Vaginal squamous epithelial cancer

　　Firstly, Etiology

　　The etiology of squamous cell carcinoma of the vaginal epithelium is still unclear. Epidemiological research suggests that it is related to the following factors.

　　1. Chronic irritation:Primary vaginal squamous cell carcinoma often occurs in the posterior fornix, which is believed to be related to the long-term use of pessaries in patients with uterine prolapse. The long-term stimulation by pessaries may lead to vaginal cancer. However, due to the few cases of pessary use and the low incidence of vaginal cancer, it is rarely listed as a pathogenic factor.

　　2. Pelvic radiotherapy:About 20% of patients with primary vaginal cancer have a history of pelvic radiotherapy. Large-scale data show that after radiotherapy for cervical cancer, 0.180% to 1.545% develop primary vaginal cancer. It is generally believed that vaginal dysplasia or vaginal cancer may occur 10 to 40 years after radiotherapy for cervical cancer. The incidence of vaginal cancer is higher in women under 40 years of age who have received pelvic radiotherapy.

　　3. Viral infection:Since human papillomavirus (HPV) may play an important role in the etiology of cervical cancer, and 1% to 3% of cervical cancer patients may develop vaginal cancer simultaneously or later, papillomavirus, especially types 16 and 18, may be considered as the initiating factor for these cancers.

　　4. Immunosuppression:Patients with congenital or acquired immunosuppression and artificial immunosuppression have a higher incidence of cancer. Vaginal cancer is no exception, and its incidence is higher in immunosuppressed patients.

　　5. Estrogen deficiency:Vaginal squamous cell carcinoma often occurs in elderly women, which may be related to low estrogen levels after menopause, leading to atrophy of the vaginal mucosal epithelium, creating favorable conditions for carcinogens.

　　Secondly, Pathogenesis

　　1. Primary vaginal squamous cell carcinoma can be divided into: in situ carcinoma, early invasive carcinoma, and invasive carcinoma according to the development of the lesion.

　　(1) In situ carcinoma: When the atypical hyperplasia of vaginal intraepithelial tumors develops severely, involving the entire epithelium, but not penetrating the basal membrane, it is called in situ carcinoma. The symptoms and signs are the same as those of intraepithelial tumors.

　　(2) Minimal invasive vaginal squamous cell carcinoma: Since minimal invasive vaginal squamous cell carcinoma is rare in clinical practice, most cases are found during the study of intraepithelial tumors, hence the research on this type of cancer is relatively superficial. Nevertheless, it is generally believed that minimal invasive vaginal squamous cell carcinoma should be the carcinoma of the epithelial layer breaking through the basal membrane at the bottom, and then infiltrating the stroma below, with an infiltration depth less than 3mm, and without invasion of blood vessels and lymphatic vessels in the stroma. The macroscopic appearance of the lesion is the same as that of intraepithelial tumors.

　　(3) Invasive squamous cell carcinoma of the vagina:

　　①Macroscopy: Most tumors form exophytic masses, half of the tumors form ulcers, followed by papillary, cauliflower-like lesions, which are mostly located on the upper third of the posterior vaginal wall. The tumor often penetrates the vaginal wall, infiltrating parauterine tissue, rectum, and bladder. In surgical cases, 12% of the lymph nodes were invaded.

　　②Under the microscope: Vaginal squamous cell carcinoma is similar to squamous cell tumors in other parts, usually these tumors contain polymorphic squamous cells with tissue disorganization and lack of intracellular cohesion, deeply stained nuclei, and atypical mitosis. They appear as keratinocytes with squamous cell nodules and intercellular bridges.

　　2、在宫颈肿瘤治疗5年后发生阴道癌有3个可能的机制

　　（1）宫颈肿瘤治疗后在阴道上皮有残余病灶。

　　（2）由于HPV感染使下生殖道易于发生癌变。

　　（3）放射治疗使下生殖道易于发生癌变。

　　3、转移方式：阴道黏膜的淋巴管和血管均极为丰富，黏膜下结缔组织疏松，此结构导致阴道癌的转移方式主要是淋巴转移和直接浸润邻近器官和组织。

　　（1）淋巴转移：依解剖部位，阴道上1/3的淋巴引流入盆腔淋巴结，下1/3引流入腹股沟淋巴结，中1/3则即可引流入盆腔淋巴结，又可引流入腹股沟淋巴结。因此，随阴道癌灶的位置不同，其淋巴转移有所不同。由于位于阴道各种部位的阴道癌都可能发生淋巴结转移，因此，要强调对大多数病人进行区域性治疗的重要性。

