Dysplasie de haut grade (VAIN)
Les dysplasies de haut grade sont des lésions précancéreuses du vagin. Une exploration par vaginoscopie (microscope permettant de détecter des lésions non visibles à l’œil nu) peut être parfois nécessaire pour déterminer l’extension locale de la maladie. En fonction de l’extension, des caractéristiques de la maladie et de l’âge, un traitement par vaporisation laser, ou un traitement chirurgical seront proposés. La plupart des dysplasies de haut grade qui sont traitées n’évoluront pas vers un cancer.
Pour vous aider
Des associations informent les patients et les familles :
AMARAPE, association des maladies rares du péritoine (Lyon)
www.amarape.com
Tél. : 04 78 86 59 84
IMAGYN, Initiative des malades atteintes de cancers gynécologiques (Paris)
Tél. : 01 42 34 83 23
RENAPE, Réseau National de prise en charge des Tumeurs Rares du Péritoine
Tél. : 04 78 86 45 36
Vaginal cancer
The vagina is the internal part of a woman’s genitals that connects the vulva (the external part) to the uterus. Vaginal cancer accounts for less than 1% of gynecological cancers and mostly affect older women. It is most common in women between the ages of 60 and 70. The risk factors for vaginal cancer are the same as those for cervical cancer: HPV (human papillomavirus) infection, HIV infection, and smoking, which favors the persistence of HPV infections
Diagnosis
The main symptom is bleeding between periods, especially after sexual intercourse. Other possible symptoms include pain during sex, stomach pain and, if the disease has spread to the bladder, painful and/or frequent urination. Diagnosis involves a pelvic examination and a biopsy, sometimes carried out under general anesthetic. In all cases, an MRI scan of the pelvis is carried out. This may be combined with a PET scan if the tumor is locally advanced.
Treatment
Once the diagnosis has been made, each case is discussed at a multidisciplinary team (MDT) meeting, during which the specialists involved in treating vaginal cancer decide on the most appropriate treatment options for each patient. Treatment usually involves surgery and radiotherapy.
The medical team may ask if you would be prepared to take part in a clinical trial. As well as giving patients the opportunity to benefit from a new form of treatment, clinical trials may be used to improve understanding of how cancer arises and develops, or to evaluate patients’ quality of life and see how it can be improved.
If the lesion is in the upper third of the vagina, the tumor will be treated as a cervical tumor. Small tumors in the upper part of the vagina are treated by surgery to remove the uterus, vagina and pelvic lymph nodes. If your vagina has to be completely removed, you will be offered reconstructive surgery. At the IUCT-Oncopole, we provide a full range of complex reconstruction techniques, sometimes in conjunction with our plastic surgery team, in order to preserve your body image and the function of the vagina.
If the tumor is in the middle third or lower third of the vagina, treatment will primarily involve radiotherapy and brachytherapy. However, depending on how the cancer responds to these treatments, you may still need to have surgery.
Radiotherapy uses ionizing radiation to destroy cancer cells. Two radiotherapy techniques are used to treat vaginal cancer: external radiotherapy and brachytherapy, usually in association.
External radiotherapy: Before treatment begins, a 3-dimensional scan of the tumor (or the affected area) and neighboring organs, which have to be protected, is taken in order to define the area to be treated (preparation stage). A medical physicist then calculates the dose of radiation you will receive and how this does will be distributed (dosimetry stage). This is why there is always a waiting period between the decision to use radiotherapy and the start of the treatment.
A course of radiotherapy usually lasts 5 to 6 weeks and involves 25 radiotherapy sessions, provided from Monday to Friday (5 sessions a week). Each session lasts 15 minutes. Most of this time is spent checking the positioning and targeting of the radiation. The actual treatment time is very short. Radiation is invisible and the treatment is completely painless, so you will not feel a thing. Radiotherapy sessions do not make you radioactive and you do not have to take any precautions with respect to the people around you when the session is over.
Brachytherapy: This is a form of internal radiotherapy in which radiation is applied directly to the area being treated. It involves inserting an applicator, under general anesthetic, so it is in contact with the tumor, and then injecting a radioactive material (iridium) through it. Compared with external radiotherapy, brachytherapy targets radiation precisely on the vagina, thereby allowing higher doses to be used while preventing harm to healthy organs. Brachytherapy requires a short stay in hospital (2 or 3 days), because the radioactive source is injected through the applicator for 15 to 30 minutes every hour. You must remain lying down throughout the treatment, but you are isolated only during the periods in which the radiation is injected. As a result, you are free to receive visits from healthcare staff and from family and friends for 30 minutes every hour. You will not be radioactive, even during the treatment periods, and your room will be a traditional hospital room apart from the presence of an afterloader (machine that delivers the radiation dose).
Brachytherapy may seem restrictive because you have to remain lying down throughout, but it is entirely painless, so you won’t feel a thing during treatment sessions. In addition, no anesthetic is needed to remove the applicator. The nursing staff will answer any questions you may have.