Vagina-Vulva

--Creasman WT, Phillips JL, Menck HR. A survey of hospital management practices for vulvar melanoma. JACS 1999; 188:670-675. (!)

--Creasman WT, Phillips JL, Menck HR. The National Cancer Data Base report on cancer of the vagina. Cancer 1998; 83:1033-1040. (!)

This study describes the practice patterns for the management of vaginal cancer. The cases reviewed were 4,885 cases of primary vaginal cancer diagnosed between 1985 and 1994 that were submitted to the National Cancer Data Base (NCDB). Patients with a prior history of malignancy were excluded. More than 90% of the patients were diagnosed with epithelial neoplasia (carcinoma), with approximately 25% of those being in situ lesions only. Squamous carcinoma was more common as the age of the patient progressed. Adenocarcinomas represented nearly all of the carcinomas in patients under 20 years of age, and were observed with decreasing frequency among older patients. Five-year relative survival for carcinoma patients was stage-related: stage 0: 96%; Stage I: 73%; stage II: 58%; stage III-IV: 36%. Melanoma had an extremely poor prognosis, with only 14% relative survival after 5 years. A significant number of sarcomas were observed in children, for whom chemotherapy played a major role in treatment. Survival was better in the younger patients (90% vs 30% in the oldest group). Although vaginal cancer is the rarest of genital malignancies, it appears that the treatment and results represented in the NCDB data reported from multiple institutions followed prescribed treatment guidelines.

--Creasman WT, Phillips JL, Menck HR. The National Cancer Data Base report on early stage invasive vulvar carcinoma. Cancer 1997; 80(3):505-13. (!)

Recent advances in the recommended treatment of early stage vulvar carcinoma have emphasized the role of pathologic indications of tumor size and lymph node involvement. The purpose of this study was to identify the current method of management for early stage vulvar carcinoma with primary disease. Data submitted to the National Cancer Data Base by 1,147 hospitals were used to examine cases diagnosed between 1988-1989 and between 1993-1994. The analysis was based on 1,553 invasive nonmetastatic carcinomas (confined to the vulva and/or perineum) for which primary lesion size and pathologic inguinal lymph node evaluation had been recorded. There were no differences in demographic or disease characteristics between the earlier (1988-1989) and later (1993-1994) periods. Surgery alone was most often the treatment for lymph node negative patients. Radiation was given as an adjunct treatment to 49% of patients with positive lymph nodes. Radiation therapy was given fairly equally to patients in all lymph node positive categories (1, 2-3, and 4 or more positive lymph nodes), with little change between the two time periods. Patients with lesions less than 2 cm in diameter were more often treated with conservative surgery. The major diagnostic groups and number of positive lymph nodes were confirmed to be prognostically important. Although literature on vulvar disease notes a benefit of radiation therapy for patients with more than one positive lymph node, use of radiation therapy was not predictive of survival for patients in this study.

--Trimble EL, Rubenstein LV, Menck HR, Hankey BF, Kosary C, Giusti RM. Vaginal clear cell adenocarcinoma in the United States. Gynecol Oncol 1996; 61:113-115.

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