Lilic V, Lilic G, Filipovic S, Visnjic M, Zivadinovic R
Clinic of Gynecology and Obstetrics, Clinical Centre Nis, Nis, Serbia.
J BUON. 2010 Apr-Jun;15(2):241-7.
In this paper we reviewed the risk factors for primary carcinoma of the vagina (PCV), diagnostic and therapeutic modalities, and principles leading to rational decision-making in the individualized management of vaginal carcinoma patients. The review was based on the recent literature and our own years- long experience with the disease. PCV is a rare gynecologic malignancy accounting for about 2% of all neoplasms of the female genitals. Most of the affected women are over 60 years of age, peaking between 70 and 80 years. Only 10-15% of patients are below 50 years. Histopathologically, most common are squamous cell carcinoma (80-90%) and adenocarcinoma (4-10%). The leading risk factor for vaginal intraepithelial neoplasia (VAIN) and subsequent squamous cell vaginal carcinoma is long-lasting infection with human papillomavirus (HPV) type 16. Prognosis of the disease depends on several factors, the most important of which are age, histologic type, and tumor stage. Survival depends on the disease stage. Five -year survival rates are about 95% for stage 0, 75% for stage I, 60% for stage II, 35% for stage III, 20% for stage IVa, and 0% for IVb stage. Due to its being a rare entity, there are still controversies as to the most optimal treatment. Individualized treatment approaches have been increasingly used. In most centres, standard treatment for this cancer is radiotherapy. Some reports have shown that surgery might also be an option, while in some centres radiation is supplemented by cisplatin-based chemotherapy. The supposed advantage of radiotherapy is the preservation of the anatomy and function of the vagina. We believe that there are certain psychologic benefits with the preservation of the vagina, regardless of its function. However, preservation of the vaginal function after treatment of invasive vaginal cancer is a rare phenomenon, both in the literature and from our own experience.
在本文中，我们回顾了阴道原发性癌（PCV）的危险因素、诊断和治疗方式，以及在阴道癌患者个体化管理中进行合理决策的原则。该综述基于近期文献以及我们多年来对该疾病的经验。PCV是一种罕见的妇科恶性肿瘤，约占女性生殖器所有肿瘤的2%。大多数受影响的女性年龄超过60岁，发病高峰在70至80岁之间。只有10 - 15%的患者年龄低于50岁。组织病理学上，最常见的是鳞状细胞癌（80 - 90%）和腺癌（4 - 10%）。阴道上皮内瘤变（VAIN）及随后的鳞状细胞阴道癌的主要危险因素是长期感染16型人乳头瘤病毒（HPV）。该疾病的预后取决于几个因素，其中最重要的是年龄、组织学类型和肿瘤分期。生存率取决于疾病分期。0期的五年生存率约为95%，I期为75%，II期为60%，III期为35%，IVa期为20%，IVb期为0%。由于其罕见性，关于最优化治疗仍存在争议。个体化治疗方法已越来越多地被采用。在大多数中心，这种癌症的标准治疗是放疗。一些报告表明手术也可能是一种选择，而在一些中心，放疗辅以基于顺铂的化疗。放疗的假定优势在于保留阴道的解剖结构和功能。我们认为，无论阴道功能如何，保留阴道都有一定的心理益处。然而，无论是在文献中还是根据我们自己的经验，侵袭性阴道癌治疗后保留阴道功能都是罕见的现象。
