Recurrent Vaginal Cancer
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|What Does A Recurrence Mean?
Recurrent cancer of the vagina means that cancer has come back after it has been treated. The cancer may come back in the vagina or in other parts of the body. There is no clearly defined timeline as to what constitutes a recurrence. There is for example a difference between recurrence and progression. Progression is where cancer continues to grow after treatment, although symptoms may not be immediately apparent. The doctor will question - if cancer seems to be gone for 3 months and then reappears, it is a recurrence or was it really ever gone? It may be difficult to say. However there is a general consensus among medical experts that if symptoms of vaginal cancer recur within a few months of treatment it is likely to be progression. In such cases it may be that the original vaginal cancer treatment left behind some small clusters of cancer cells which were not large enough to picked up by imaging and blood tests. These cells then grew until symptoms returned. Or it may be that the tumor was resistant to the original therapy and that the chemo (see Chemotherapy Guide) killed some but not all of the cancer cells. Most medical experts generally agree that for cancer to be considered recurrent, there has to be no sign of it for one year. Otherwise, it is assumed that it was not really cured in the first place. See, also what does cancer remission mean?
A prognosis describes the likely outcome and probability of survival for a patient (see vaginal cancer survival rates). Most recurrences of vagina cancer occur in the first 2 years after the original treatment. The longer the woman can live cancer free, the less her chance of a recurrence becomes. One large study reported that only 5 out of 50 patients with recurrent vaginal cancer were 'salvaged' by surgery or radiation therapy. This statistic indicates that the prognosis is grave for cases of recurrences. Women diagnosed with a recurrence should check the National Cancer Institute's (NCI) website for cancer clinical trials accepting patients with recurrent vaginal cancer. Experimental treatments and therapies may be worth pursuing.
What Are The Symptoms?
If the recurrence is centrally located in the vagina, it may be treated by radiation therapy. Radiosensitizers may also be used. A radiosensitizer is a drug (such as tetrahydrouridine and cytochlor) which makes tumor cells more sensitive to radiation therapy. Chemo drugs such as cisplatin work in a different way, they operate by either killing cancer cells directly or stopping them from dividing. Radiosensitizers are sometimes used in combination with chemotherapy for other types of cancers. If radiation is not an option, some patients may be a candidate for pelvic exenteration. This is a highly radical surgery and usually only considered as a treatment of last resort. It can involve removing the entire vagina, lower colon, bladder, uterus, rectum and cervix. How much organ tissue is removed will depend on the extent of the cancer (see vaginal cancer treatment for more details).
According to a study published in the BioMed Central Journal Radiation Oncology (2008), high dose rate brachytherapy (HDRB) appears to be effective in treating patients with both primary and recurrent cases of vaginal cancer. Brachytherapy is a form of internal radiation where implants are physically inserted into a cavity in the body and left to emit doses of radiation. It is sometimes used for endometrial cancer treatment and other gynecologic cancers. The study examined 6 patients with primary vaginal cancer and 12 with a recurrence. Researchers concluded that the overall survival rate for recurrent patients was significantly improved with the aid of HDRB. The rate was even higher again for those patients who had not received prior external radiation therapy to the pelvic area. Pelvic radiotherapy seemed to lower the response rate and increased the risks of complications. However, further follow-up studies are still needed. One problem is that the incidence rate of recurrent vaginal cancers is so low it makes it difficult for any large scale studies to be carried out.
Interesting Statistics. Did You Know....
According to the Centers for Disease Control and Prevention (CDC) 2010 report on the Nations health, 37 percent of uninsured Americans delayed seeking medical care due to cost within the past year. This compared to 12 percent for those with private insurance and 14 percent with Medicaid. The combined amount of people not taking needed prescription drugs for the same reason was 11 percent and those not receiving needed dental care was 17 percent.
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