cervical or endometrial cancer, spreads. This is called secondary vaginal cancer. Primary vaginal cancer is very rare. Most primary vaginal cancers start in skin cells called squamous cells. The rest are adenocarcinoma (6%), melanoma (3%), and sarcoma (3%). The cause of squamous cell carcinoma of the vagina is unknown. However, up to 30% of patients have had cervical cancer. About 75% of patients with squamous cell cancer of the vagina are over 50. Adenocarcinomas of the vagina more commonly affect younger women. The average age at which adenocarcinoma of the vagina is diagnosed is 19. Women whose mothers took diethylstilbestrol (DES) during the first 3 months of pregnancy are at increased risk for developing adenocarcinoma. Sarcoma botryoides of the vagina is a rare type of cancer that mainly occurs in infancy and early childhood. Symptoms: Bleeding after sexual intercourse Painless vaginal bleeding and discharge Pain in the pelvis or vagina About 5 - 10% of patients have no symptoms. Signs and tests: In patients with no symptoms, the cancer may be found during a routine pelvic examination and Pap smear. Other tests to diagnose vaginal tumors include: Biopsy Pelvic examination If a Pap smear is abnormal but the health care provider cannot see problems with the vagina during a pelvic exam, a colposcopy may be done. Other tests that may be done include: Chest x-ray CT scan of the abdomen and pelvis Treatment: Treatment of vaginal cancer depends on the type of cancer, and how far the disease has spread. Surgery is sometimes used to remove the cancer, but most patients are treated with radiation. If the tumor is cervical cancer that has spread to the vagina, then radiation and chemotherapy are both given. Sarcoma botryoides may be treated with a combination of chemotherapy, surgery, and radiation. Support Groups: You can ease the stress of illness by joining a support group whose members share common experiences and problems. You can find these support groups by searching the Internet or contacting the American Cancer Society. Expectations (prognosis): How well patients with vaginal cancer do depends on the stage of disease and the type of tumor. Complications: Vaginal cancer may spread to other areas of the body. Complications can occur from radiation, surgery, and chemotherapy. Calling your health care provider: Call for an appointment with your health care provider if you notice bleeding after intercourse or have persistent vaginal bleeding or discharge. Prevention: There are no definite ways to prevent this cancer. You can increase your chances of early detection by getting regular yearly pelvic examinations and Pap smears. References: Dotters DJ, Katz VL. Malignant diseases of the vagina: intraepithelial neoplasia, carcinoma, sarcoma. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby; 2007:chap 31.

Review Date:6/10/2008 Reviewed By:David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and James R. Mason, MD, Oncologist, Director, Blood and Marrow Transplantation Program and Stem Cell Processing Lab, Scripps Clinic, Torrey Pines, California. Also reviewed byDavid Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.