Is there an Association between Vaginal Cancer and Genital Prolapse? A Data-Analysis and Review of Literature

Purpose: Primary vaginal cancer represents a rare disease. The main risk factor for vaginal carcinoma is a persistent human papillomavirus (HPV) infection. However, chronic mechanic irritation of the vagina, have long been suspected to contribute to the development of vaginal cancer. This study examined to assess possible associations between genital prolapse and the incidence of vaginal cancer. Methods: We conducted a systematic literature search regarding the association between vaginal cancer and genital prolapse, supplemented with our own data set of the Centre for Gynaecological Oncology of the Ortenau Clinic Offenburg. Results: Our case analysis of prolapse-associated vaginal carcinomas corresponds to a large extent with the total collective of vaginal carcinomas. The most frequent histological subtype was squamous cell carcinoma in 90%. The median age of patients with genital prolapse-associated vaginal carcinomas was 75 years (72.9 ± 12.1 years). However prolapse associated vaginal cancers had FIGO stage IV more often than cases of vaginal cancer in general. FIGO stage I was reported as most frequent (39%). FIGO stage IV was the second most frequent stage in prolapse associated cases (25%). Furthermore, the Kaplan-Meier curves are significantly different from unselected vaginal cancer cases. In the prolapse associated cases FIGO stages I and II have a far better disease-free survival; in contrast, the prognosis in the advanced stages is much worse. Conclusion: In addition to the HPV infection, patients with genital prolapsed and those with ongoing systemic corticosteroid therapy or other immunocompromising medications, should be perceived as risk groups and regularly examined.