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Abramson Cancer CenterNCI CANCERLIT® Search: Vaginal and Vulvar Cancer - June 2002
National Cancer Institute®
Last Modified: June 1, 2002
- Photodynamic therapy of vulvar and vaginal condyloma and intraepithelial neoplasia using topically applied 5-aminolevulinic acid.
- Periodic genital pruritus caused by syringoma of the vulva.
- Malignant peripheral nerve sheath tumor of the vulva: a multimodal treatment approach.
- Salvage hemipelvis radiotherapy with fertility preservation in an adolescent with recurrent vulvar carcinoma.
- Primary invasive vaginal cancer in the setting of the Mayer-Rokitansky-Kuster-Hauser syndrome.
- Angiomyofibroblastoma of the vulva.
- [Vulvar carcinoma--retrospective study of 47 cases (epidemiology, etiology and long-term results]
- Patterns of failure in squamous cell carcinoma of the vagina treated with definitive radiotherapy alone: what is the appropriate treatment
- Molecular evidence of a common clonal origin and subsequent divergent clonal evolution in vulval intraepithelial neoplasia, vulval squamous
- Photodynamic therapy of vulvar intraepithelial neoplasia III using topically applied 5-aminolevulinic acid.
- Schwannoma of the clitoris.
- Quantitative RT-PCR assay for mRNA of VEGF and histone H4 in the determination of proliferative and angiogenic activity in vulvar
- Squamous cell vulvar carcinoma associated with Fanconi's anemia: a case report.
- Angiomyofibroblastoma of the vulva.
- Advanced primary clear cell carcinoma of the vagina not associated with diethylstilbestrol.
- The role of vascular endothelial growth factor-A (VEGF-A) and platelet-derived endothelial cell growth factor/thymidine phosphorylase
- Vaginal cancer.
- Recurrent vulvar cancer.
Table of Contents
1
UI - 11948597
AU - Fehr MK; Hornung R; Degen A; Schwarz VA; Fink D; Haller U; Wyss P
TI -
Photodynamic therapy of vulvar and vaginal condyloma and intraepithelial
neoplasia using topically applied 5-aminolevulinic acid.
SO - Lasers Surg Med 2002;30(4):273-9
AD - Department of Obstetrics and Gynecology, Division of Gynecology,
University Hospital, CH-8091 Zurich, Switzerland.
Mathias.Fehr@fhk.usz.ch
BACKGROUND AND OBJECTIVES: To determine the feasibility of photodynamic
therapy (PDT) of vulvar and vaginal condyloma and intraepithelial
neoplasia (VIN, VAIN) and to compare PDT results with conventional
treatments. STUDY DESIGN/MATERIALS AND METHODS: Thirty-eight patients
with vulvar or vaginal intraepithelial neoplasia (VIN) grade II/III (n =
22) or condyloma (n = 16) had 10% 5-aminolevulinic acid (ALA)-gel
applied topically. After 2-4 hours, 80-125 J/cm(2) laser light at a
wavelength of 635 nm was applied. PDT was compared to conventional
treatments for condyloma (CO(2) laser evaporation) and for VIN III
(laser evaporation, surgical excision). RESULTS: The complete clearance
rate for condyloma treated by PDT was 66% and the rate for IN was 57%
(as determined by biopsy). Of the neoplasia patients, none with
hyperkeratotic VIN (n = 4) responded, and only one of four with
increased pigmentation cleared. No scarring occurred, and postoperative
discomfort lasted 4.9 +/- 3.4 days. Reduced disease-free survival (DFS)
was associated with multifocal VIN (P = 0.02, OR 2.17, 95% CI
1.15-4.08), but DFS did not vary with treatment mode. CONCLUSIONS:
Although PDT is not equally efficacious for all subgroups, PDT for
condyloma and intraepithelial neoplasia appears to be as effective as
conventional treatments, but with shorter healing time and excellent
cosmetic results. Copyright 2002 Wiley-Liss, Inc.
2
UI - 11952472
AU - Gerdsen R; Wenzel J; Uerlich M; Bieber T; Petrow W
TI -
Periodic genital pruritus caused by syringoma of the vulva.
SO - Acta Obstet Gynecol Scand 2002 Apr;81(4):369-70
AD - Department of Dermatology, University of Bonn, Germany, Bonn, Germany.
