Vaginal cancer in patient presenting with advanced pelvic organ prolapse: case report and literature review

Background: Vaginal cancer presenting concurrently with stage 4 uterovaginal prolapse is a rare occurrence, representing less than 1% of all gynecologic malignancies. Case: We review the case of an 82-year-old woman who presented for care of prolapse. Examination demonstrated complete uterovaginal prolapse and a vaginal ulcer, later confirmed to be vaginal cancer. Conclusion: The management of these complicated patients is limited by a lack of data available to guide treatment. This case and the literature review highlight the need for a multidisciplinary approach to treatment and a high level of clinical suspicion for diagnosis of these very challenging cases. University of Iowa Hospitals and Clinics, Department of Obstetrics and Gynecology, Iowa City, Iowa University of Iowa Hospitals and Clinics, Department of Pathology, Iowa City, Iowa Introduction Primary vaginal carcinomas are extremely rare, accounting for only about 1% of all gynecologic malignancies. At the time of diagnosis, patients are typically in their 6th or 7th decade of life and most commonly present with vaginal bleeding from a lesion localized to the upper third of the vagina. There are currently no specific guidelines for treatment of vaginal cancer due to the paucity of available data. However, certain cases of early stage disease may be treated with primary surgery. Advanced disease is generally treated with chemoradiation or radiation alone. The incidence of symptomatic prolapse and prolapse surgery increases with age. Women older than 80 years are the fastest growing segment of the population. However, primary vaginal Proceedings in Obstetrics and Gynecology, 2015;5(1):3 Vaginal cancer with advanced pelvic organ prolapse 2 carcinomas are rare. A primary vaginal carcinoma presenting in conjunction with stage IV uterovaginal prolapse is an even rarer phenomenon. The reported incidence of prolapse from referral centers range from 13.6% to 16.3% of patients with primary vaginal cancer. A comprehensive review of the available English language literature reveals only 7 case reports and 1 case series (6 patients) of primary vaginal cancer associated with pelvic organ prolapse (Table 1). Conversely, finding an erosion of the vaginal mucosa in a postmenopausal woman in the setting of treatment for pelvic organ prolapse is not uncommon. This finding may be present with or without the use of a vaginal pessary and warrants very close monitoring. We will describe the case of a patient referred for management of pelvic organ prolapse who was found to have vaginal cancer. We will also review all other English language reports of prolapse complicated by vaginal cancer with an emphasis on the unique challenges of diagnosis and management that this situation presents.