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Vaginal Cancer: The Experience From 2 Large Academic Centers During a 15-Year Period

Gunderson, Camille C. MD1; Nugent, Elizabeth K. MD1; Yunker, Amanda C. DO, MSCR1; Rocconi, Rodney P. MD2; Graybill, Whitney S. MD2; Erickson, Britt K. MD2; Moore, Kathleen N. MD, MS1

Journal of Lower Genital Tract Disease: October 2013 - Volume 17 - Issue 4 - p 409–413
doi: 10.1097/LGT.0b013e3182800ee2
Original Articles

Objective: Limited data regarding the natural history, management, and prognosis of vaginal cancer exist owing to the relative disease rarity.

Materials and Methods: A retrospective chart review was performed at 2 institutions to identify women receiving treatment for vaginal cancer between 1990 and 2004. Demographics, risk factors, histology, International Federation of Gynecology and Obstetrics stage, treatment, and treatment-related complications were recorded. Statistical Analysis Software (SAS) version 9.2 was used.

Results: A total of 110 patients were identified in the 2 university databases. Median age was 63 years (range = 36–93 years), and 84% were white; 73% had squamous cell carcinoma, 40% were ever users of tobacco, and 64% had no abnormal Pap smear results. Of the patients, 83% had early-stage (I or II) disease. Treatment varied by stage with increasing use of radiation with advancing stage. Recurrence was 24%, 32%, and 53% for stage I, II, and III/IV disease, respectively. After a median follow-up of 21 months, progression-free survival was 59, 35, and 23 months for stage I, II, and III/IV disease, respectively. Overall survival was 106, 58, and 34 months for stage I, II, and III/IV disease, respectively. Age greater than 60 years (p = .0339; hazard ratio [HR] = 2.162), advanced stage (p = .0004; HR = 2.475), and tobacco use (p = .0004; HR = 1.02) were negatively associated with survival. Thirty percent developed a significant complication (fistula, stricture, cystitis, or proctitis), and 21% developed a vesicovaginal and/or rectovaginal fistula. There was no association of fistula development with age, stage, tobacco use, histological finding, or treatment history (including radiation therapy).

Conclusions: Age, stage, and tobacco abuse seem to be negatively associated with survival in vaginal cancer. However, no risk factors were associated with fistula development.

Vaginal cancer is a rare malignancy associated with high morbidity and poor prognosis.

1Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Oklahoma, Oklahoma City, OK; and 2Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL

Reprint requests to: Camille Gunderson, MD, 800 NE 10th St, Suite 5050, Oklahoma City, OK 73104. E-mail: camille-gunderson@ouhsc.edu

The authors have declared they have no conflicts of interest.

Copyright © 2013 by the American Society for Colposcopy and Cervical Pathology