Rainer.Gerdsen@ukb.uni-bonn.de
3
UI - 11972402
AU - Lambrou NC; Mirhashemi R; Wolfson A; Thesiger P; Penalver M
TI -
Malignant peripheral nerve sheath tumor of the vulva: a multimodal
treatment approach.
SO - Gynecol Oncol 2002 May;85(2):365-71
AD - Division of Gynecologic Oncology, Department of Obstetrics and
Gynecology, University of Miami/Jackson Memorial Hospital, Holtz
Building, Suite 3003, 1611 NW 12th Avenue, Miami, FL 33136, USA.
nlambrou@med.miami.edu
BACKGROUND: Malignant peripheral nerve sheath tumors (MPNSTs) are rare
in the gynecological population and have a high risk for local and
distant failures. Multimodal management of a patient with MPNST of the
vulva and review of the literature are outlined. CASE: A 34-year-old
woman presented with a complaint of a rapidly increasing pelvic mass,
pain, and difficulty ambulating. A disfiguring 20 x 20-cm vulvar mass
was identified and a recurrent MPNST diagnosed. Therapy included
external-beam radiation, anterior pelvic exenteration with pelvic
reconstruction, and adjuvant chemotherapy without complication.
CONCLUSION: It is recommended that for malignant peripheral nerve sheath
tumors of the vulva, complete surgical resection be performed with
adjuvant radiation and chemotherapy in selected cases. (c) 2002 Elsevier
Science (USA).
4
UI - 11972405
AU - Serkies K; Wysocka B; Emerich J; Hrabowska M; Jassem J
TI -
Salvage hemipelvis radiotherapy with fertility preservation in an
adolescent with recurrent vulvar carcinoma.
SO - Gynecol Oncol 2002 May;85(2):381-3
AD - Department of Oncology and Radiotherapy, Medical University of Gdansk, 7
Debinki Street, 80-211 Gdansk, Poland. oncol@amg.gda.pl
BACKGROUND: To preserve fertility, hemi-pelvis irradiation was chosen
for locoregional groin recurrence of vulvar cancer in an adolescent.
CASE: A case of squamous cell vulvar carcinoma in uncommonly young
patient is presented. First surgical management (local excision of
T1N0M0 tumor of the right labia minora) was performed at the age of 16.5
years. Further therapy included wide local resection of recurrent local
lesion, two subsequent ipsilateral groin dissections of nodal metastases
(with extranodal spread at the first instance), and ipsilateral pelvic
lymphadenectomy. The patient was administered external beam irradiation
of 45 Gy to the hemi-pelvis followed by 10.8 Gy boost to the right
inguinal region. After 6.5 years from the completion of radiotherapy the
patient is free of disease. She managed to conceive but the labor was
premature and the infant died in its 7th week of life. CONCLUSION: In
this case salvage hemi-pelvic irradiation for groin metastases of vulvar
cancer has proved to be an effective treatment, allowing preservation of
hormonal and obstetric functions. Partial post-irradiation damage of the
uterus might have caused premature labor. Thus, special obstetric care
is advisable in such situations. (c) 2002 Elsevier Science (USA).
5
UI - 11972406
AU - Tewari DS; McHale MT; Kuo JV; Monk BJ; Burger RA
TI -
Primary invasive vaginal cancer in the setting of the
Mayer-Rokitansky-Kuster-Hauser syndrome.
SO - Gynecol Oncol 2002 May;85(2):384-7
AD - Division of Gynecologic Oncology, Division of Radiation Oncology, Chao
Family Comprehensive Cancer Center, University of California Irvine
Medical Center, 101 The City Drive, Orange, CA 92868, USA.
