Dear OncoLink "Ask The Experts,"
Is the optimum treatment for Vaginal Carcinoma in Situ laser surgery? Is there any other option? Is this early stage considered to be pre-cancer or cancer?
Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:
Vaginal carcinoma in situ is considered a premalignant, or preinvasive, disorder. Several treatment options exist--the best option depends on the location and extent of the abnomality. Limited lesions may be removed through surgical excision. Larger areas may be treated with laser vaporization. However, because this method does not produce a biospy specimen for examination by a pathologist, it is very important that adequate biopsies be performed before the laser therapy to exclude the presence of small areas of invasive cancer.
When the lesions are in several different areas, or cover a large portion of the vagina, the situation is more challenging. Treatment with intravaginal 5-FU (Efudex) cream is one option. Total removal of the vagina (total vaginectomy) with skin grafting, and radiation therapy have also been utilized.
You should be aware that these lesions often recur after treatment, and occasionally may recur as invasive cancer. Usual follow-up requires physical examination and vaginal Pap testing every 3-6 months after treatment.