　　（2）直接浸润：阴道前壁癌灶可累及尿道和膀胱；后壁病灶可累及直肠或直肠旁组织；侧壁病灶常向阴道旁浸润，上1/3和下1/3病灶可分别累及宫颈和外阴。

　　（3）血行转移：常发生于晚期病例。经血液远处转移，如转移到肺、肝脏及骨骼等器官。血源性转移通常发生较晚，最常见经血液转移的组织是肺。

　　晚期并发膀胱及肠瘘、放射性囊肿及直肠炎、膀胱炎、尿道狭窄、直肠狭窄或溃疡、放射性阴道坏死、溃疡或狭窄、阴道纤维化等。

　　治疗并发症：不管采用手术还是放射治疗，主要的并发症发生率是10％～15％。由于阴道癌与尿道、膀胱和直肠较近，其并发症较宫颈癌发生率高。主要的并发症是膀胱及肠瘘、放射性囊肿及直肠炎、膀胱炎、尿道狭窄、直肠狭窄或溃疡、放射性阴道坏死、溃疡或狭窄、阴道纤维化。治疗后应行扩张器扩张阴道和鼓励病人恢复规律的性生活并阴道局部给予雌激素使阴道保持良好的功能。

　　1、症状

　　有10％～20％的阴道上皮内肿瘤或早期浸润癌可无明显的症状，或仅有阴道分泌物增多和接触性出血和不规则出血或可及包块，这种包块可以表现为向外生长或形成溃疡，呈浸润性生长，随着病程的发展，阴道癌灶的增大，坏死，可出现阴道排恶臭液，无痛性阴道出血，当肿瘤向周围器官和组织扩展时，可出现相应的症状，累及尿道或膀胱可出现尿频，尿急，血尿和排尿困难；累及直肠可出现排便困难或里急后重；阴道旁，主韧带，宫骶韧带受侵犯时，可出现腰骶部的疼痛等。

　　2. Signs

　　Vaginal squamous epithelial cancer commonly occurs in the posterior wall of the upper one-third and the anterior wall of the lower one-third of the vagina. The lesions of vaginal intraepithelial tumors or early invasive cancers can be merely erosive. Generally, invasive cancer lesions are exophytic, with papillary or cauliflower types being common, and can also appear in the form of ulcerative, flat submucosal, or para-vaginal invasive types. Early vaginal lesions are relatively localized, and late lesions can appear in the entire vagina, para-vaginal, cardinal ligament, and sacro-cervical ligament invasion, vaginal or urethral fistula or rectovaginal fistula, as well as metastasis to inguinal, pelvic, supraclavicular lymph nodes, and even distant metastasis.

　　3. Clinical staging

　　The staging of vaginal cancer uses the FIGO staging system. This clinical staging system is based on clinical physical examination, chest X-ray, cystoscopy, rectoscopy, and skeletal radiography, lymphangiography, CT, MRI, or surgical staging data, which does not change the clinical staging. The AJCC recommends a TNM staging system, which is rarely used. The FIGO staging of vaginal cancer is as follows:

　　Stage 0:In situ cancer, intraepithelial cancer.

　　Stage I:Cancer is limited to the vaginal wall.

　　Stage II:Cancer has invaded the lower vaginal tissue but has not reached the pelvic wall.

　　Stage III:Cancer has reached the pelvic wall.

　　Stage IV:Cancer has exceeded the true pelvis or has clinically involved the bladder, rectal mucosa, but bubbling edema should not be considered stage IV.

　　Stage IVa:Tumor invasion of adjacent organs or direct extension out of the true pelvis.

　　Stage IVb:Tumor spread to distant organs.

　　Prognosis

　　The prognosis of vaginal squamous epithelial cancer is poor, as there are few clinical cases, and no effective treatment method has been developed so far. According to the current available information, the prognosis is related to the following factors:

　　1. Clinical staging:The overall 5-year cure rate of vaginal squamous epithelial cancer is 36.8% to 62.3%. The cure rates for each stage are shown in Table 1.

　　2. Tumor tissue cell differentiation degree:The tissue cells of vaginal squamous epithelial cancer have poor differentiation, usually with more than 75% being grade III to IV, indicating a high degree of malignancy.

