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Is There an Association Between Vaginal Cancer and Genital ISSN: 2643-4563 Männle et al. Int J Oncol Res 2021, 4:027 DOI: 10.23937/2643-4563/1710027 Volume 4 | Issue 1 International Journal of Open Access Oncology Research REVIEW ARTICLE Is there an Association between Vaginal Cancer and Genital Prolapse? A Data-Analysis and Review of Literature Heidrun Männle1*, Birthe Osorio1, Felix Momm2 and Karsten Münstedt1 1Department of Gynecology and Obstetrics, Ortenau-Klinikum Offenburg-Kehl, Germany 2Department of Radio-Oncology, Ortenau-Klinikum Offenburg-Kehl, Weingartenstr, Germany *Corresponding author: Heidrun Männle, Ortenau-Klinikum Offenburg-Kehl, Ebertplatz 12, 77654 Check for Offenburg, Germany, Tel: 0049/781/472-3501, Fax: 0049/781/472-3502 updates Abstract Introduction Purpose: Primary vaginal cancer represents a rare disease. Primary vaginal cancer represents a rare disease. For The main risk factor for vaginal carcinoma is a persistent hu- Germany, the relevant figures for this disease in 2014 man papillomavirus (HPV) infection. However, chronic me- were incidence approximately 1190 cases, mortality chanic irritation of the vagina, have long been suspected to contribute to the development of vaginal cancer. This study 456 cases, mean age at diagnosis 71 years and 5-year examined to assess possible associations between genital overall survival 52% [1]. The main histologic types of prolapse and the incidence of vaginal cancer. vaginal cancers are squamous cell cancers (> 95%). Ade- Methods: We conducted a systematic literature search re- nocarcinomas can be found in about 5-10% of the cases garding the association between vaginal cancer and genital [2]. Clear cell carcinoma, which is associated with in ute- prolapse, supplemented with our own data set of the Centre ro exposition of diethylstilboestrol, represents an even for Gynaecological Oncology of the Ortenau Clinic Offen- burg. rarer subtype of this tumour and is not found any more today [3]. Results: Our case analysis of prolapse-associated vagi- nal carcinomas corresponds to a large extent with the total The main risk factor for vaginal carcinoma is a per- collective of vaginal carcinomas. The most frequent histo- sistent human papillomavirus (HPV) infection, and HPV logical subtype was squamous cell carcinoma in 90%. The median age of patients with genital prolapse-associated type 16 is the most frequently encountered subtype [4]. vaginal carcinomas was 75 years (72.9 ± 12.1 years). How- Prior cervical dysplasia [5], immunosuppression (e.g., ever prolapse associated vaginal cancers had FIGO stage due to HIV infection or after organ transplant), which IV more often than cases of vaginal cancer in general. FIGO facilitates an HPV infection, and lichen sclerosus [6] can stage I was reported as most frequent (39%). FIGO stage IV be regarded as risk factors. was the second most frequent stage in prolapse associat- ed cases (25%). Furthermore, the Kaplan-Meier curves are However, chronic mechanic irritation of the vagina, significantly different from unselected vaginal cancer cases. for example, due to pessaries, has long been suspected In the prolapse associated cases FIGO stages I and II have a far better disease-free survival; in contrast, the prognosis to contribute to the development of vaginal cancer [7]. in the advanced stages is much worse. Although such correlations have been suspected since Conclusion: In addition to the HPV infection, patients with 1961, mainly case reports and small case series have genital prolapsed and those with ongoing systemic cortico- been published so far, which have not been able to con- steroid therapy or other immunocompromising medications, firm or disprove it [8]. should be perceived as risk groups and regularly examined. In order to assess possible associations between Keywords genital prolapse and the incidence of vaginal cancer, Vaginal cancer, Vaginal carcinoma, Pessary, Genital prolapse we analysed patient data at the Centre for Gynaecolog- Citation: Männle H, Osorio B, Momm F, Münstedt K (2021) Is there an Association between Vaginal Cancer and Genital Prolapse? A Data-Analysis and Review of Literature. Int J Oncol Res 4:027. doi. org/10.23937/2643-4563/1710027 Accepted: March 11, 2021: Published: March 13, 2021 Copyright: © 2021 Männle H, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Männle et al. Int J Oncol Res 2021, 4:027 • Page 1 of 8 • ISSN: 2643-4563 Selection ofpublications Criteria foreligibility Search ofliterature Material andMethods those relatedtogenitalprolapse. current knowledge on vaginal the expand carcinomas, to intended we cases available all of analysis especially gynaecological tumour types [ literature in accordance with earlier analyses of wanted rare to supplement our cases with cases from the ical Oncology of the Ortenau Clinic Offenburg. We also DOI: excluded. also were cancers genital occurring simultaneously with included publications were analysed. Cases of patients cations were excluded. Afterwards, the full texts of the publi