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9 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
Vaginal adenocarcinoma is a rare glandular form of vaginal cancer, best known through the clear cell type that struck young women whose mothers took the hormone DES in pregnancy. Unlike the common squamous form it is not caused by HPV, it is treated with surgery where possible because it often affects young women, and radiotherapy and platinum chemotherapy are used when it is advanced.
Adenocarcinoma of the vagina is uncommon and heterogeneous. The clear cell type arises from adenosis, glandular tissue left in the vagina when the Müllerian epithelium fails to be replaced, and in 1971 Arthur Herbst linked a cluster of cases in teenagers and young women in Boston to their mothers' use of diethylstilboestrol (DES) in early pregnancy, the first proof that a drug taken in pregnancy could cause cancer in the child decades later. DES was withdrawn for that use the same year; exposed women carry a lifetime risk of about one in a thousand, most tumours appeared between the ages of 15 and 30, and cases still occur as the cohort ages. Sporadic clear cell, endometrioid, mucinous and mesonephric adenocarcinomas also arise, usually in older women, and any vaginal adenocarcinoma must first be shown not to be a metastasis from the endometrium, cervix, ovary or bowel.
Treatment follows the same stage-based principles as squamous cell carcinoma, but with a greater place for surgery because patients with DES-associated disease were young and fertility and vaginal function mattered: radical vaginectomy or hysterectomy with lymphadenectomy for early upper-vaginal tumours, sometimes with vaginal reconstruction, and radiotherapy with brachytherapy for larger or lower tumours or after surgery. Clear cell tumours spread to lymph nodes early and can recur late, so follow-up is prolonged. Advanced or recurrent disease is treated with platinum-based chemotherapy, extrapolating from clear cell cancers of the ovary and cervix, and immunotherapy is being explored because clear cell carcinomas at other sites respond in a minority. The DES story remains the model for transplacental carcinogenesis and led to lifelong surveillance programmes for exposed daughters.
| Setting | Approach | Guideline |
|---|---|---|
| Diagnosis | Biopsy with immunohistochemistry to exclude metastasis; MRI and PET-CT staging; DES exposure history. | not mapped |
| Early stage | Radical vaginectomy or radical hysterectomy with lymphadenectomy, with vaginal reconstruction and ovarian preservation where appropriate; adjuvant radiotherapy for close margins or positive nodes. | not mapped |
| Locally advanced disease | External beam radiotherapy with brachytherapy, with concurrent cisplatin by extrapolation from cervical cancer. | not mapped |
| Recurrent or metastatic disease | Platinum-based chemotherapy (carboplatin and paclitaxel); checkpoint inhibitors for mismatch-repair-deficient or PD-L1-positive tumours; pelvic exenteration for isolated central recurrence. | not mapped |
| DES-exposed women | Lifelong annual gynaecological examination with cytology of the cervix and vagina and colposcopy of adenosis. | not mapped |