BACKGROUND: The Mayer-Rokitansky-Kuster-Hauser syndrome occurs in 1 in
4000 to 5000 female births. Primary vaginal cancer constitutes less than
2% of all malignancies of the female genital tract. A report of the
first case of the unlikely occurrence of both of these developments in
the same patient is presented. CASE: A 34-year-old nulligravid
Philippine woman with a history of Mayer-Rokitansky-Kuster-Hauser
syndrome presented with a 5-month history of bleeding from a blind
vaginal pouch. Vaginal biopsy identified a moderately differentiated
endometrioid adenocarcinoma. Exploratory laparotomy, bilateral
salpingo-oophorectomy, pelvic and iliac lymph node samplings, and
excision of a mullerian remnant were performed with no evidence of
disease. A FIGO Stage I vaginal cancer was assigned and pelvic
irradiation was given. Disease recurred 4 months later and the patient
underwent total pelvic exenteration. More than 1 year since the
exenteration procedure, she is without evidence of disease. CONCLUSION:
This is the first reported case of a primary vaginal cancer in a patient
with Mayer-Rokitansky-Kuster-Hauser syndrome. It is a reminder that
routine gynecologic examinations are still warranted as these patients
are at risk for malignant changes in residual mullerian tissues. (c)
2002 Elsevier Science (USA).
6
UI - 11787931
AU - Mohan H; Punia RS; Mohan P; Bhutani A; Chopral R
TI -
Angiomyofibroblastoma of the vulva.
SO - Aust N Z J Obstet Gynaecol 2001 Nov;41(4):469
AD - Department of Pathology, Government Medical College and Hospital,
Chandigarh, India.
7
UI - 11987574
AU - Jancarkova N; Freitag P; Zivny J
TI -
[Vulvar carcinoma--retrospective study of 47 cases (epidemiology,
etiology and long-term results]
SO - Ceska Gynekol 2002 Mar;67(2):78-82
AD - Gynek.porod. klinika, UK 1. LF a VFN, Praha.
OBJECTIVE: To evaluate the incidence of vulvar carcinoma,
epidemiological signs and therapeutic results in patients with vulvar
malignancies during the stated time period. DESIGN: Retrospective
clinical study. SETTING: Department of Obstetrics and Gynaecology, First
Faculty of Medicine, Charles University and General Faculty Hospital,
Prague. METHOD: An analysis of the available clinical documentation of
the patients of the oncological outpatient service of the Department of
Obstetrics and Gynaecology. RESULTS: Vulvar carcinoma represents 4% of
all malignant tumours of female genital tract. It concerns predominantly
elder women (the average age is 74.2 years). The overall 5-year
survival, with no regard to the stage of the disease, is 39.1% in our
group. This low figure is due to the high age of the group and to the
inappropriate therapeutic approach owed to the internal comorbidity,
advanced age and the fact that the majority of cases are diagnosed in
advanced stage. CONCLUSION: In spite of good access, the introduction of
screening program is unlikely due to the age distribution, biological
behaviour and difficulties in diagnostic of premalignant lesions. With
regard to the increasing incidence of in situ carcinoma whose
ethiopathogenesis is affected by HPV infection, it is necessary to pay
more attention to vulva lesions in terms of an early histopathological
verification. The treatment of the external genital tract malignancies
should be concentrated to the centers with the greatest experience of
their management.
8
UI - 11992394
AU - Yeh AM; Marcus RB Jr; Amdur RJ; Morgan LS; Million RR
TI -
Patterns of failure in squamous cell carcinoma of the vagina treated
with definitive radiotherapy alone: what is the appropriate treatment
volume?
SO - Int J Cancer 2001;96 Suppl():109-16
AD - Department of Radiation Oncology, University of Florida College of
Medicine, Gainesville, Florida 32610, USA.
The purpose of this study was to review treatment results, sites of
failure, and complications in relation to the irradiation volume for
carcinoma of the vagina treated with radiotherapy alone. A retrospective
review of 65 patients with histologically confirmed squamous cell
carcinoma of the vagina who received definitive radiotherapy was
undertaken. The 5-year cause-specific survival rates were as follows:
Stage I, 91%; Stage IIA (paravaginal extension), 90%; Stage IIB, 55%;
Stage III, 89%; and Stage IVA, 62%. The pelvic disease control rates at
5 years were as follows: Stage I, 74%; Stage IIA, 90%; Stage IIB, 79%;
Stage III, 89%; and Stage IVA, 67%. Recurrence in the pelvis occurred in
22% of patients. Eighty-five percent of pelvis recurrences were in the
primary treatment field. Although pelvic control rates were not
increased by use of larger treatment fields (>2,700 cm(3)), moderate
acute and late effects were increased with these fields. Carcinoma of
the vagina appears to have a different failure pattern than carcinoma of
the cervix. The primary failure sites are the vagina and the paracolpal
tissues and the inguinal nodes. Because of this, the superior edge of
the pelvic fields does not have to extend above the bottom of the
sacroiliac joints except with advanced lesions. Copyright 2002
Wiley-Liss, Inc.
