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symptoms of vaginal squamous carcinoma, early symptoms and signs of vaginal squamous carcinoma

symptoms of vaginal squamous carcinoma, early symptoms and signs of vaginal squamous carcinoma

Squamous carcinoma of vagina

Early symptoms: irregular vaginal bleeding, bleeding after sexual intercourse and postmenopausal bleeding; Leucorrhea increased, even vaginal watery, bloody secretions accompanied by stench; Waist, abdominal pain, dysuria including frequent urination, hematuria, pain in urination, hematochezia, constipation, etc.

Late symptoms: Renal dysfunction, anemia, etc., such as cough and hemoptysis in lung metastasis, and swollen lymph nodes in superficial lymph node metastasis.

Related symptoms: Increased vaginal secretions, vaginal bleeding, severe squamous epithelial urination, urgent urination and frequent urination

I. Symptoms

10% ~ 20% of vaginal intraepithelial tumors or early invasive cancers may have no obvious symptoms, or only have increased vaginal secretions, contact bleeding and irregular bleeding or accessible masses, which may show outward growth or ulcer formation and invasive growth. With the development of the course of disease, the vaginal cancer is enlarged and necrotic, and vaginal stench can be discharged and painless vaginal bleeding can occur. When the tumor expands to surrounding organs and tissues, corresponding symptoms may appear. Frequent micturition, urgent micturition, hematuria and dysuria may occur when urethra or bladder is involved; Involving rectum may cause difficulty in defecation or tenesmus; When the vaginal side, main ligament and uterosacral ligament are invaded, lumbosacral pain may occur.

Second, the signs

Vaginal squamous cell carcinoma usually occurs in the posterior wall of the upper 1/3 and the anterior wall of the lower 1/3 of the vagina. Vaginal intraepithelial tumors or early invasive cancers may only be erosive. Generally, invasive cancer lesions are mostly exogenous, with papillary or cauliflower types as common, and can also appear in the form of ulcer type, flat submucosal type or vaginal infiltration type. Early vaginal lesions are limited, and late infiltration of whole vagina, paravaginal, main ligament and uterosacral ligament, vaginal fistula of bladder or urethra or rectovaginal fistula, and metastasis of inguinal, pelvic and supraclavicular lymph nodes, even distant metastasis.

Third, diagnosis

The diagnosis of primary vaginal squamous cell carcinoma is formulated according to the International Federation of Obstetrics and Gynecology: ① No cancer is found in cervix and vulva; It should be 5 years after surgical treatment of invasive cervical cancer, 2 years after operation of cervical carcinoma in situ and 10 years after radiotherapy for cervical cancer.

Vaginal cancer is often misdiagnosed at the first examination, especially when the lesion is small and located in the lower 2/3 of the vagina, because the blade of the speculum covers the lesion tissue. Frick et al. reported that at least 10 of 52 cases of vaginal cancer were misdiagnosed at the first examination. The speculum should be rotated and withdrawn so that the lesions of the anterior and posterior walls of vagina are Local biopsy of visible lesions can make a definite diagnosis. Patients with positive Pap smear, unexplained vaginal bleeding and ulcerative erythema at the upper end of vagina should undergo careful colposcopy and iodine smear on the whole vaginal wall. When colposcopy biopsy can not make a definite diagnosis, it is necessary to perform partial vaginal resection to make a definite diagnosis of occult invasive cancer, especially for patients who have undergone hysterectomy. Embedding some vaginal epithelial cells when the vaginal fornix is closed is a risk factor for canceration. Tjalma reported 55 patients with primary squamous cell carcinoma who were hospitalized in NGOC from 1974 to 1999. The average age was 58 years old (ranging from 34 to 90 years old), and the average follow-up time was 45 months (0.6 to 268 months). 62% of the patients went to see a doctor because of increased vaginal secretions. 16% went to see a doctor because of positive vaginal cytology. 13% went to see a doctor because of feeling vaginal tumor. 4% went to see a doctor because of pelvic pain. 2% went to see a doctor because of dysuria; 3% went to see a doctor because of other accompanying symptoms. Most patients were misdiagnosed, and the average misdiagnosis time was 4 months (ranging from 3 to 12 months). Gynecological examination showed that the tumor size ranged from 4 mm to 115mm, with an average diameter of 39mm. 53% of the patients had lesions in the upper 1/3 of the vagina, 16% in the lower 1/3 of the vagina, 7% in the middle 1/3 of the vagina, and 13% covered the whole vagina. The lesions in the anterior wall of vagina accounted for 24%, the posterior wall of vagina accounted for 47%, and both anterior and posterior walls of vagina accounted for 29%.

For invasive vaginal cancer confirmed by pathology, blood routine, biochemical complete set, chest radiograph, cystoscopy and rectoscopy should be examined. For some patients, barium enema or bone radiation examination should be performed. CT and MRI can judge whether metastasis is possible.

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