Vaginal Cancer

　　The causes of vaginal cancer are numerous, such as:

　　1, Vulvar infection such as sexually transmitted diseases, caused by viruses, bacteria, trichomonads, fungi, etc., leading to vulvitis. The vulva is the primary site and frequent site of occurrence.

　　2, Mechanical stimulation such as poor hygiene habits, vulvar dirt, tight underwear, sweat stains, etc.

　　3, Systemic diseases such as diabetes, systemic lupus erythematosus, psoriasis, etc.

　　4, Long-term placement of pessaries or foreign bodies in the vagina, or residual foreign bodies in the vagina causing infection and irritation of the vulva, leading to swelling and pain.

　　5, Allergic vulvitis caused by allergens such as detergents, cosmetics, condoms, and medical supplies.

　　6, Urinary and fecal irritation, urological disease, fecal soiling, and diabetic urine irritation.

　　The following complications may occur:

　　Due to the special anatomical relationship of the vagina (loose connective tissue, thin wall, rich lymphatic vessels), cancer tumors are more likely to spread. The main pathways of spread are direct extension, lymphatic metastasis, and occasionally distant metastasis. The lymphatic metastasis pathway of vaginal upper segment cancer is basically the same as that of cervical cancer; the lower one-third of the vagina is basically the same as that of vulvar cancer; the middle one-third can transfer through both pathways, from the lower vaginal lesions through the inguinal lymph nodes; from the upper vaginal lesions through the pelvic lymph nodes; or hematogenous metastasis. Vaginal cancer can directly extend and spread to local para-vaginal tissues, bladder, or rectum.

　　1, The main clinical manifestations of vaginal cancer include:Irregular vaginal bleeding, bleeding after sexual intercourse, and post-menopausal bleeding; increased leukorrhea, even watery or bloody vaginal discharge with foul odor; with the progression of the disease, back and abdominal pain, urinary and fecal incontinence (including frequent urination, hematuria, dysuria, and hematochezia, constipation, etc.) may occur; severe cases may form vesicovaginal fistula or rectovaginal fistula; advanced patients may experience renal dysfunction, anemia, and if lung metastasis occurs, hemoptysis may occur. Local lesions of vaginal cancer are most commonly papillary or cauliflower-like, followed by ulcerative or infiltrative. Difficulty in sexual intercourse is a typical symptom of advanced vaginal tumors.

　　2, Vaginal cancer most commonly occurs in the upper one-third of the posterior vaginal wall.:Most patients report small irregular bleeding after menopause, malodorous discharge, and pain. Rectovaginal examination can help determine whether there is submucosal, para-vaginal invasion, or rectal involvement.

　　Actively treat diseases such as vaginal leukoplakia, chronic inflammation, and ulcers.

　　For any irregular vaginal bleeding or abnormal leukorrhea, an early and clear diagnosis should be made, and active treatment should be carried out.

　　After the treatment of vaginal cancer, it is necessary to have a follow-up examination every 3 to 6 months, and cytological examination should be performed. If vaginal bleeding or abnormal leukorrhea occurs again, seek medical attention immediately.

　　About 20% of vaginal cancer patients can be detected through Pap smear and pelvic examination. In addition to chest X-ray examination and intravenous pyelography, cystoscopy and sigmoidoscopy of the rectum can also be used as routine examinations. CT and MRI can differentiate intraperitoneal and extraperitoneal lesions. MRI can also differentiate post-radiotherapy fibrosis lesions and recurrent tumors.

　　Firstly, eat

　　1. Eat more foods that enhance immunity: turtle, tortoise, sea turtle, sandworm, crucian carp, shark, water snake, shrimp, white flower snake, crucian carp, mulberry, fig, lychee, walnut, loofah, drumstick, olive, almond, luffa.

　　2. For infection and ulcers, eat water chestnuts, snails, needlefish, eels, smelt, chrysanthemum flower, rapeseed, taro, mung bean, red bean, Malan head.

