Primary vaginal cancer after hysterectomy

We sought to examine the patients who developed vaginal cancer after prior hysterectomy and to determine whether any of these cancers could have been prevented.

The records of patients treated with vaginal cancer over a 15-year period in the Department of Gynecologic Oncology at the Mercy Hospital for Women were reviewed. Those patients who had developed a vaginal cancer after hysterectomy between 1980 and 1994 were identified.

A total of 1,511 primary gynecological cancers were treated between 1980 and 1994, and 23 (1.5%) were primary vaginal cancers. Of these 23 patients, 13 had had a prior hysterectomy (57%). Four of the 13 patients (31%) were asymptomatic and presented after routine vault smears, and 9 were symptomatic and were diagnosed after further investigation. All 13 patients had squamous cell cancers. Two patients had had a history of cervical intraepithelial neoplasia (CIN) grade 3 reported on cervical smear but not been accounted for, both cone biopsy and hysterectomy having found no histological abnormality.

Primary vaginal cancer is uncommon. After hysterectomy, vaginal vault cytology should continue to be performed if high-risk factors, such as history of lower genital tract neoplasia, are present. The two patients with unaccounted-for CIN3 reported on Papanicolaou smear may have had undiagnosed vaginal intraepithelial neoplasia grade 3 (not CIN3) resulting in vaginal cancers 10 and 15 years later. Therefore, when colposcopy is being performed to investigate an abnormal Pap smear, the entire lower genital tract always should be examined.