most appropriate treatment of vaginal SCC

[K06100]

A 57-year-old G3P3 woman presents to her gynecologist
with complaints of vaginal pruritus
and increased vaginal discharge. The patient
has no history of gynecologic surgery or sexually
transmitted diseases; she is not currently
sexually active. A bimanual examination and
Pap smear are performed. The Pap smear is
positive for malignant squamous cells. Followup
colposcopy shows no cervical lesions, but a
small lesion is noted on the lower vagina. Biopsy
of this lesion confi rms the diagnosis of
vaginal squamous cell cancer, while cross-sectional
imaging excludes invasion of surrounding
tissues. What is the most appropriate course
of treatment?

(A) Chemotherapy
(B) Radiation therapy
(C) Surgical excision
(D) Surgical excision and chemotherapy
(E) Surgical excision and radiation therapy

[Novobiocin]

(C) Surgical excision assuming it is less than 2 cm

(B) Radiation therapy if > 2 cm

[K06100]

The correct answer is B. Small squamous cell
vaginal cancers in the upper portion of the vagina
are often treated by surgical excision,
which consists of radical hysterectomy, upper
vaginectomy, and bilateral lymph node dissection.
However, resection of malignancies in the
lower portion of the vagina is diffi cult, and the
primary treatment is radiation therapy. Early
stage cancers may be treated solely with
brachytherapy, but more advanced cancers are
treated with external beam radiation.
Answer A is incorrect. Several chemotherapeutic
agents have been studied for use in advanced
vaginal cancer, but none have been
found to initiate a signifi cant therapeutic response.
Some experts advocate the use of chemotherapy
in addition to radiation therapy,
although randomized controlled trials investigating
this issue did not fi nd compelling evidence
to support this position.
Answer C is incorrect. Surgical resection of
cancer in the lower vagina is diffi cult, and the
primary modality of treatment is radiation therapy.
Answer D is incorrect. Lower vaginal cancers
are not amenable to surgical resection, and
chemotherapeutic agents are of limited use in
the treatment of vaginal cancer.
Answer E is incorrect. The technical diffi culty
of resection of lower vaginal cancers precludes
surgical treatment for this disease.

[Novobiocin]

I think this QBank is outdated.
Treatment depends on stage and not the site.
Read UW QID:3745

[K06100]

Originally Posted by Novobiocin

I think this QBank is outdated.
Treatment depends on stage and not the site.
Read UW QID:3745

yep ...u r right sir....

also the qbank is outdated (2009 edition )

but m still doing bcoz it has lot of other good questions ....

[step_enhancer]

Then the right answer is B

can we do surgery in this patient ?

http://www.cancer.org/Cancer/Vaginal...eating-surgery

Surgery is usually only used for small stage I tumors and for cancers that were not cured by radiation. Surgery is not often used to treat squamous cell cancers of the vagina, but it is used for sarcomas and melanomas.

The extent of the surgery depends on the size and stage of the cancer.

Surgery is sometimes used to remove the cancer, but most patients are treated with radiation. If the tumor is cervical cancer that has spread to the vagina, then radiation and chemotherapy are both given.