　　3. Swollen lymph nodes should eat taro, hawthorn, lily, water chestnut, mulberry seeds, snails, yellowfish, cat meat.

　　Secondly, avoid

　　3. Avoid moldy and preserved foods.

　　4. Avoid fried, greasy, smoked, and roasted foods.

　　5. Avoid all warm foods such as mutton, dog meat, chive, etc.

　　1. Radiotherapy

　　The primary treatment for most early and late vaginal cancer patients is radiotherapy, which includes intracavitary and extracavitary irradiation. Intracavitary treatment mainly targets the primary tumor in the vagina and the adjacent infiltrative area, while extracavitary irradiation mainly targets the tumor, the surrounding infiltrative area, and the lymphatic drainage area. Intracavitary irradiation: The upper segment vaginal tumor can be treated with intracavitary radiotherapy as for cervical cancer. Other primary tumors can be treated with vaginal cylindrical containers (cylinders), and exophytic tumors can be treated with interstitial implantation irradiation. Tumors in the middle and lower segments of the vagina or the entire vaginal lesion can be treated with vaginal cylinders or interstitial implantation irradiation. If the tumor is located on only one side of the vagina and is large, interstitial implantation irradiation can be performed to reduce the tumor size, followed by vaginal cylinder irradiation, and at the same time, appropriate lead blocks should be used for areas that do not require irradiation. The dose reference point is generally chosen at the base of the tumor. Traditional low-dose rate intracavitary irradiation usually gives a dose of 50 to 60 Gy at the base of the tumor, while high-dose rate afterloading intracavitary irradiation usually gives a dose of 30 to 40 Gy at the base of the tumor. Foreign scholars reported that efficacy was achieved when the vaginal tumor base dose was about 80 Gy (including the dose of extracavitary irradiation). Extracavitary irradiation: The upper segment tumor is treated with pelvic external irradiation, a full pelvic hexagonal field (after 30 Gy, a medium lead block (4×10CM) is used), and external irradiation, with a para-aortic tissue dose of 45 to 50 Gy/5 to 6 weeks. The lower segment tumor requires irradiation of the inguinal region. An irradiation field parallel to the inguinal ligament of 8×12CM to 14CM can be used, and 6 to 8MV X-ray irradiation can be given first at Dm40Gy/4 weeks, followed by electron beam irradiation at Dm20Gy/2 weeks. For patients with more advanced vaginal cancer, intracavitary irradiation may be difficult, and extracavitary irradiation can be performed first, with a tumor dose of DT45 to 50 Gy, and intracavitary irradiation can be supplemented according to the regression of the tumor.

　　2. Surgical Treatment

　　Early-stage primary vaginal cancer patients can choose surgery. Vaginal in situ cancer can be treated with local resection, partial or total vaginectomy, and simultaneous vaginoplasty. Early-stage patients with superficial infiltration of vaginal upper segment tumors can undergo extensive hysterectomy and partial vaginectomy and pelvic lymph node dissection, with the vaginal margin should be 2-3 centimeters below the cancer margin. Early-stage lesions in the lower segment of the vagina can be treated with vaginectomy and vulvectomy and inguinal lymph node dissection. For vaginal middle segment tumors, in addition to total hysterectomy and vaginectomy, inguinal lymph node or pelvic lymph node dissection should be selected according to the extent of the lesion and the site of lymph node metastasis. For lesions with extensive and deep infiltration, total vaginectomy including resection of the rectum or bladder (organ resection) is required, but the surgery is complex and has a high incidence of complications.

　　3. Chemotherapy

　　The efficacy of simple chemotherapy for vaginal cancer is poor, and commonly used drugs include cisplatin (PDD), pingyangmycin (BLM), mitomycin (MMC), 5-fluorouracil (5FU), ifosfamide (IFO), paclitaxel (PTX), and others. Combined chemotherapy regimens include PVB, PIB, TP, PDD+MMC, PDD+5FU+CTX, and others. In addition to intravenous administration, interventional chemotherapy is also applied in clinical practice.