double as well as them match not did which tions for agreement with the criteria for KM) eligibility. (HM, study this Publica of authors two the by checked were German andSpanish. text articles in the following languages: English, French, steps were included if they could be retrieved as full and systematicreviews. the referred databases, which included meta-analyses further publications that might not have been found in ences in all retrieved publications in order to identify our search. In the second step, we analysed the refer Google scholar, Scopus and JUST find) complemented Library, (Cochrane systems data medical electronic ther linked by “AND” and afterwards by “OR”. Use ofsary or vaginal pessary. A and B as well as A and C were fur prolapse or genital prolapse or prolapse; and (C): Pes or genital descensus or uterovaginal prolapse or total vagina; (B): Uterine prolapse or pelvic organ prolapse vaginal squamous cell carcinoma or adenocarcinoma of cinoma of (the) vagina, or carcinosarcoma of vagina or gina or vaginal neoplasia or vaginal carcinoma or car the keywords (A): Vaginal cancer or cancer of the va ered. The search in PubMed (Medline) was based on All publications published until July 2019 were consid sociation between vaginal cancer and genital prolapse. prolapse. and 2018. Four of them were in the context of genital patients with primary vaginal carcinoma between 2010 retrospective analysis of this data set revealed seven their consent for the documentation and evaluation. A GeDos. All patients were informed about this and gave umented in our own tumour-documentationcal system Oncology of the Ortenau Clinic Offenburg are doc Titles and abstracts of the retrieved publications All publications that were identified in the first two We conducted a systematic search regarding the as All tumour patients at the Centre for Gynaecologi 10.23937/2643-4563/1710027 9 , 10 ]. Using a combined - - - - - - - - - - - Table 1: Data base of the gynaecological cancer center Offenburg/Germany with all patients with vaginal cancer. Genital prolapse Immunosuppression Patient Age at initial FIGO T N M G Died of Histology Total Pessary Mesh Kolporraphy Immunosuppressive Immunosuppressive diagnosis stage tumor prolaps diagnoses medication 1 76 II 0 0 1 No Squamous No No Yes No No Yes 2 89 III 0 2 Yes Squamous Yes No No No No No 3 82 I 1 0 3 No Squamous Yes No No Yes No No 4 58 III 1 1 0 2 Yes Clear cell No No No No No No • 5 91 II 2 Yes Squamous No No No No No No Page 2of 8 6 79 II 2 No Squamous No No No No No Yes 7 81 IVB 2 1 3 Yes Squamous yes No No No No No • Patients associated with genital prolapse are highlighted in gray. TNM stage: T: tumour, N: nodes, M: metastasis G: grading Männle et al. Int J Oncol Res 2021, 4:027 DOI: 10.23937/2643-4563/1710027 ISSN: 2643-4563 Figure 1: Transvaginal sonography: A 29 × 37mm moderately hyperechoic mass passing through the mesh. Data management and statistical analyses We used SPSS for Windows (version 11.5) for statisti- cal data analyses, which included descriptive and analyt- ical methods as well as survival analyses (Kaplan-Meier curves and log-rank tests). A p-value of 0.05 was consid- ered significant. Results Database of the gynaecological cancer centre Of- fenburg/Germany Table 1 provides an overview of the main character- istics of our patients with vaginal cancer. Six out of sev- en (86%) of our patients had squamous cell carcinomas. Unfortunately, no HPV testing was done at the time of diagnosis. One case (14%) presented as an adenocarci- noma, namely a clear cell carcinoma. Table 1 shows that, among patients with squamous Figure 2: Total prolapse with ulceration on the anterior cell carcinomas, urogynaecological problems were wall, histologically confirmed as squamous cell carcinoma. found in four cases. Interestingly, three out of six pa- tients (50%) had pronounced genital prolapse. One case Data analyses of squamous cell carcinoma occurred after transvaginal mesh surgery (16.6%). Figure 1 shows the transvaginal Relevant data (author, year of publication, age at sonographie (TVS) with a 29 × 37 mm moderately hyper- diagnosis, histology, FIGO stage, TNM stage, grading, echoic mass passing through the mesh with pronounced observation period, tumour associated death (yes/no), vascularization. Figure 2 shows exemplary a total pro- primary treatment (radiotherapy or surgery), prolapse lapse with ulceration on the anterior wall, histologically stage, use of pessaries, earlier treatment with vaginal confirmed as squamous cell carcinoma. synthetic mesh, prior urogynaecological surgery, con- current immunosuppressive diseases or treatments) Systematic literature search were assessed in a table. The initial search strategy in the medical databases Ethics and the associated hand search yielded 719 titles. As shown in Figure 3 (search strategy flow chart), most We obtained positive consent from the Ethics items were excluded due to duplicate records or mis- Committee of the Medical Faculty of the University of leading titles.
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