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)

Abstract

Purpose This is an official guideline, published and coordinated by the Gynecological Oncology Working Group (AGO) of the German Cancer Society (DKG) and the German Society for Gynecology and Obstetrics (DGGG). Vaginal cancers are rare tumors, which is why there is very little evidence on these tumors. Knowledge about the optimal clinical management is limited. This first German S2k guideline on vaginal cancer has aimed to compile the most current expert knowledge and offer new recommendations on the appropriate treatment as well as providing pointers about individually adapted therapies with lower morbidity rates than were previously generally available. The purpose of this guideline is also to set up a register to record data on treatment data and the course of disease as a means of obtaining evidence in future.

Methods The present S2k guideline was developed by members of the Vulvar und Vaginal Tumors Commission of the AGO in an independently moderated, structured, formal consensus process and the contents were agreed with the mandate holders of the participating scientific societies and organizations.

Recommendations To optimize the daily care of patients with vaginal cancer: 1. Monitor the spread pattern; 2. Follow the step-by-step diagnostic workup based on initial stage at detection; 3. As part of individualized clinical therapeutic management of vaginal cancer, follow the sentinel lymph node protocol described here, where possible; 4. Participate in the register study on vaginal cancer.

Key words

vaginal cancer - VaIN - sentinel lymph node biopsy

• References/Literatur

• 1 Schubert-Fritschle G, Schlesinger-Raab A, Engel J. Malignome der Vulva und Vagina. In: Dannecker C, Kolben M, Kürzl R. Hrsg. Manuale Tumorzentrum München. 2. Aufl.. München: Zuckschwerdt Verlag; 2011
• 2 Lilic V, Lilic G, Filipovic S. et al. Primary carcinoma of the vagina. J BUON 2010; 15: 241-247
• 3 Melnick S, Cole P, Anderson D. et al. Rates and risks of diethylstilbestrol-related clear-cell adenocarcinoma of the vagina and cervix. An update. N Engl J Med 1987; 316: 514-516
• 4 Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner MJ. eds. SEER Survival Monograph: Cancer Survival among Adults: U.S. SEER Program, 1988 – 2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD: NIH. 2007
• 5 Madsen BS, Jensen HL, van den Brule AJ. et al. Risk factors for invasive squamous cell carcinoma of the vulva and vagina–population-based case-control study in Denmark. Int J Cancer 2008; 122: 2827-2834
• 6 Henson D, Tarone R. An epidemiologic study of cancer of the cervix, vagina, and vulva based on the Third National Cancer Survey in the United States. Am J Obstet Gynecol 1977; 129: 525-532
• 7 Aho M, Vesterinen E, Meyer B. et al. Natural history of vaginal intraepithelial neoplasia. Cancer 1991; 68: 195-197
• 8 Gadducci A, Fabrini MG, Lanfredini N. et al. Squamous cell carcinoma of the vagina: natural history, treatment modalities and prognostic factors. Crit Rev Oncol Hematol 2015; 93: 211-224
• 9 Strander B, Andersson-Ellstrom A, Milsom I. et al. Long term risk of invasive cancer after treatment for cervical intraepithelial neoplasia grade 3: population based cohort study. BMJ 2007; 335: 1077
• 10 Horn LC, Schierle K. Pathologie der Präkanzerosen und der Karzinome von Vulva und Vagina sowie morphologische Prognosefaktoren. Onkologe 2009; 15: 15-27
