vaginal cancer, a malignancy of the vagina occurring rarely as a primary neoplasm and more often as a secondary lesion or extension of vulvar, cervical, endometrial, or ovarian cancer. Clear cell adenocarcinoma occurs in young women ages 14 to 30 exposed in utero to diethylstilbestrol, given to their mothers to prevent abortion, but most primary vaginal cancers arise in Caucasian women over 60 years of age. A predisposing factor is cervical carcinoma, HPV infection, and a previous hysterectomy. Vaginal leukoplakia, erythematosus, erosion, or granulation of the mucosa may prove to be carcinoma in situ. ▪ OBSERVATIONS: Symptoms of invasive lesions are postmenopausal bleeding, purulent discharge, pain, and dysuria. Diagnostic measures include cervical, endocervical, and vaginal Papanicolaou smears, colposcopy, biopsy, and Schiller’s iodine test in which malignant cells do not stain dark brown. ▪ INTERVENTIONS: Depending on the patient’s age and condition and the site and extent of the lesion, treatment may be by irradiation or vaginectomy and radical hysterectomy with lymph node dissection. Cryosurgery, topical 5-fluorouracil, and dinitrochlorobenzene may be used, but chemotherapy is not usually effective. ▪ PATIENT CARE CONSIDERATIONS: The majority of vaginal cancers are squamous cell carcinomas; others are clear cell or undifferentiated adenocarcinomas, malignant melanomas, and sarcomas. When diagnosed in the early stages, vaginal cancer can often be cured.