9
UI - 11992544
AU - Rosenthal AN; Ryan A; Hopster D; Jacobs IJ
TI -
Molecular evidence of a common clonal origin and subsequent divergent
clonal evolution in vulval intraepithelial neoplasia, vulval squamous
cell carcinoma and lymph node metastases.
SO - Int J Cancer 2002 Jun 1;99(4):549-54
AD - Gynaecological Oncology Unit, St. Bartholomew's and Royal London
Hospitals Medical College, Queen Mary and Westfield College,
Charterhouse Square, London EC1M 6GM, UK.
VIN is thought to be the precursor of some VSCCs because it is
monoclonal, frequently occurs contiguously with VSCC and shares similar
risk factors with a subgroup of VSCC. There has been no conclusive
molecular evidence supporting this assumption. We performed X-chromosome
inactivation analysis on 9 cases of lone VIN, 10 cases of VSCC and
associated contiguous VIN and 11 cases of VSCC and associated
noncontiguous VIN. Eight of the 9 cases of lone VIN appeared to be
monoclonal. All 7 informative and monoclonal cases of VIN with
contiguous VSCC and 6/9 informative cases of VIN with noncontiguous VSCC
showed patterns of X-chromosome inactivation consistent with a common
monoclonal origin for both VIN and VSCC. Two of the 9 cases of VIN with
noncontiguous VSCC showed X-chromosome inactivation patterns consistent
with a separate clonal origin. We performed LOH analysis at 6
chromosomal loci on these samples and 7 cases with lymph node
metastases. Identical losses occurred 7 times in VIN and contiguous VSCC
(random probability 1.2 x 10(-9)), twice in VIN and noncontiguous VSCC
(random probability 1.5 x 10(-3)) and 3 times in VSCC and associated
metastases (random probability 1.8 x 10(-5)). Some losses occurring in
VSCC did not appear in the contiguous VIN or associated metastases and
vice versa. These data provide molecular evidence that VIN is the
precursor of VIN-associated VSCC, that multifocal disease may arise via
either different clones or a single clone and that continued divergent
clonal evolution may occur in vulval neoplasia. Copyright 2002
Wiley-Liss, Inc.
10
UI - 11136571
AU - Fehr MK; Hornung R; Schwarz VA; Simeon R; Haller U; Wyss P
TI -
Photodynamic therapy of vulvar intraepithelial neoplasia III using
topically applied 5-aminolevulinic acid.
SO - Gynecol Oncol 2001 Jan;80(1):62-6
AD - Department of Obstetrics and Gynecology, Division of Gynecology,
University Hospital, Frauenklinikstrasse 10, Zurich, CH-8091,
Switzerland. Mathias.Fehr@fhk.usz.ch
OBJECTIVES: The aim of this study was twofold: first, to determine the
feasibility of photodynamic therapy (PDT) of vulvar intraepithelial
neoplasia III (VIN III) using topically applied 5-aminolevulinic acid
(ALA) for photosensitization, and second, to compare PDT results with
those of laser evaporation and local excision. METHODS: Fifteen patients
with VIN III had 10 g of 10% ALA gel applied to the entire vulva. Two to
three hours after drug application the vulva was irradiated with 120
J/cm(2) laser light at a wavelength of 635 nm. The procedure was
performed without anesthesia in most patients. Thirty patients with VIN
III treated by laser evaporation and 27 patients treated by surgical
excision served as controls. RESULTS: Eight weeks following PDT, 11 of
15 patients were free of VIN III as determined by biopsy. Excellent
tissue preservation was achieved and no ulcers or scarring occurred.
Three recurrences were seen during follow-up, at 5, 6, and 7 months
after PDT. Twelve months after treatment, analysis of disease-free
survival revealed no statistically significant difference between
patients treated with PDT and patients treated with conventional
treatment modalities (P = 0.67) but the power of this analysis is low.
