Pelvic organ prolapse and vaginal cancer: A systematic literature review

Abstract

Background: Primary vaginal cancer is a rare gynecologic malignancy. Few cases describing the concurrence of a vaginal tumor with advanced genital prolapse are reported in the literature and there is no consensus on optimal treatment.

Objectives: To investigate available evidence on presentation, treatment, and outcomes of these concurrent conditions.

Search strategy: We performed a systematic search of literature indexed on PubMed, Scopus, ISI Web of Science, and Cochrane using a combination of keywords and text words represented by "pelvic organ prolapse", "genital prolapse", and "vaginal cancer", "vaginal carcinoma".

Selection criteria: No article type restrictions were applied.

Data collection and analysis: Twenty-one studies (case reports and two small case series) were incorporated into the review process, for a total of 27 patients.

Main results: Management usually involved surgery or primary external beam radiation therapy. External beam radiation therapy was reported to be highly associated with the development of vesicovaginal fistula. A surgical approach was the treatment of choice in most cases. Exclusive interstitial brachytherapy was rarely performed.

Conclusion: A multidisciplinary approach considering risks and benefits is of the utmost importance to provide counseling and tailor treatment strategy in these complex cases.

Keywords: pelvic floor disorders; pelvic organ prolapse; pelvic reconstructive surgery; radiotherapy; systematic review; vaginal cancer.