• 11 Ferenzcy AS, Colgan TJ, Herrington CS, Hirschowitz L, Löning T, Park KJ, Stoler M, Wells M, Wilbur DC, Wright T. Epithelial Tumors of the Vagina. In: Kurman RJ, Carcangiu ML, Herrington CS, Young RH. eds. WHO Classification of Tumours of the female reproductive Tract. Lyon: IARC Press; 2014: 210-217
• 12 Horn LC, Schierle K, Schmidt D. et al. [Current TNM/FIGO classification for cervical and endometrial cancer as well as malignant mixed mullerian tumors. Facts and background]. Pathologe 2011; 32: 239-243
• 13 Darragh TM, Colgan TJ, Thomas Cox J. et al. The Lower Anogenital Squamous Terminology Standardization project for HPV-associated lesions: background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. Int J Gynecol Pathol 2013; 32: 76-115
• 14 Wittekind C. TNM-Klassifikation maligner Tumoren. 8th ed. Weinheim: Wiley-VHC; 2017: 213-215
• 15 Adams TS, Cuello MA. Cancer of the vagina. Int J Gynaecol Obstet 2018; 143 (Suppl. 02) 14-21
• 16 Wu X, Matanoski G, Chen VW. et al. Descriptive epidemiology of vaginal cancer incidence and survival by race, ethnicity, and age in the United States. Cancer 2008; 113: 2873-2882
• 17 Kurman RJ, Ronnett BM, Sherman ME, Wilkinson EJ. Tumors of the Vagina. Tumors of the Cervix, Vagina and Vulva. In: Kurman RJ, Ronnett BM, Sherman ME, Wilkinson EJ. eds. AFIP Atlas of Tumor Pathology, Series 4. Silver Spring: ARP Press; 2010: 255-291
• 18 Wilkinson EJ, Rico MJ, Pierson KK. Microinvasive carcinoma of the vulva. Int J Gynecol Pathol 1982; 1: 29-39
• 19 Crum CP, Herrington CS, McCluggage WG, Regauer S, Wilkinson EJ. Epithelial Tumors of the Vulva. In: Kurman RJ, Carcangiu ML, Herrington CS, Young RH. eds. WHO Classification of Tumours of the female reproductive Tract. Lynon: IARC Press; 2014: 233-242
• 20 Hermanek P, Hutter RV, Sobin LH. et al. International Union Against Cancer. Classification of isolated tumor cells and micrometastasis. Cancer 1999; 86: 2668-2673
• 21 Wittekind C, Compton C, Brirley J, Sobin L. TNM Supplement: a Commentary on Uniform Use. London: Wiley-Blackwell; 2012
• 22 American Joint Committee on Cancer. Vagina. In: Amin MB, Edge S, Greene F. et al., eds. AJCC Cancer Staging Manual. 8th ed. New York: Spinger; 2017: 641-647
• 23 Luo LM, Huang HF, Pan LY. et al. [Clinical analysis of 42 cases of primary malignant tumor in vagina]. Zhonghua Fu Chan Ke Za Zhi 2008; 43: 923-927
• 24 Stock RG, Chen AS, Seski J. A 30-year experience in the management of primary carcinoma of the vagina: analysis of prognostic factors and treatment modalities. Gynecol Oncol 1995; 56: 45-52
• 25 Manetta A, Gutrecht EL, Berman ML. et al. Primary invasive carcinoma of the vagina. Obstet Gynecol 1990; 76: 639-642
• 26 Tjalma WA, Monaghan JM, de Barros Lopes A. et al. The role of surgery in invasive squamous carcinoma of the vagina. Gynecol Oncol 2001; 81: 360-365
• 27 Frank SJ, Jhingran A, Levenback C. et al. Definitive radiation therapy for squamous cell carcinoma of the vagina. Int J Radiat Oncol Biol Phys 2005; 62: 138-147
• 28 de Crevoisier R, Sanfilippo N, Gerbaulet A. et al. Exclusive radiotherapy for primary squamous cell carcinoma of the vagina. Radiother Oncol 2007; 85: 362-370
• 29 Greenwalt JC, Amdur RJ, Morris CG. et al. Outcomes of Definitive Radiation Therapy for Primary Vaginal Carcinoma. Am J Clin Oncol 2015; 38: 583-587