In multivariate analysis, multifocal disease was the sole variable
associated with a reduced disease-free survival. CONCLUSION: While PDT
of VIN III seems to show efficacy similar to that of conventional
treatment modalities it offers unique advantages: healing time is short,
preservation of normal vulvar appearance is excellent, and PDT may be
performed without anesthesia. Hence, PDT of VIN III deserves further
investigation. Copyright 2001 Academic Press.
11
UI - 12027824
AU - Llaneza P; Fresno F; Ferrer J
TI -
Schwannoma of the clitoris.
SO - Acta Obstet Gynecol Scand 2002 May;81(5):471-2
AD - Department of Obstetrics and Gynaecology, Asturias Central University
Hospital, Oviedo, Spain. pllanezac@sego.es
Schwannoma is a tumor of the peripheral nerve sheath, which rarely
affects the female genitalia. These tumors are often associated with von
Recklinghuasen neurofibromatosis; however, they have also been reported
in patients without that disease, and its most common location is the
posterior mediastinum, the retroperitoneum, the head and neck, and the
extremities. Simple surgical excision and follow up is the most
convenient treatment (1).
12
UI - 11820562
AU - Michalski B; Mazurek U; Olejek A; Graniczka M; Loch T; Poreba R; Wilczok
TI -
T
Quantitative RT-PCR assay for mRNA of VEGF and histone H4 in the
determination of proliferative and angiogenic activity in vulvar
pathology.
SO - Folia Histochem Cytobiol 2001;39 Suppl 2():108-9
AD - Department of Obstetrics and Gynecology, Medical University of Silesia,
Tychy, Poland. bogdan.michalski@proloc.com.pl
Proliferative and angiogenic activity of tissue specimens taken from
women with various vulvar pathologies were evaluated by determining the
number of mRNA VEGF molecules and H4 histone mRNA molecules, by means of
the QRT-PCR (TaqMan) technique. Following a cluster analysis the
results, where normalised. Euclidean distances were used, all the cases
were classified into three groups of pathologies. Group I included low
degree vulvar pathologies, group II included high degree vulvar
pathologies and group III included vulvar pathologies with high
proliferative and angiogenic activity. Significant differences were
found in the proliferative and angiogenic activity between groups I and
III, and between groups II and III, while no statistically significant
differences were found between groups I and II.
13
UI - 11975685
AU - Carvalho JP; Dias ML; Carvalho FM; Del Pilar Estevez Diz M; Petito JW
TI -
Squamous cell vulvar carcinoma associated with Fanconi's anemia: a case
report.
SO - Int J Gynecol Cancer 2002 Mar-Apr;12(2):220-2
AD - Departments of Gynecology and Pathology, Clinical Oncology Service and
Radiotherapy Service, University of Sao Paulo School of Medicine, Sao
Paulo, Brazil.
Fanconi's anemia (FA) is a rare autosomal recessive syndrome associated
with a strong predisposition to cancer, particularly squamous cell
carcinoma (SCC) of various organs. A few cases of lower genital tract
neoplasia have been described. We present a 14-year-old black girl with
an advanced squamous cell vulvar carcinoma treated with cisplatin
chemotherapy plus radiation therapy. The patient died because of fungal
sepsis. Polymerase chain reaction (PCR) was positive to human
papillomavirus (HPV)-16. Vulvar carcinoma is a very rare condition in
teenagers, but the association of Fanconi's anemia and SCC of many sites
is common. Vulvar carcinoma when associated with Fanconi's anemia is a
great treatment challenge.
14
UI - 11975687
AU - Nasu K; Fujisawa K; Takai N; Miyakawa I
TI -
Angiomyofibroblastoma of the vulva.
SO - Int J Gynecol Cancer 2002 Mar-Apr;12(2):228-31
AD - Department of Obstetrics and Gynecology, Oita Medical University,
Hasama-machi, Oita 879-5593, Japan. nasu@oita-med.ac.jp
A case of angiomyofibroblastoma of the vulva in a 53-year-old woman was
examined by means of immunohistochemistry. Histological examination of
the tumor revealed typical characteristics of vulval
angiomyofibroblastoma. Immunohistochemistry of the tumor cells revealed
diffuse immunoreactivity for estrogen receptors, progesterone receptors,
vimentin, and CD34. The stains for cytokeratin, epithelial membrane
antigen, desmin, smooth muscle alpha-actin, muscle-specific actin, and
S-100 were negative. These results were mostly consistent with those of
previous reports and suggest that the tumors cells were derived from
primitive mesenchymal cells which occur normally in this lesion and
which show the potential for diverse lines of myoid differentiation.