　　3. Lesion location:The vaginal cancer lesion located in the upper one-third of the vagina has a better prognosis, while the lesion located in the middle and lower two-thirds has a poor prognosis. The reason is that the lymphatic drainage of the upper and lower segments of the vagina is different. The lymphatic drainage of the upper segment goes to the pelvic lymph nodes, making treatment more successful, whereas the middle and lower segments can drain to the inguinal and pelvic lymph node areas, making treatment more difficult. At the same time, the interval tissue between the middle and lower segment vaginal cancer and the bladder, rectum is extremely thin, making it easy to involve these organs, leading to a poor prognosis.

　　4, Treatment method:The treatment for vaginal cancer should be individualized to achieve satisfactory efficacy. When vaginal cancer is treated with radiotherapy, the dose of radiotherapy should be sufficient. For advanced lesions, interstitial implantation radiotherapy should be used to increase the dose of radiotherapy to the lesion. For cases of vaginal squamous cell carcinoma, the main reason for the unsatisfactory effect of radiotherapy is insufficient dose of radiotherapy. For advanced cases, comprehensive therapy should be adopted - including radiotherapy, surgery, and pelvic artery infusion of anticancer drugs, which is expected to improve the efficacy.

　　5, Recurrence:If the lesion is not metastatic, the treatment for recurrent lesions after radiotherapy is pelvic exenteration. If the recurrent lesion is located on the anterior or posterior wall of the vagina, excision of the anterior or posterior wall should be performed. For patients who have previously undergone hysterectomy, recurrent lesions located at the top of the vagina should be treated with total exenteration, as the bladder and rectum are closely attached to the upper part of the vagina.

　　1, Diagnostic curettage:Understand the presence of cancer foci in the cervical canal and endometrium.

　　2, Tissue biopsy and vaginal cytology examination:All suspicious tissues on the vaginal wall need to be biopsied for定性, for patients with no obvious lesions, vaginal cytology examination can be performed, with a positive rate ranging from 10% to 42%.

　　3, Serum immunological examination:Perform CEA, AT-4, and CA125 tests before surgery, which is beneficial for the evaluation of prognosis and follow-up monitoring after treatment.

　　4, Endoscopic examination:All patients with advanced stages of disease need to undergo urethro-vesical cystoscopy and recto-sigmoidoscopy to exclude the invasion of cancer into these organs.

　　5, Imaging examination:Those who have the condition should undergo this examination before treatment, including ultrasound, CT, magnetic resonance imaging (MRI), intravenous pyelography, and chest X-ray examination.

　　Dietetic therapy for vaginal smooth muscle tumors

　　1, Astragalus and Poria cocos Porridge

　　Ingredients: 30 grams of raw Astragalus, 50 grams of Poria cocos, and 20 grams of glutinous rice.

　　Preparation: First, decoct raw Astragalus and Poria cocos in water, then add the cleaned glutinous rice and cook into porridge. It has the effects of invigorating the body, promoting diuresis, and detoxifying, and is used for patients with malignant tumors of the vulva that do not heal.

　　2, Yam and Lotus Seed Soup

　　Ingredients: 50 grams of yam, 20 grams of lotus seeds, and red dates

　　Preparation: First, cook the lotus seeds until soft, then add red dates and yam powder, and simmer for 15 minutes. Take twice a day in the morning and evening, which has the effects of invigorating the body, nourishing the blood, strengthening the spleen, and eliminating dampness, as well as anti-cancer effects.

　　3, Chestnut Yellow Croaker

　　Ingredients: 2 yellow croaker fish, 10 chestnuts, scallions, ginger, garlic, cooking wine, soy sauce, salt, oil, and monosodium glutamate as needed.

　　Preparation method: Remove the shell from the chestnuts and wash them clean. Heat the oil in a frying pan, fry the fish on both sides until golden, then remove and set aside. Stir-fry scallions, ginger slices, and garlic slices, then add clear soup, chestnuts, salt, and soy sauce. Put the fish in the soup and bring to a boil, skim off the foam, cook until tender, and add monosodium glutamate before serving.

　　Effect: Strengthening the spleen and stomach, promoting blood circulation and reducing swelling. The yellow croaker has a neutral nature and sweet taste, promoting diuresis and reducing swelling, chestnuts are warm in nature and sweet in taste, nourishing the stomach and spleen, promoting blood circulation and stopping bleeding.

　　4. Braised winter melon

　　Ingredients: 300g of winter melon, 12ml of cooking oil, 15ml of soy sauce, 30g of cornstarch, 9g of salt, 6ml of lard, scallion threads, ginger juice, and garlic as needed.