• 30 Lian J, Dundas G, Carlone M. et al. Twenty-year review of radiotherapy for vaginal cancer: an institutional experience. Gynecol Oncol 2008; 111: 298-306
• 31 Jang WI, Wu HG, Ha SW. et al. Definitive radiotherapy for treatment of primary vaginal cancer: effectiveness and prognostic factors. Int J Gynecol Cancer 2012; 22: 521-527
• 32 Smith GL, Jiang J, Giordano SH. et al. Trends in the Quality of Treatment for Patients With Intact Cervical Cancer in the United States, 1999 Through 2011. Int J Radiat Oncol 2015; 92: 260-267
• 33 Showalter TN, Camacho F, Cantrell LA. et al. Determinants of Quality Care and Mortality for Patients With Locally Advanced Cervical Cancer in Virginia. Medicine (Baltimore) 2016; 95: e2913
• 34 Lin JF, Berger JL, Krivak TC. et al. Impact of facility volume on therapy and survival for locally advanced cervical cancer. Gynecol Oncol 2014; 132: 416-422
• 35 Bakker RM, ter Kuile MM, Vermeer WM. et al. Sexual rehabilitation after pelvic radiotherapy and vaginal dilator use: consensus using the Delphi method. Int J Gynecol Cancer 2014; 24: 1499-1506
• 36 Bakker RM, Mens JW, de Groot HE. et al. A nurse-led sexual rehabilitation intervention after radiotherapy for gynecological cancer. Support Care Cancer 2016;
• 37 Bakker RM, Vermeer WM, Creutzberg CL. et al. Qualitative accounts of patientsʼ determinants of vaginal dilator use after pelvic radiotherapy. J Sex Med 2015; 12: 764-773
• 38 Lethaby A, Ayeleke RO, Roberts H. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev 2016; (08) CD001500
• 39 Perri T, Ben-Baruch G, Davidson T. et al. Use of Titanium Spiral Tacks for Long-term Oophoropexy Before Pelvic Irradiation. Int J Gynecol Cancer 2014; 24: 1133-1136
• 40 Han SS, Kim YH, Lee SH. et al. Underuse of ovarian transposition in reproductive-aged cancer patients treated by primary or adjuvant pelvic irradiation. J Obstet Gynaecol Res 2011; 37: 825-829
• 41 Morice P, Castaigne D, Haie-Meder C. et al. Laparoscopic ovarian transposition for pelvic malignancies: indications and functional outcomes. Fertil Steril 1998; 70: 956-960
• 42 Meirow D, Nugent D. The effects of radiotherapy and chemotherapy on female reproduction. Hum Reprod Update 2001; 7: 535-543
• 43 Ghadjar P, Budach V, Kohler C. et al. Modern radiation therapy and potential fertility preservation strategies in patients with cervical cancer undergoing chemoradiation. Radiat Oncol 2015; 10: 50
• 44 DGGG; DGU, BGRM. Fertility preservation for patients with malignant disease. Guideline of the DGGG, DRU and BGRM (S2k – Level, AWMF Registry No. 015/082, November 2017). 2017. Online: http://www.ammf.org/leitlinien/detail/II/015-082.html last access: 15.02.2018
• 45 Salani R, Backes FJ, Fung MF. et al. Posttreatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncologists recommendations. Am J Obstet Gynecol 2011; 204: 466-478
• 46 Dannecker C, Strand V, Hegewisch-Becker S. Nachsorge beim Vulva- und Vaginalkarzinom. Der Onkologe 2014; 20: 355-357
• 47 Oonk MH, de Hullu JA, Hollema H. et al. The value of routine follow-up in patients treated for carcinoma of the vulva. Cancer 2003; 98: 2624-2629
• 48 Gardner CS, Sunil J, Klopp AH. et al. Primary vaginal cancer: role of MRI in diagnosis, staging and treatment. Br J Radiol 2015; 88: 20150033
• 49 Gunderson CC, Nugent EK, Yunker AC. et al. Vaginal cancer: the experience from 2 large academic centers during a 15-year period. J Low Genit Tract Dis 2013; 17: 409-413