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History of hysterectomy and vaginal cancer. Done vulvectomy. Chemotherapy advised. Want opinion

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Answered by

OBGYN, Gynecologic Oncology
Practicing since : 1984
Answered : 99 Questions
Hi Doctor,
This is regarding my mother cancer treatment
For Quick Reference
1.She underwent Hysterectomy in Dec 2010 [Biopsy Impression was Severe Dysplasia]
2.She underwent Radiation and chemo for Ca Vault of vagina in July 2012 [One & Half Year Later after operation;since there was cancer in vagina]
3.In May 2013 she had some problem and the tests that were done by doctor are Vulval Biopsy and Pap-smear
4.In XXXXXXX 2013,the doctor has performed Total Vulvectomy and he had a doubt that the recurrence of cancer might also occur in vagina based on pap-smear report.[He told that,as of now clinically it is clear by looking the patient vagina,but chances of recurrence is greater as per pap-smear report]

Sending All reports.
Now, the oncologist has advised Chemotherapy treatment [6 cycles of TPF in cycle gap of 21 days];2nd cycle of treatment is completed.
Can you please give Opinion on this chemo treatment and is there a chance to undergo further radiation?The Surgical Doctor has said that no further radiation can be given to her as she had earlier radiation for ca Valut of Vagina.

From the Biopsy Report of Vulva,is the cancer confined to it (or) is there re-occurence in vagina?can you please let me know.

Attached pap-smear,Vulval Biopsy & Vulvectomy Histopathology report's
Not able to attach the old reports,please let me know if they are required,i will send via mail
FYI:PET scan was done in Feb 2013 and every thing was normal at that time

Posted Fri, 16 Aug 2013 in Cervical and Ovarian Cancer
Answered by Dr. Manjunath L Ramarajapalli 8 hours later

I went through all the reports and history.

Good news? is that PET scan done in Feb 2013 was normal. But I am wondering why it did not pick up vulval cancer of 3.5 x 0.5 x 0.5 cm which was operated in XXXXXXX 2013.

Chemotherapy is given in squamous cell cancers as palliative care. It itself cannot cure this disease.
I advise you to take second opinion of the histopathology slides and let your mother be examined by another specialist.

Let me know if you need further clarification about this regards.

Good luck
Above answer was peer-reviewed by
Follow-up: History of hysterectomy and vaginal cancer. Done vulvectomy. Chemotherapy advised. Want opinion 17 hours later
Hello Doctor,

Thanks for your reply.

I have couple of questions.

1.From the histopathology report of the vulva after operation in XXXXXXX 2013;Is the cancer confined only to vulva (or) spread to vagina?

2.From the pap-smear report which was done in May 2013,Is the Cancer of Vagina reoccured?
[In July 2012 the radiation has finished for Ca Vault of Vagina]
The doctor has examined now and said that clinically there is no disease and the recurrence is high as per the latest pap-smear report.

3.Form the PET Scan can it detect the vulva cancer,as the cancer has been on the right side of the vulva,which is the external part of the body?

Thanks in Advance,
Answered by Dr. Manjunath L Ramarajapalli 58 minutes later

My answers as follows:

1. Based on the report, it looks confined to the vulva.

2. Biopsy would be confirmatory as pap is a screening test only. Therefore go by the biopsy report.

3. PET scan can detect vulval cancer.

Hope I answered your question. Let me know if you need further clarification.

Good luck...
Above answer was peer-reviewed by
Follow-up: History of hysterectomy and vaginal cancer. Done vulvectomy. Chemotherapy advised. Want opinion 1 hour later
Hi Doctor,

Many Thanks for your reply.

Few more doubts please

1. To confirm whether the cancer is there in the vagina (or) not,we need to undergo vaginal biopsy right?
we cant confirm with pap-smear report;is this right?

2.Can PET Scan detect vulval cancer,if the stage of it is VIN3?

3.Instead of Vaginal Biopsy,if we undergo PET SCAN again,will it detect Vaginal Cancer which is confined to vagina? (or) we need to undergo only vaginal biopsy to confirm it?

4.Can further radiation be given to her? [Either radiation to vulva (or) vagina]
Since she has earlier received radiation to vagina in July 2012.


Answered by Dr. Manjunath L Ramarajapalli 15 hours later
1 The presence of cancer in the vagina is confirmed by biopsy only.Pap smear is screening test only and it gives clue to investigate further if it is abnormal.
2 VIN3 is microscopic disease (vulva looks normal to naked eye).Your mother's case was invasive vulval cancer.PET may show hot spots (cancer,infection etc.).
3 Vaginal biopsy is the standard to confirm cancer.Diagnostic tests like PET,MRI,CT scan suggest abnormal areas from which biopsy has to be done to confirm the disease.
4 Regarding radiation if any area has received radiation previously further radiation is not given to that area because of permanent changes (damage to tissues).
Good luck
Above answer was peer-reviewed by
Follow-up: History of hysterectomy and vaginal cancer. Done vulvectomy. Chemotherapy advised. Want opinion 26 hours later
Hi Doctor,

Many Thanks for the reply.
Please suggest which doctor to XXXXXXX for second opinion.

1.So,if we want to go the second opinion for the TPF chemo treatment that we are taking for my mother now,should we consult Medical Oncologist (or) Surgical Oncologist.Please suggest

2.Since we don't have Vaginal biopsy done,to confirm the disease in vagina,we can ask the concerned doctor to make it done right?

Answered by Dr. Manjunath L Ramarajapalli 29 minutes later

1. XXXXXXX any Gynec-oncologist at your place for second opinion
2. Good to consult medical oncologist for chemotherapy is preferred.
3. And yes, ask for biopsy.

Good luck
Above answer was peer-reviewed by
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