June 2004 · Vol. 16, No. 6Vaginal intraepithelial neoplasia: Risky and underrecognized
Hysterectomy for cervical neoplasia, radiation for cervical carcinoma, and chronic immunocompromise heighten risk—and both diagnosis and treatment can be tricky.
MITCHEL
S.
HOFFMAN,
MDDr. Hoffman is professor and director, department of obstetrics and gynecology, division of gynecologic oncology, University of South Florida College of Medicine,
Tampa, Fla.
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KEY POINTS
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Most women diagnosed with vaginal intraepithelial neoplasia (VAIN) have a history of cervical intraepithelial neoplasia.
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Compelling clinical and laboratory data indicate a causal relationship between human papillomavirus and VAIN.
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Like its cervical counterpart, VAIN 3 is thought to have substantial potential to progress to invasive cancer.
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Diagnosis includes careful gross and colposcopic inspection of the entire vagina (with mapping of involved areas), representative colposcopically directed biopsies, and careful palpation of the vaginal walls, especially the vaginal cuff scar.
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Important factors to consider when selecting appropriate treatment for women with VAIN include prior hysterectomy, prior radiation therapy, age, whether she is sexually active, comorbidities, vaginal anatomy, and prior treatments.
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We can easily identify vulvar intraepithelial neoplasia (VIN): The patient complains of itching and has a visible lesion. We find cervical intraepithelial neoplasia (CIN) by investigating an abnormal Pap test. But what about vaginal intraepithelial neoplasia (VAIN)? It does not itch and is invisible to the naked eye. A Pap test sometimes catches it, although this test is used mainly to screen for CIN, not VAIN.
VAIN just does not grab our attention. It is uncommon, and invasive vaginal cancer is rare. But before you slip this article into the “obscure disease” file, consider the following:
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