　　Preparation method: Peel the winter melon, remove the seeds and flesh, cut it into pieces, and boil it in the pot for 5 minutes, then remove and drain it. Mix soy sauce, salt, scallion threads, garlic slices, ginger juice, and cornstarch with warm water to make a sauce. (3) Heat oil in the pot over high heat, stir-fry the seasonings evenly, add the winter melon, stir-fry evenly, and turn over with a little lard.

　　Effect: Clearing heat and promoting diuresis. Winter melon is slightly cool in nature and sweet and tasteless, combined with a little spicy ginger, scallions, and garlic, it has the effects of clearing heat and generating body fluid, detoxifying and promoting diuresis, lowering blood pressure, and lowering blood sugar.

　　5. Quick-fried cauliflower

　　Main ingredients: 150g of cauliflower, 15g of carrots, 15g of cucumber, 15ml of soybean oil, salt, monosodium glutamate, Sichuan pepper seeds, and sesame oil as needed.

　　Preparation method: Tear the cauliflower into small pieces, cut carrots into diamond-shaped slices, and blanch both in boiling water until just cooked, then cool them with cold water and drain them. Slice the cucumber and place it in the dish. Drizzle with fried Sichuan pepper oil, steam for a while, and then add a little salt, monosodium glutamate, and sesame oil, mix well.

　　Effect: Tonify the Qi and strengthen the spleen. Cauliflower is sweet and neutral in taste, tonifying the middle and Qi, cucumber is sweet and cold in nature, clearing heat and cooling the body, carrots are neutral in nature and sweet in taste, with the effect of strengthening the spleen and stomach, and supplementing Qi and blood.

　　6. Stir-fried chicken cubes with water chestnuts

　　Main ingredients: 1 young chicken, 10 fresh water chestnuts, 5g of mushrooms, and an appropriate amount of scallions, ginger, soy sauce, and other seasonings.

　　Preparation method: Kill the chicken, pluck the feathers, and cut the breast meat into cubes. Wash the fresh water chestnuts, peel them, and slice them. Clean the mushrooms and boil them in water until cooked, then remove them. Pour a little sesame oil into the pot, stir-fry the chicken cubes, add water chestnuts, mushrooms, and seasonings together, and cook until the meat is done.

　　Effect: Tonify the Qi and generate body fluid, nourish Yin and clear heat. Chicken is rich in nutrients and contains effective anticancer components. Water chestnuts are cool in nature and sweet in taste, clearing heat and thirst, nourishing Yin and preventing cancer. Mushrooms have a strong anticancer effect.

　　7. Steamed mandarin fish with Poria

　　Ingredients: 15g of Poria, 1 mandarin fish, and an appropriate amount of scallions and ginger.

　　Preparation method: Grind Poria into powder, then make several incisions on the cleaned mandarin fish, and cut ginger and scallions into threads for later use. Spread the Poria powder evenly on the mandarin fish and inside the fish belly, and cover the fish with ginger and scallion threads. Place the prepared mandarin fish in a pot and steam it over high heat for 10 minutes. After removing the fish from the pot, add some soy sauce to the juice that the fish has steamed out, add a little salt according to taste, mix well, and then pour it over the fish.

　　Effect: Poria has a spleen-strengthening effect, which can help patients quickly recover the digestive and absorptive function of the gastrointestinal tract, thereby aiding in comprehensive recovery. The mandarin fish has a neutral nature and benefits the spleen and stomach, when combined with Poria, it also reflects the principle of clear and nourishing in traditional Chinese medicine, which is not easy to cause internal heat.

　　I. Traditional Chinese Medicine Treatment

　　1. Empirical Syndrome:Generally in the early stage of the lesion, symptoms may include thirst, dry mouth, restlessness, poor appetite, reddish and whitish vaginal discharge, red tongue with thin white fur, wiry and rapid pulse. Treatment: Soothe the liver and harmonize the spleen, clear heat and drain dampness. Main prescription: Xiao Yao San combined with Aloe Pill, modified. Deficiency syndrome: In the late stage of the lesion, symptoms may include sallow complexion, emaciation, fatigue, dry mouth and restlessness, palpitations, piercing pain, malodorous discharge, frequent stools with heat. Treatment: Invigorate Qi and nourish blood, calm the mind and tranquilize the spirit, reduce swelling and relieve pain. Main prescription: Gui Pi Tang combined with Xiao Jin Dan, modified. Modifications: For excessive leukorrhea, add 15g of Haematite, 10g of Yu Yu Liang, 12g of Haliotis, 10g of Rubus suavissimus; for uncontrolled bleeding, add 10g of fried Aconitum, 10g of Polygonum cuspidatum, 30g of Herba epimedii, 10g of Coptis, 10g of Phellodendron, 12g of Sanguisorba; for lumbar and abdominal pain, dizziness and blurred vision, add 15g of prepared Rehmannia, 10g of Eucommia, 10g of Du Zhong, 10g of Cuscuta (decocted), 10g of Morinda; for constipation, add 12g of Semecarpus anacardium, 10g of Sesamum, 10g of Alisma orientale; for frequent and dripping urine, add 0.6g of Ammonium chloridum, 10g of Poria, 15g of Talcum, 6g of Herba epimedii, 10g of Equisetum hyemale.

