Vaginal cancer after hysterectomy for benign disease: value of cytologic screening

Of 87 patients who were treated at the author's institution for primary cancer of the vagina, 31 had undergone total hysterectomy for benign disease. In this group of 31 patients, vaginal bleeding was the most common presenting symptom, although there were eight patients who were entirely asymptomatic and were diagnosed on routine examination. The stage of cancer was more advanced in the symptomatic patients than in the asymptomatic patients. There were seven patients with stage 0 disease, and four of these were asymptomatic and diagnosed by routine Papanicolaou smear. Overall, Papanicolaou smears were positive in 12 of 19 patients tested, a sensitivity rate of 63%. The authors recommend that patients who have a hysterectomy for benign disease continue to have Papanicolaou smears taken from the vaginal vault at regular intervals.