CHALLENGES IN THE TREATMENT OF VAGINAL CANCER: FUNCTIONAL PRESERVATION AND ONCOLOGICAL CONTROL
DOI:
https://doi.org/10.56238/arev8n2-018Keywords:
Vaginal Neoplasms, Human Papillomavirus, Brachytherapy, Quality of Life, Women's Health, Vaginal StenosisAbstract
Primary vaginal cancer is a rare gynecological neoplasm, mainly associated with persistent infection by high-risk human papillomavirus, whose clinical management is challenging due to its anatomical complexity, the functional impact of treatments, and the absence of well-established therapeutic guidelines. Therefore, this study aimed to review current diagnostic and therapeutic strategies, focusing on the balance between oncological control and functional preservation. This is a narrative literature review, conducted using a search in the PubMed database, including studies published in the last ten years related to the diagnosis and treatment of vaginal cancer. The findings demonstrate that diagnosis depends on histopathological confirmation and the complementary use of imaging methods for adequate staging and therapeutic planning. Treatment should be individualized, considering the stage of the disease, tumor characteristics, and the patient's clinical conditions. Radiotherapy represents the main therapeutic pillar, especially in advanced stages, while surgery, CO₂ laser, and less invasive therapies are indicated in selected cases.
Downloads
References
ADAMS, T. S. et al. Cancer of the vagina: 2021 update. International Journal of Gynecology & Obstetrics, v. 155, n. S1, p. 19-27, 2021. DOI: https://doi.org/10.1002/ijgo.13867
ADAMS TS, MALULEKE JC, CUELLO MA. Cancer of the vagina: 2025 update. Int J Gynaecol Obstet. 2025 Sep;171 Suppl 1(Suppl 1):48-59. doi: 10.1002/ijgo.70325. Epub 2025 Jul 9. PMID: 40631450; PMCID: PMC12411808. DOI: https://doi.org/10.1002/ijgo.70325
AKEFLO L, ELMERSTIG E, BERGMARK K, DUNBERGER G. Barriers to and strategies for dealing with vaginal dilator therapy – Female pelvic cancer survivors’ experiences: A qualitative study. European Journal of Oncology Nursing, Volume 62 (2023), 102252. https://doi.org/10.1016/j.ejon.2022.102252 DOI: https://doi.org/10.1016/j.ejon.2022.102252
AUL, A. et al. Guidelines for the prevention and diagnosis of vaginal and vulvar cancers: A systematic review. Critical Reviews in Oncology/Hematology, v. 216, p. 104970, 2025. DOI: https://doi.org/10.1016/j.critrevonc.2025.104970
CHOEKOE, J. et al. Cancer of the vagina: 2025 update. International Journal of Gynecology & Obstetrics, 2025.
JHINGRAN, A. Updates in the treatment of vaginal cancer. International Journal of Gynecological Cancer, v. 32, n. 3, p. 344-351, 2022. DOI: https://doi.org/10.1136/ijgc-2021-002517
KULKARNI A, DOGRA N, ZIGRAS T. Innovations in the Management of Vaginal Cancer. Curr Oncol. 2022 Apr 27;29(5):3082-3092. doi: 10.3390/curroncol29050250. PMID: 35621640; PMCID: PMC9139564. DOI: https://doi.org/10.3390/curroncol29050250
LIU, Y. et al. HiPorfin photodynamic therapy for vaginal high-grade squamous intraepithelial lesion. Archives of Gynecology and Obstetrics, v. 310, p. 1197-1205, 2024. DOI: https://doi.org/10.1007/s00404-024-07600-4
NAUMANN, R. W. et al. Safety and Efficacy of Nivolumab Monotherapy in Recurrent or Metastatic Cervical, Vaginal, or Vulvar Carcinoma: Results From the Phase I/II CheckMate 358 Trial. Journal of Clinical Oncology, v. 37, n. 31, p. 2825-2834, 2019. DOI: https://doi.org/10.1200/JCO.19.00739
NOGUEIRA-RODRIGUES, A. et al. Comprehensive management of vulvovaginal cancers. CA: A Cancer Journal for Clinicians, 2025. DOI: https://doi.org/10.3322/caac.70014
WEI, J. et al. Comprehensive evaluation of vaginal intraepithelial neoplasia development after hysterectomy: insights into diagnosis and treatment strategies. Archives of Gynecology and Obstetrics, v. 310, p. 1-10, 2024. DOI: https://doi.org/10.1007/s00404-024-07530-1
SCHNÜRCH, Hans-Georg et al. Diagnosis, therapy and follow-up of vaginal cancer and its precursors. Guideline of the DGGG and the DKG (S2k-Level, AWMF Registry No. 032/042, October 2018). Geburtshilfe und Frauenheilkunde, v. 79, n. 10, p. 1060-1078, 2019. DOI: https://doi.org/10.1055/a-0919-4959
BOGANI, Giorgio et al. LASER treatment for women with high‐grade vaginal intraepithelial neoplasia: A propensity‐matched analysis on the efficacy of ablative versus excisional procedures. Lasers in surgery and medicine, v. 50, n. 9, p. 933-939, 2018. DOI: https://doi.org/10.1002/lsm.22941
FIASCONE, Stephen; VITONIS, Allison F.; FELDMAN, Sarah. Topical 5-fluorouracil for women with high-grade vaginal intraepithelial neoplasia. Obstetrics & Gynecology, v. 130, n. 6, p. 1237-1243, 2017. DOI: https://doi.org/10.1097/AOG.0000000000002311
DODGE, Jeffrey A. et al. Clinical features and risk of recurrence among patients with vaginal intraepithelial neoplasia. Gynecologic oncology, v. 83, n. 2, p. 363-369, 2001. DOI: https://doi.org/10.1006/gyno.2001.6401
TAINIO, Karoliina et al. Randomised trial on treatment of vaginal intraepithelial neoplasia—Imiquimod, laser vaporisation and expectant management. International journal of cancer, v. 139, n. 10, p. 2353-2358, 2016. DOI: https://doi.org/10.1002/ijc.30275
TRANOULIS, A. et al. Efficacy of 5% imiquimod for the treatment of Vaginal intraepithelial neoplasia—A systematic review of the literature and a meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology, v. 218, p. 129-136, 2017. DOI: https://doi.org/10.1016/j.ejogrb.2017.09.020
PERROTTA, Myriam et al. Use of CO2 laser vaporization for the treatment of high-grade vaginal intraepithelial neoplasia. Journal of lower genital tract disease, v. 17, n. 1, p. 23-27, 2013. DOI: https://doi.org/10.1097/LGT.0b013e318259a3ec