15
UI - 12040657
AU - Watanabe Y; Ueda H; Nozaki K; Kyoda A; Nakajima H; Hoshiai H; Noda K
TI -
Advanced primary clear cell carcinoma of the vagina not associated with
diethylstilbestrol.
SO - Acta Cytol 2002 May-Jun;46(3):577-81
AD - Department of Obstetrics and Gynecology, Kinki University School of
Medicine, 377-2 Ohno-Higashi, Osakasayama, Osaka 589-8511, Japan.
watanabe@med.kindai.ac.jp
BACKGROUND: Primary vaginal clear cell carcinoma occurs in young women
exposed to diethylstilbestrol (DES) in utero. Primary vaginal clear cell
carcinoma not associated with DES is very rare. We report the
clinicopathologic and cytopathologic features of a patient with
advanced, sporadic primary vaginal clear cell carcinoma with metastases
to liver, lung and paraaortic lymph nodes. CASE: A postmenopausal,
63-year-old woman presented to our department with genital bleeding. A
hemorrhagic tumor found in the vagina was diagnosed as a clear cell
carcinoma by cytopathologic examination of the tumor smear and by
histopathologic examination of a biopsy specimen. A chest radiograph
revealed multiple lung metastases, and metastases to the liver and
paraaortic lymph nodes were noted on computed tomography and magnetic
resonance imaging. The tumor was diagnosed as primary clear cell
carcinoma of the vagina, stage IVb (FIGO) based on a normal
cytopathologic examination of the cervix, endometrium and ascites;
normal appearance of the uterus, ovaries and kidneys on magnetic
resonance imaging; and absence of detectable tumor in the urinary tract.
The patient died of respiratory failure 31 days after hospitalization.
The tumor demonstrated overexpression of p53 protein and did not show
microsatellite instability. CONCLUSION: This patient was the second
reported Japanese woman with advanced primary vaginal clear cell
carcinoma not associated with DES.
16
UI - 12014662
AU - Ellis PE; Wong Te Fong LF; Rolfe KJ; Crow JC; Reid WM; Davidson T;
TI -
MacLean AB; Perret CW
The role of vascular endothelial growth factor-A (VEGF-A) and
platelet-derived endothelial cell growth factor/thymidine phosphorylase
(PD-ECGF/TP) in Paget's disease of the vulva and breast.
SO - Anticancer Res 2002 Mar-Apr;22(2A):857-61
AD - Department of Obstetrics and Gynaecology, Royal Free & University
College Medical School, London, UK.
BACKGROUND: Paget's disease of the vulva and the breast are uncommon
conditions. The pathogenesis underlying these diseases is still unclear.
Vascular endothelial growth factor-A (VEGF-A), a potent angiogenic
factor, has been demonstrated in a variety of tumour cell types and is
thought to be involved in tumour expansion. Platelet-derived endothelial
cell growth factor/thymidine phosphorylase (PD-ECGF/TP) has also been
shown to stimulate angiogenesis. MATERIALS AND METHODS: Fifty-four cases
of Paget's disease of the vulva, including 10 with an associated
invasive adenocarcinoma, and 38 cases of Paget's disease of the breast,
including 26 with available associated ductal carcinoma in situ (DCIS)
and/or invasive carcinoma of the breast, were evaluated
immunohistochemically for the expression of VEGF-A and PD-ECGF/TP.
RESULTS: VEGF-A was not expressed in Paget's disease of the vulva or
breast. PD-ECGF/TP was expressed in 22 out of 54 (41%) cases of Paget's
disease of the vulva. Four of the cases associated with invasive disease
(40%) expressed PD-ECGF/TP. Twenty-one out of 38 (55%) cases of Paget's
disease of the breast were positive for PD-ECGF/TP. CONCLUSION: Our data
suggest that PD-ECGF/TP may have a role to play in the pathogenesis of
Paget's disease of the vulva and the breast. The role of VEGF-A in
Paget's disease of the vulva and the breast remains to be fully
elucidated.
17
UI - 12057075
AU - Grigsby PW
TI -
Vaginal cancer.
