Cancer of the Vagina

summary Ninety cases of carcinoma of the vagina are reviewed, 72 being primary cancers (1 non‐invasive) and 18 secondary cancers. The incidence of primary carcinoma of the vagina is 1.6% of 4,446 cases of primary genital cancer registered at the NewSouth Wales Gynaecological Cancer Registry. Staging was conducted according to the recommendation of the Cancer Committee of F.I.G.O. and this showed that 31 tumours were Stage 1, 28 Stage 2, 4 Stage 3 and 8 Stage 4. The site of the tumour was in the upper vagina in 39 cases, in the lower vagina in 15 cases, and in the middle third of the vagina in the remaining 17 cases. The mean age of patients with primary invasive carcinoma was 66.5 years, compared with 58.5 years for those with secondary carcinoma. The highest incidence of primary carcinoma was noted in the 70–80 age group, whereas for secondary carcinoma it was in the 50–60 age group. Primary invasive tumours were of squamous type in 80% of cases and adenocarcinoma in only 8 % Two‐thirds of the secondary tumours were adenocarcinomas. Neither marital status nor parity appeared to have any significant association and there was no predisposing cause that could be substantiated. Lymphatic involvement was observed clinically in 20% of patients; 25% of surgically removed nodes showed histological evidence of metastases. Difficulty was often experienced in determining whether a tumour involving the cervix or vulva was a primary or secondary vaginal tumour. For primary tumours, irradiation alone was used in 45 of the 71 patients, surgery alone in 12, surgery and irradiation in 7 and no treatment was employed in 7. A description of methods of applying radiotherapy is given and a dissection is made of the results of treatment according to both the site and the stage of the disease. Fifty per cent. of secondary tumours were treated by surgery compared with 27% of primary tumours. The best results, regardless of the nature of treatment, were obtained when the tumour was in the upper vagina and the principles of treatment applied in carcinoma of the cervix could be carried out. Annual and cumulative relative survival ratios are given for primary carcinoma of the vagina and these are compared with those for primary carcinoma of other genital sites. The 5‐year survival figure of 33.8% is considerably lower than that for other sites except the ovary. Secondary tumours of the vagina from the colon, rectum, cervix, vulva, body of the uterus, and urethra are discussed in relation to pathology and treatment. Secondary squamous tumours appear to have a better outlook than glandular tumours, particularly if treated by surgery.