Innovations in the Management of Vaginal Cancer

Abstract

Primary vaginal cancer is a rare gynecologic malignancy. Given the rarity of the disease, standardized approaches to management are limited, and a great variety of therapeutic conditions are endorsed. This paper reviews advances in surgical approaches, radiation, chemoradiation, and immunotherapy. Advances in surgical management including the increasing use of laparoscopic and endoscopic approaches, as well as the novel techniques in vaginal reconstruction, are reviewed. Concurrent chemoradiation remains a mainstay of treatment for vaginal cancer and has improved local control of disease and overall survival. Additionally, with metastatic disease or situations where toxicity from CCRT is unacceptable, systemic therapies including immunotherapy approaches are reviewed.

Keywords: brachytherapy; concurrent chemoradiation; external beam radiation; human papilloma virus; immunotherapy; surgery; vaginal cancers; vaginal carcinoma; vaginal tumors.

Figure 1

Specific pathway of the lymphatic drainage of vaginal tumors: the upper two-thirds of the vagina drain primarily to pelvic nodes; and the lower one-third drains into the inguinal nodes.