Loading
Vaginal adenocarcinoma is a rare glandular form of vaginal cancer, best known through the clear cell type that struck young women whose mothers took the hormone DES in pregnancy. Unlike the common squamous form it is not caused by HPV, it is treated with surgery where possible because it often affects young women, and radiotherapy and platinum chemotherapy are used when it is advanced.
Adenocarcinoma of the vagina is uncommon and heterogeneous. The clear cell type arises from adenosis, glandular tissue left in the vagina when the Müllerian epithelium fails to be replaced, and in 1971 Arthur Herbst linked a cluster of cases in teenagers and young women in Boston to their mothers' use of diethylstilboestrol (DES) in early pregnancy, the first proof that a drug taken in pregnancy could cause cancer in the child decades later. DES was withdrawn for that use the same year; exposed women carry a lifetime risk of about one in a thousand, most tumours appeared between the ages of 15 and 30, and cases still occur as the cohort ages. Sporadic clear cell, endometrioid, mucinous and mesonephric adenocarcinomas also arise, usually in older women, and any vaginal adenocarcinoma must first be shown not to be a metastasis from the endometrium, cervix, ovary or bowel.
Treatment follows the same stage-based principles as squamous cell carcinoma, but with a greater place for surgery because patients with DES-associated disease were young and fertility and vaginal function mattered: radical vaginectomy or hysterectomy with lymphadenectomy for early upper-vaginal tumours, sometimes with vaginal reconstruction, and radiotherapy with brachytherapy for larger or lower tumours or after surgery. Clear cell tumours spread to lymph nodes early and can recur late, so follow-up is prolonged. Advanced or recurrent disease is treated with platinum-based chemotherapy, extrapolating from clear cell cancers of the ovary and cervix, and immunotherapy is being explored because clear cell carcinomas at other sites respond in a minority. The DES story remains the model for transplacental carcinogenesis and led to lifelong surveillance programmes for exposed daughters.
A small minority of vaginal cancers; the clear cell form appeared as an epidemic in young women exposed to diethylstilboestrol before birth between the 1940s and 1971 and is now rare, while adenocarcinomas in older women are usually metastases rather than primaries.
Most high-grade ovarian cancers begin at the tip of the fallopian tube; endometrial cancer lines the uterus, cervical cancer starts at the transformation zone; each drains to a different node group.
Same organ: Adenosquamous carcinoma of the cervix, Small cell neuroendocrine carcinoma of the cervix, Bartholin gland carcinoma, Vulvar melanoma, Vaginal melanoma, High-grade serous ovarian cancer, Low-grade serous ovarian cancer, Clear cell ovarian cancer, Mucinous ovarian cancer, Adult granulosa cell tumour of the ovary, Ovarian cancer, Endometrial cancer, Cervical cancer, Vulvar cancer, Gestational trophoblastic neoplasia, Uterine sarcoma, Vaginal cancer, POLE-ultramutated endometrial cancer, Mismatch-repair-deficient endometrial cancer, p53-abnormal endometrial cancer, including uterine serous carcinoma, Endometrial cancer with no specific molecular profile, Advanced or recurrent endometrial cancer, Uterine carcinosarcoma, Early cervical cancer and fertility-sparing surgery, Locally advanced cervical cancer, Recurrent or metastatic cervical cancer, Platinum-sensitive ovarian cancer, Platinum-resistant ovarian cancer, HPV-associated vulvar squamous cell carcinoma, HPV-independent vulvar squamous cell carcinoma (p53-mutant), Vaginal squamous cell carcinoma (HPV-associated), Low-risk gestational trophoblastic neoplasia (FIGO score 0 to 6), High-risk gestational trophoblastic neoplasia (FIGO score 7 or more, including ultra-high-risk), Placental-site trophoblastic tumour and epithelioid trophoblastic tumour
Nothing recorded yet.
Nothing recorded yet.
Also on OnCo: Symptoms and red flags · Early detection roadmap.
Biopsy with immunohistochemistry to exclude metastasis; MRI and PET-CT staging; DES exposure history.
Radical vaginectomy or radical hysterectomy with lymphadenectomy, with vaginal reconstruction and ovarian preservation where appropriate; adjuvant radiotherapy for close margins or positive nodes.
External beam radiotherapy with brachytherapy, with concurrent cisplatin by extrapolation from cervical cancer.
Platinum-based chemotherapy (carboplatin and paclitaxel); checkpoint inhibitors for mismatch-repair-deficient or PD-L1-positive tumours; pelvic exenteration for isolated central recurrence.
Lifelong annual gynaecological examination with cytology of the cervix and vagina and colposcopy of adenosis.
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
The treatment pathway on the vaginal cancer pages, radiotherapy with brachytherapy and cisplatin sensitisation for locally advanced disease, follows this report.
Clear cell adenocarcinoma of the vagina is the archetype of a cancer caused by exposure before birth; DES-exposed daughters still need lifelong gynaecological surveillance, and the paper is the reason drugs in pregnancy are now scrutinised for effects on the child.
Query for this cancer: (TITLE:"Vaginal adenocarcinoma" OR ABSTRACT:"Vaginal adenocarcinoma" OR TITLE:"including DES-associated clear cell adenocarcinoma" OR ABSTRACT:"including DES-associated clear cell adenocarcinoma" OR TITLE:"Clear cell adenocarcinoma of the vagina" OR ABSTRACT:"Clear cell adenocarcinoma of the vagina" OR TITLE:"DES-associated vaginal cancer" OR ABSTRACT:"DES-associated vaginal cancer" OR TITLE:"Mesonephric and endometrioid adenocarcinoma of the vagina" OR ABSTRACT:"Mesonephric and endometrioid adenocarcinoma of the vagina") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Vaginal adenocarcinoma (including DES-associated clear cell adenocarcinoma), not a curated reading list.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
Dose by Calvert formula using GFR (see the calculators).
Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
During chemotherapy a temperature over 37.5 C or below 36 C, shivering, or feeling unwell even with a normal temperature means ringing the hospital's 24-hour line straight away; breathing very fast, confusion, mottled skin or no urine in a day means 999.
See all on the product pages:CarboplatinCisplatinPaclitaxel / nab-paclitaxelPembrolizumab·Printable cards in the navigator
Newly diagnosed? Read the first 60 days with Vaginal adenocarcinoma, then print the one-page appointment sheet with room for the answers.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record.
Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked.