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Neoplasia in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
The incidence of squamous cell carcinoma of the vagina during pregnancy is very rare, with fewer than 20 reported cases (1). Symptoms of vaginal cancers are bleeding or discharge. More advanced disease may present with symptoms of bladder or bowel dysfunction, including frequent urinary tract infections, urinary retention, constipation, or tenesmus. While a persistently abnormal Papanicolaou (Pap) smear may rarely provide initial evidence of vaginal cancer, thorough speculum examination with biopsy of suspicious gross lesions provides definitive diagnosis. Preinvasive disease, vaginal intraepithelial neoplasia, which is far more common than invasive disease in the pregnant population, is best diagnosed with the use of colposcopic-guided biopsies. If biopsy confirms preinvasive disease, treatment with laser, 5-FU, or other ablative therapy can be postponed until completion of the pregnancy.
Risk Reduction and Screening for Women’s Cancers
Published in James M. Rippe, Lifestyle Medicine, 2019
Ama McKinney, Jo Marie Tran Janco
A recent development in the prevention of cervical cancer has been the introduction of the vaccines Gardasil and Cervarix. Both are protective against the high-risk HPV st rains 16 and 18, which have been implicated as being the most frequent strains associated with cervical cancer in the United States. Gardasil adds additional protection against HPV strains 6 and 11, which are low risk for the development of cervical cancer but cause genital warts. In the approximate three-year follow-up of the vaccines, the efficacy of Gardasil has been reported to be near 100% for HPV 16 and 18 CIN 2/3, adenocarcinoma in situ, vulvar intraepithelial neoplasia 2/3, and vaginal intraepithelial neoplasia 2/3 (high-risk dysplasia or carcinoma in situ). Similarly, 99–100% efficacy for genital warts was reported. Cervarix was found to have a rate of 93% protection for HPV-16 and -18-associated lesions. Both have also demonstrated cross-protection for several other strains of HPV. Even if sexual activity has been initiated, it should not preclude administration of the vaccine, as women may not have been exposed to any or all strains of HPV covered by the vaccines. The vaccines are currently approved for routine vaccination of girls aged 11–12 years, at the physician’s discretion at ages nine to 10, and for catch-up vaccination at ages 13–26. Gardasil has also been approved for males aged nine to 26 for the prevention of genital warts but could potentially also reduce the burden of HPV transmission.151
Cross-sectional and molecular imaging
Published in J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, An Atlas of Gynecologic Oncology, 2018
Syed Babar Ajaz, Ruth Williamson, Tara Barwick
Vaginal cancer is a rare disease predominantly seen in elderly females with 70% to 80% occurring in women above the age of 60. According to the American Cancer Society estimates for 2015, 4070 new cases of vaginal cancer will be diagnosed, and about 910 women will die of this cancer (Anon 2015d). Invasive vaginal cancer is usually associated with vaginal intraepithelial neoplasia (VAIN).
Primary vaginal malignancies: a single oncology centre experience
Published in Journal of Obstetrics and Gynaecology, 2019
Mariana Lima, Gisela Rio, Mariana Horta, Teresa Margarida Cunha
When analysing previous hysterectomies, we found a high number in both groups (56% for SCCs group and 80% in the adenocarcinomas group). However, in the adenocarcinomas group, all hysterectomies were performed because of benign pathology, while in the SCCs group there was an association with cervical dysplasia (73%). This association can be explained by the fact that risk factors for the development of vaginal cancer are similar to those of cervical cancer, including chronic HPV infection, multiple sexual partners, immunosuppression,and smoking (Grant et al. 2010). We highlight the role of HPV infection since it is strongly associated with the precursor of vaginal carcinoma and vaginal intraepithelial neoplasia. It has been proven that an increased incidence of vaginal carcinoma is observed in women with a previous diagnosis of cervical cancer or cervical intraepithelial neoplasia (López et al. 2005; Parikh et al. 2008; Grant et al. 2010; Walker et al. 2011). In fact, a previous study (Liu et al. 2013) points out that women over 60 years of age with a history of CIN lesions have an elevated risk of vaginal cancer and should be followed closely.
Prophylactic vaccination against human papillomaviruses to prevent vulval and vaginal cancer and their precursors
Published in Expert Review of Vaccines, 2019
Lan Xu, Amanda Selk, Suzanne M Garland, Fabrizio Bogliatto, Maria Kyrgiou, Steven Weyers, Marc Arbyn
Compared to vulvar cancer, vaginal cancer is a more rare cancer with an estimated 15,000 new cases annually worldwide, representing about 2% of all gynecological malignancies [1,7]. It is generally accepted that HPV-related vaginal cancers and cervical cancers share similar risk factors and HPV infection. Low-grade and high-grade vaginal intraepithelial neoplasia (VaIN) are classified as LSIL (VaIN1) and HSIL (VaIN2/3), respectively. Women with a history of cervical intraepithelial neoplasia are at higher risk of developing VaIN and vaginal cancer and vice versa [18]. The average prevalence of HPV is about 70% [19] and 91% in vaginal cancer and in VaIN2/3, respectively [15]. HPV16 is the most common type found in vaginal cancer and precancer [19].
Screening for Squamous Cell Anal Cancer in HIV Positive Patients: A Five-Year Experience
Published in Journal of Investigative Surgery, 2018
Chiara Santorelli, Cosimo Alex Leo, Jonathan D. Hodgkinson, Franco Baldelli, Francesco Cantarella, Emanuel Cavazzoni
Among the male group, 81% were MSM. A diagnosis of AIDS was made in 26% of the patients and a substantial number of them (43%) had a CD4+ <200 cell/mmc. Among the female group, HIV infection was contracted via sexual route in 83% of the cases. Twenty-nine patients had a past medical history of cervical intraepithelial neoplasia (CIN), vaginal intraepithelial neoplasia (VaIN), or vulvar intraepithelial neoplasia (VIN), while two patients experienced cervical and vaginal cancers respectively. AIDS diagnosis was made in 26% of all the patients and a low viral-load (<50 copies) was detected in 69% of both populations. Most of the patients (90%) were on antiretroviral therapy.