　　2. Prescription

　　① Radix Isatidis 120g, Flos Lonicerae 9g, Fructus Forsythiae 9g, Radix Sophorae 9g. Take one dose per day, decocted twice and taken in two portions. Folk remedy

　　① Camphor Resin Powder: Camphor Resin 30g, Frankincense 10g. Grind into powder and mix with a small amount of sesame oil to form a paste, apply to the affected area once a day.

　　② Herba Hedyotidis 30g, Herba Prunellae 30g. Astragalus 30g, Rhizoma Anemarrhenae 15g, Buprestis 10g, Glycyrrhiza 10g. Decocted and taken twice a day.

　　II. Western medical treatment methods for vaginal squamous epithelial cancer

　　1. Stage I squamous cell carcinoma

　　(1) Chemotherapy (Radiotherapy): Stage I vaginal squamous cell carcinoma is usually treated with radiotherapy, and many scholars suggest that for small, superficial tumors, single-dose therapy may be sufficient. Perez et al. compared the survival of 22 patients with stage I vaginal cancer treated with single-dose therapy with that of 27 patients treated with external beam radiotherapy and single-dose therapy, and found the survival rates were similar. For tumors with a diameter less than 2cm and a thickness less than 0.5cm, intracavitary cylindrical tube therapy is used, with the total dose to the entire vaginal mucosa being 6000 to 7000cGy, and an additional 2000 to 3000cGy to the tumor. If the lesion thickness is greater than 0.5cm and located on one side of the vaginal wall, a single flat spacer implant can increase the dose to the deep tissue and limit the excessive radiation dose to the vaginal mucosa, with the radiation dose released to the vaginal mucosa being 6000 to 6500cGy, and the dose to the tumor tissue increased by 1500 to 2000cGy. For larger, thicker tumors, combined external beam radiotherapy and single-dose therapy should be used, starting with external beam radiotherapy to reduce the tumor volume, with the range of external beam radiotherapy including the primary tumor and regional lymph nodes, followed by single-dose therapy to deliver high-dose radiation to the tumor. When the tumor invades the lower third of the vagina, the range of radiation should be expanded to the inguinal lymph nodes on the side, with the initial total treatment dose to the entire pelvis being 1000 to 2000cGy, the total radiation dose to the parametrial tissue reaching 5000cGy, followed by single-dose therapy to increase the total dose to the tumor to 7000 to 7500cGy.

　　(2) Surgical treatment: For the treatment of stage I vaginal squamous cell carcinoma, according to the currently available limited data, the efficacy of surgical treatment is similar to that of radiotherapy. Davis et al. reported that the 5-year survival rate for 25 patients with stage I vaginal cancer who received only surgical treatment was 85%, while the 5-year survival rate for 14 patients who received only radiotherapy was 65%.

　　Surgical indications for stage I vaginal squamous cell carcinoma: For patients with lesions in the upper third of the vagina and with uterus, radical hysterectomy, pelvic lymph node dissection, and radical upper vaginal resection can be performed. For patients who have previously undergone hysterectomy, radical upper vaginal resection and pelvic lymph node dissection can be performed. Lesions at the upper end of the posterior vaginal wall are easily resectable due to the distance between the rectum and the posterior vaginal wall, while the entire anterior vaginal wall is close to the bladder, making surgery more difficult. If the surgical margin and lymph nodes are negative, adjuvant radiotherapy is not required. Radical vaginal hysterectomy usually requires a combined abdominal-perineal approach. After entering the abdomen, paraaortic lymph nodes are taken for rapid frozen section diagnosis. If the lymph nodes are positive, there is no need for surgery. If the lymph nodes are negative, bilateral pelvic lymph node dissection and radical hysterectomy like cervical cancer are performed.

