TREATMENT OPTIONS

The treatment option you and your doctor choose depends on:

Surgery


The most common treatment for early stage clear cell cancer is surgery. A typical treatment is a radical hysterectomy, which includes removal of the uterus with a partial or complete vaginectomy (removal of part or all of vagina), pelvic lymphadenectomy (removal of pelvic lymph nodes), and, when appropriate, replacement or reconstruction of the vagina (a method to make a new or "neo-vagina"). In most cases, one or both ovaries are saved.

WHAT TO ASK


Questions to ask your doctor about surgery:

Radiation


Sometime radiation is the preferred treatment. Radiation is usually used if the size or the location of the tumor makes complete surgical removal difficult. Larger cancers, that are difficult to reach surgically, have been successfully treated with full pelvic irradiation (external radiation) in addition to intracavity implants (internal radiation). Scarring or shrinkage of the vagina from radiation may be a problem and you should ask your doctor how this may affect vaginal function. Generally reconstruction of the vagina is not done after radiation and you may wish to discuss whether this remains an option.

WHAT TO ASK


Questions to ask your doctor about radiation:

"A radical hysterectomy is not an easy operation for anyone to undergo. Somehow you do get through it, and life does go on."

Local Surgery and Radiation


Occasionally it is possible to treat very small vaginal tumors (less than one inch in diameter) with less extreme treatment in which radiation and surgery are directed to a small area. This is sometimes called local irradiation with local surgery. These methods only work for a few appropriately selected patients.

Before surgical removal of the tumor, an abdominal incision is made to examine the pelvic lymph nodes for cancer. If no cancer is found in the nodes, local irradiation is given.

This combined local surgery and radiation is best suited to a tumor located in the vagina away from the cervix. A few clear cell cancer patients have had successful pregnancies after this treatment.

WHAT TO ASK


Here are questions to ask your doctor about local surgery and radiation:

Chemotherapy


There is no known effective regimen of chemotherapy alone as a treatment for clear cell cancer, yet chemotherapy may sometimes be recommended in conjunction with radiation and/or surgery.

If I had one message to give a DES daughter with clear cell cancer it is, "Don't give up, don't hide yourself, and do begin to help yourself."


WHAT TO ASK


Questions to ask your doctor about chemotherapy:

Vaginal Reconstruction


"Reconstruction" refers to rebuilding the vagina to create a new vagina (neo-vagina) after a vaginectomy (removal of all the vagina, or a portion of the upper vagina). Vaginal reconstruction is a method that is also used in instances when a child is born without a vagina.

If you have had, or will have, a full or partial vaginectomy, discuss with your doctor whether a reconstruction is a viable option for you. Although a reconstructed vagina is not the same as an original vagina, the new vagina has the ability to take on many of the characteristics of a normal vagina, so you will be able to engage in intercourse. It is expected that resumption of sexual intercourse will be difficult with a new vagina but eventually sexual responsiveness and relationship are possible. A new vagina lubricates less well and more slowly, so you may want to apply lubricating gel inside the vagina prior to intercourse.

There are a number of methods of vaginal reconstruction. The most common sources of tissue to create a new vagina are:
Each method of vaginal reconstruction has positives and negatives. A vagina that has been significantly surgically shortened, or a new vagina constructed with a skin graft, requires use of a vaginal stent or dilator to keep the new vagina stretched open. The dilator may need to be left in place throughout the day and night for many months after surgery. After about three months, the dilator can be used less frequently. The use of the dilator during healing is critical to ensuring optimal functioning of the vagina, but it is not unusual for the dilator to be an uncomfortable reminder of the surgeries and losses from cancer. Sexual intercourse may also help keep the vagina open. Without dilation or sexual intercourse, the new vagina may shrink.

A new vagina constructed from thigh muscle or from tissue in the lower abdomen (TRAM flap) does not require use of a dilator to stay open, because the blood vessels and nerves of the tissue remain attached. The new vagina is shaped by forming the tissue into a closed tube which is sewn into the area where the vagina has been removed. The muscle or TRAM flap "neo-vagina" is similar in size and shape to the original vagina. The tissue soon becomes very similar in appearance and function to the original vagina.

A new vagina made from intestinal tissue can maintain a natural interior shape and is more likely to produce lubrication. However, it may not work well for all women. It may produce mucus discharge and normal intestinal functioning may be compromised because a small part of the intestine has been removed. In some cases narrowing of the vagina has occurred after many years.

WHAT TO ASK


Questions to ask your doctor about reconstruction:

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