SO - Curr Treat Options Oncol 2002 Apr;3(2):125-30
AD - Department of Radiation Oncology, Mallinckrodt Institute of Radiology,
Washington University Medical Center, 4939 Children's Place, Suite 5500,
Box 8224, St. Louis, MO 63110, USA. grigsbyp@netscape.net
Carcinoma of the vagina is an uncommon gynecologic cancer in the United
States and throughout the world. Carcinoma in situ of the vagina and
very early stage invasive carcinoma of the vagina may be treated with
surgery. However, the standard therapeutic intervention for patients
with carcinoma of the vagina is radiation therapy. In early stage
vaginal carcinoma, radiation therapy is chosen for definitive treatment
to preserve the anatomy and function of the vagina. In more advanced
stages of vaginal carcinoma, radiation therapy is chosen as the standard
treatment to avoid exenterative surgery, preserve anatomy and function,
and to treat known or presumed lymph node metastasis. No randomized
studies comparing irradiation alone versus irradiation and chemotherapy
have been performed for patients with advanced carcinoma of the vagina.
The standard therapy for patients with advanced cervical carcinoma is
irradiation and concurrent cisplatin-based chemotherapy. Because the
etiology and epidemiology of vaginal carcinoma appears identical to
those of patients with invasive cervical carcinoma, patients with
advanced vaginal carcinoma should be treated with irradiation and
concurrent cisplatin-based chemotherapy.
18
UI - 12057077
AU - Salom EM; Penalver M
TI -
Recurrent vulvar cancer.
SO - Curr Treat Options Oncol 2002 Apr;3(2):143-53
AD - University of Miami, Jackson Memorial Hospital, Division of Gynecologic
Oncology, 1611 NW 12 Avenue, East Tower, Room 3003, Miami, FL 33136,
USA.
Recurrent vulvar cancer occurs in an average of 24% of cases after
primary treatment after surgery with or without radiation. The
relatively few primary vulvar cancers, combined with the low proportion
of recurrences, has made it difficult to perform randomized studies to
document the most appropriate therapeutic modalities. Most reports are
small retrospective studies and anecdotal reviews that have emphasized
the importance of surgery and have led to new approaches with respect to
chemoradiation. Traditionally, the most accepted treatment of vulvar
cancer has been and continues to be surgery. Recently, radiation and
chemotherapy have been combined with very encouraging results. The
therapeutic modality used depends on the location and extent of the
recurrence. Most recurrences occur locally near the original resection
margins or at the ipsilateral inguinal or pelvic lymph nodes.
Lateralized local vulvar recurrences treated with a wide radical local
excision with inguinal lymphadectomy results in an excellent cure rate
of 70%. With a central pelvic recurrence with antecedent radiotherapy
involving the urethra, upper vagina, and rectum, total pelvic
exenteration is indicated in a select group of patients with curative
intent. Radiotherapy or chemoradiation concomitantly with wide radical
local excision of an advanced vulvar has proven successful in avoiding
an exenteration, with improved survival and less morbidity. Prospective
and retrospective studies have shown excellent results using radiation
or chemoradiation with wide radical local excision in patients with
locally advanced disease in whom adequate resection margins are
difficult to achieve (with a central lesion requiring exenteration) or
with debilitating medical conditions that preclude surgery. In these
patients, chemoradiation has shown favorable results when used before a
wide local resection. In patients with advanced local disease, external
beam and interstitial radiation has been used for palliative and
curative intent with encouraging results. Regional recurrences to the
inguinal and pelvic lymph nodes have been shown to have a poor prognosis
with a high mortality rate. We recommend that inguinal recurrences
without prior radiation therapy undergo excision followed by
radiotherapy with chemosensitization. In patients with previous
radiation to the inguinal lymph nodes, we try to avoid any excisional
procedures because of the high rate of complications. We offer these
patients brachytherapy for palliation. With pelvic recurrences, we
recommended chemoradiation as the treatment modality. In the subset of
patients with distant metastasis, chemotherapy may be offered; however,
few studies have been performed to advocate any single combination. The
literature supports the use of 5-fluorouracil or cisplatin as single
agents or in combination to have sensitivity against squamous cells.
There are few studies revealing improvement in 5-year survival, thus
these patients may benefit from recruitment into research protocols.
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