Invasive squamous cell carcinoma of the vagina during pregnancy

A Comprehensive Discussion in Vaginal Cancer Based on Mechanisms, Treatments, Risk Factors and Prevention

Vaginal cancer is a rare and uncommon disease that is rarely discussed. Although vaginal cancer traditionally occurs in older postmenopausal women, the incidence of high-risk human papillomavirus (HPV)-induced cancers is increasing in younger women. Cervical cancer cells contain high-risk human papillomavirus (HPV) E6 and E7 proteins and inhibiting HPV gene expression leads the cells to stop proliferating and enter senescence. As E6, and E7 protein promoted the carcinogenesis mechanism, and here not only regulate the cellular degradation of P53, and pRb but also enhances the cell proliferation along with E6 protein targets the p53 for breakdown and subsequently promote the apoptotic cell death, and DNA repair inhibition, that is indispensable to the continue the lifecycle of the HPV. As a synchronous or metachronous tumor, vaginal cancer is frequently found in combination with cervical cancer. It is uncertain what causes invasive female vaginal organ cancer. HPV type 16 is the most often isolated HPV type in female vaginal organ cancers. Due to cancer’s rarity, case studies have provided the majority of etiologic findings. Many findings demonstrate that ring pessaries, chronic vaginitis, sexual behavior, birth trauma, obesity, vaginal chemical exposure, and viruses are all risk factors. Because of insufficient understanding and disease findings, we are trying to find the disease’s mechanism with the available data. We also address different risk factors, therapy at various stages, diagnosis, and management of vaginal cancer in this review.

Cancer in pregnancy. Part I: basic diagnostic and therapeutic principles and treatment of gynecological malignancies

PURPOSE

Cancer in pregnancy is a rare circumstance. However, the coincidence of pregnancy and malignancy is supposed to increase due to a general tendency of postponing childbearing to older age. To date, clinical guidelines are scarce and experience regarding therapeutic management is limited to case reports.

METHODS

This review focuses on general diagnostic and therapeutic principles including systemic therapy for malignancies in pregnancy.

RESULTS

In part I, we report on diagnosis and therapy of gynecological tumors.

CONCLUSION

The diagnosis of gestational cancer faces both oncologist and obstetrician to the dilemma of applying appropriate diagnostic techniques and adequate local and systemic therapy to an expectant mother without harming the fetus.

Stage I squamous cell carcinoma of vagina complicating pregnancy: Successful conservative treatment

BACKGROUND

Vaginal squamous cell carcinoma in pregnancy is very rare situation.

CASE

The patient was a 33-year-old woman, presenting with a complaint of vaginal brownish discharge at a 23 weeks of gestation. On pelvic examination at that time, a 2 by 2 cm mass on posterior vaginal fornix was seen. Biopsy of the lesion demonstrated a nonkeratinizing type invasive squamous cell carcinoma. She desired to continue the pregnancy and postpone the treatment until after delivery. On 23 weeks of gestation, we performed wide local excision, confirming T1 stage. On 33 weeks of gestation, a pelvic lymphadenectomy was carried out at the time of cesarean section to secure lymph node status pathologically. Further, she began intracavitary brachytherapy via vaginal cylinder in an adjuvant setting. She is 36 months from her initial surgery and remains disease free.

CONCLUSION

Treatment could be individualized for primary stage I vaginal squamous cell carcinoma complicating pregnancy.