Methods
References from relevant articles for this review were identified by a search of PubMed using the term vaginal metastasis. All patients with metastasis to the vagina were classified according to the primary tumour areas, and patient characteristics were discussed.
Vaginal recurrence of colorectal cancer
Vaginal metastasis from CRC is very rare, and only 58 cases have been reported in the literature. Data were available for only 23 of these patients, while data for the remaining 35 patients were not available. The first clinical sign of vaginal metastasis in most patients was vaginal bleeding. Only 20 patients’ information on stages at the time of diagnosis was reported, and 5% (1/20) had stage I, 30% (6/20) had stage II, 50% (10/20) had stage III, and 15% (3/20) had stage IV disease. Forty-four percent of patients (10/23) whose data were available had metastases in other areas in addition to vaginal metastases. RT, surgery, and chemotherapy treatments were applied in various combinations to these patients with multiple metastases. And, 56% of patients (13/23) had isolated vaginal metastasis. The mean time from the first diagnosis of CRC to the detection of isolated vaginal metastasis in these patients was 15.2 months (range 3–24). Transvaginal wide excision was performed in 11 of 13 patients with the isolated vaginal metastases, and external beam RT (EBRT) was applied to the remaining 2 patients. Of the 11 patients who underwent the transvaginal wide excision, 3 received postoperative chemotherapy, 5 received postoperative RT, and the remaining 3 were followed without additional therapy [3].
Vaginal recurrence of renal cell cancer
Metastasis to the vagina from renal cell cancer (RCC) is extremely rare. The first case of RCC-originated vaginal metastasis described in the literature was reported by Penham in 1906, and less than 100 such cases have been reported in the medical literature to date. A firm solitary lesion was found in the lower third of the anterior vaginal wall in most of these patients. While vaginal metastasis in most of the cases was reported as a metachronous metastatic disease in a long-term period after radical nephrectomy, synchronous vaginal metastasis was described in only four patients [4]. The median age at diagnosis in the reported cases was 57 years (range 14–88). Clinical presentation in 65% of cases was due to vaginal leaking, bleeding, or mass effect. Vaginal metastases were usually solitary, and lesion size varied between 0.5 and 8 cm. The median survival was 19 months (range 1–96). Local excision and RT are the recommended treatment modalities for solitary vaginal metastasis in patients previously treated with radical nephrectomy [5].
Vaginal recurrence of gastric cancer
In the current literature, there is only one case with isolated vaginal metastasis of gastric cancer. The patient was operated with negative surgical margins for gastric cancer. Metastases were detected in the patient’s vagina and bladder wall in the 5th month after surgery, and chemotherapy was applied [6].
Vaginal recurrence of urothelial cancer
Metastasis of urothelial cancer to the vagina is extremely rare, and only 15 cases have been reported worldwide. While muscle invasion was reported in the surgical material of primary urothelial carcinoma in four of these cases, it was not reported in the remaining 11 patients. Synchronous metastasis developed in 2 patients and metachronous metastasis in 13 patients. The median time from urothelial cancer diagnosis to vaginal metastasis was 4.3 years (range 0–14). Endoscopic resection was performed in 11 patients, and total hysterovaginectomy in 2 patients. The prognosis was good, and relapse was rare in these cases [7].
Vaginal recurrence of bladder cancer
Vaginal cuff recurrence occurred in 34 of 469 women (7.3%) treated with radical cystectomy for bladder cancer. The 5-year overall mortality-free survival rate was 32.4% for isolated vaginal cuff recurrence and 25% for other recurrence sites. The cancer-specific mortality-free survival rate was 32.4% for isolated vaginal cuff recurrence and 30.3% for the other recurrence sites [8].
Vaginal recurrence of leiomyosarcoma
Three cases of uterine leiomyosarcoma spread to the vagina have been reported in the literature. All had one lesion, and the complaint was vaginal bleeding in all. Therefore, patients underwent surgery [9].
Vaginal recurrence of breast cancer
Only 3 cases of breast cancer that had metastases in the vagina have been reported in the current literature. Only one had data available. The stage of this patient who underwent lumpectomy plus axillary lymphadenectomy for invasive lobular breast cancer was T2N1M0. Hormone therapy was administered for 5 years after adjuvant chemotherapy and RT. She presented with vaginal bleeding approximately three years after the treatment was completed. There was no metastasis in other regions except the vagina. The patient was treated with adjuvant liposomal doxorubicin after complete resection of the mass by modified vaginectomy [10].
Vaginal recurrence of pancreatic cancer
In the literature, there are three cases of pancreatic cancer with vaginal metastasis. In all three patients, the diagnosis of primary pancreatic adenocarcinoma was made at the time of evaluation due to symptoms arising from vaginal metastasis [11,12,13].
Vaginal recurrence of lung cancer
Only one case with vaginal metastasis of lung adenocarcinoma was reported in the literature. The patient admitted with frequent urination 2 years after surgery for lung cancer and metastasis in the vagina was detected [14].
Vaginal recurrence of salivary duct carcinoma
In the literature, there was only one case in which vaginal metastasis of salivary duct carcinoma was detected [15].
Vaginal recurrence of endometrial cancer
In a study, it was reported that vaginal recurrence occurred in 30 patients who underwent hysterectomy for EC, and the median time to recurrence after surgery was 20.6 months (range 2–219). The most common site of recurrence was the vaginal apex (60%) followed by the distal vagina (10%). All of the patients received salvage RT in combination with EBRT and vaginal brachytherapy in 24 patients and as a single modality in 6 patients. And, concurrent chemotherapy was applied in 20 patients during the RT period [16]. In another study, disease recurrence was documented in 14.5% (40/273) of patients with EC. The most frequent subtype was endometrioid subtype, and 30% of them had isolated vaginal relapses. The majority of patients had grade 2 and stage 1C disease at the time of initial diagnosis [17]. In a multicentre randomised study in which 714 patients with early-stage EC were evaluated, it was reported that isolated vaginal recurrence occurred in 5% of patients (37/714). While 30 of these patients did not receive RT at the time of initial diagnosis for EC, the remaining 7 received RT [18].
Carcinomas of the vagina are rare tumours involving approximately 1–3% of cancers occurring in the female genital tract [19]. The majority of vaginal malignancies are metastatic, often arising from the endometrium, cervix, vulva, ovary, breast, rectum, and kidney [20,21,22,23]. Vaginal metastases may occur by a direct extension (especially from endometrium, cervix, and vulva) or lymphatic or hematogenous spread [24, 25]. Ninety percent of EC are adenocarcinomas, and most primary vaginal cancers are SCC [26]. Therefore, histopathological examination is essential for an accurate diagnosis. Besides, when the literature was reviewed, we saw that the term of vaginal involvement could also be used for vaginal metastases, but we used the term vaginal metastasis because it is the most commonly used term for these patients.