　　2. Stage II vaginal squamous cell carcinoma

　　Medication: Stage II vaginal squamous cell carcinoma requires combined external beam radiotherapy and brachytherapy. Perez et al. followed up 165 patients with vaginal cancer for 7.6 years and found that the pelvic control rate for the 62 patients who received combined radiotherapy was 66%, and for the 13% of patients who received only external beam radiotherapy or brachytherapy, the pelvic control rate was 31%. Data indicate that sufficient radiation dose is important for tumor control. Many scholars emphasize that the radiation dose for the primary tumor should be at least 7000 to 7500 cGy. The total pelvic radiation dose for stage II vaginal squamous cell carcinoma is 2000 cGy, with an additional 3000 cGy for parauterine irradiation. The minimum dose of external beam radiotherapy combined with interstitial and intracavitary radiotherapy delivered to the tumor is 7500 cGy. Surgical treatment: Some patients with stage II vaginal squamous cell carcinoma can be cured by radical surgery.

　　3. Chemotherapy (radiotherapy) for stage III and IV vaginal squamous cell carcinoma:Stage III and IVa vaginal squamous cell carcinoma usually has large size and highly invasive lesions, including most of the vaginal wall or the entire vaginal wall, and reaches the pelvic wall, bladder, or rectum. The standard treatment is radiotherapy, but it rarely achieves satisfactory results, and the control of pelvic tumors is less than 1/2. All patients require external beam radiation therapy, and if possible, add近距离 therapy. Perez et al. recommend an external beam radiation dose of 5500 to 6000 cGy, combined with interstitial and intracavitary treatment to release a total dose of 7500 to 8000 cGy to the tumor. For stage IVb vaginal squamous cell carcinoma, only palliative treatment can be performed, and doxorubicin (adriamycin) combined with cisplatin treatment has significant efficacy. For patients with stage IV vaginal cancer with rectovaginal or vesicovaginal fistula, pelvic and para-aortic lymph node dissection can be performed, and anorectal anastomosis, urethral displacement, and vaginal reconstruction can be performed. In the 55 cases of primary vaginal cancer reported by Tjalma, there were 27 cases in stage I, 12 cases in stage II, 6 cases in stage III, and 10 cases in stage IV. The treatment is individualized, based on the medical condition at the time, the age of the patient, the stage of the tumor, the size and location of the tumor. Patients suitable for surgery undergo surgical treatment, those with large lesions that cannot be completely removed by surgery are first treated surgically, and adjuvant radiotherapy is performed after surgery for those with incomplete tumor resection or metastatic lesions in the resected lymph nodes. 67% of the patients underwent surgical treatment, 33% underwent radiotherapy, and 7 patients underwent radiotherapy after surgery. 21 patients recurred after treatment, of whom 19 were recurrent in the vagina or pelvis. Among the 55 patients, 19 (35%) died of the disease, 4 (7%) died of other diseases, 2 (3%) patients survived after recurrence, 30 (55%) still survived without recurrence, and the two main factors affecting the prognosis were the age of the patient at the time of onset and the size of the tumor. Patients with curative potential through surgery are those with stage I FIGO, a few with stage II, and those with stage IV who undergo pelvic debridement. There are very few hospitals that treat vaginal cancer with surgery alone. From 1980 to 2000, a total of 6138 patients were reported by 21 research centers, with a 5-year survival rate of 47% and a 10-year survival rate of 42%. More than half of the patients in 17 research centers received radiotherapy, with a 5-year survival rate of 68% in stage I, 48% in stage II, 34% in stage III, and 19% in stage IV. More than half of the patients in 4 research centers received only surgery or adjuvant radiotherapy after surgery, with a 5-year survival rate of 77% in stage I, 52% in stage II, 44% in stage III, and 14% in stage IV. In the surgical group, stage I patients accounted for 42%, while in the radiotherapy group, stage I patients accounted for 19%. Due to the low rate of surgical treatment for stage II to IV patients, it is difficult to formulate surgical methods. For stage II to IV patients, conventional combined treatment with近距离 radiotherapy and external beam radiotherapy is used, and surgery is used when the central lesion recurs after radiotherapy. For patients with minimal vaginal wall invasion in stage II, treatment can be performed as for stage I patients. Due to the poor prognosis of stage IV patients, palliative treatment is generally adopted, and pelvic debridement should be performed when the lesion is central without metastasis, especially when there is a vesicovaginal or rectovaginal fistula. Therefore,Patients in stages Ⅰ to Ⅱ will have a better prognosis after postoperative radiotherapy.