Management of Vaginal Intraepithelial Neoplasia

Gurumurthy, Mahalakshmi; Cruickshank, Margaret

doi:10.1097/lgt.0b013e31823da7fb

Cited by 60 publications

(48 citation statements)

References 37 publications

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“…Management of patients with VaIN requires an individualized treatment plan [13] and a conservative approach is appropriate for VaIN1 and most VaIN2 lesions, while laser vaporization is usually the most effective treatment for small VaIN2/3 lesions. However, we have no data to suggest that laser-skinning colpectomy can entirely replace conventional, radical colpectomy or if cases with deep involvement of the hysterectomy scar may finally benefit from a more radical approach.…”

Section: Discussionmentioning

confidence: 99%

“…There is a broad consensus that patients with low-grade disease (VaIN1) should be managed conservatively without any ablative or destructive treatment, or with topical intravaginal application of estrogen [12][13][14]. A similarly conservative approach is appropriate for the majority of patients with VaIN2 and selected cases with VaIN3 lesions.…”

Section: Introductionmentioning

confidence: 99%

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Laser-skinning colpectomy for extended vaginal intraepithelial neoplasia and microinvasive cancer

Luyten

Hastor

Vasileva

et al. 2014

Gynecologic Oncology

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Laser-skinning colpectomy for extended vaginal intraepithelial neoplasia and microinvasive cancer

Luyten

Hastor

Vasileva

et al. 2014

Gynecologic Oncology

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“…(42, 43) In our experience, the most common therapies include CO2 laser ablation and excision/vaginectomy. Topical options can be considered for patients who are not good surgical candidates, however side effects such as burning and irritation may limit their tolerance.…”

Section: Discussion/guidancementioning

confidence: 99%

A common clinical dilemma: Management of abnormal vaginal cytology and human papillomavirus test results

Khan

Massad

Kinney

et al. 2016

Gynecologic Oncology

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Objective Vaginal cancer is an uncommon cancer of the lower genital tract, and standardized screening is not recommended. Risk factors for vaginal cancer include a history of other lower genital tract neoplasia or cancer, smoking, immunosuppression, and exposure to diethylstilbestrol in utero. Although cervical cancer screening after total hysterectomy for benign disease is not recommended, many women inappropriately undergo vaginal cytology and/or human papillomavirus (hrHPV) tests, and clinicians are faced with managing their abnormal results. Our objective is to review the literature on vaginal cytology and hrHPV testing and to develop guidance for the management of abnormal vaginal screening tests. Methods An electronic search of the PubMed database through 2015 was performed. Articles describing vaginal cytology or vaginal hrHPV testing were reviewed, and diagnostic accuracy of these tests when available was noted. Results The available literature was too limited to develop evidence-based recommendations for managing abnormal vaginal cytology and hrHPV screening tests. However, the data did show that 1) the risk of vaginal cancer in women after hysterectomy is extremely low, justifying the recommendation against routine screening, and 2) in women for whom surveillance is recommended, e.g. women post-treatment for cervical precancer or cancer, hrHPV testing may be useful in identification of vaginal cancer precursors. Conclusion Vaginal cancer is rare, and asymptomatic low-risk women should not be screened. An algorithm based on expert opinion is proposed for managing women with abnormal vaginal test results.

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“…For example, restricting the application of a drug to a specific lesion within the cervicovaginal canal (e.g., intraepithelial neoplasia) without affecting normal tissues may be a challenging task [9][10]. Highly toxic drugs such as those used for the treatment of neoplastic lesions (e.g., imiquimod, 5-fluorouracil, and tricholoroacetic acid) are usually formulated as mucoadhesive solid or semi-solid systems and restricted placement at the site of interest by a physician is advised [10]. However, retention is often not completely achieved as re-distribution and leakage within the vagina occur due to fluid dynamics and natural biomechanical forces [11].…”

Section: Introductionmentioning

confidence: 99%

Polymer-based nanocarriers for vaginal drug delivery

Neves

Nunes

Machado

et al. 2015

Advanced Drug Delivery Reviews

117

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The vaginal delivery of various drugs is well described and its relevance established in current medical practice. Alongside recent advances and achievements in the fields of pharmaceutical nanotechnology and nanomedicine, there is an increasing interest in the potential use of different nanocarriers for the delivery of old and new pharmacologically active molecules with either therapeutic or prophylactic purposes. Nanosystems of polymeric nature in particular have been investigated over the last years and their interactions with mucosal fluids and tissues, as well as genital tract biodistribution upon vaginal administration, are now better understood. While different applications have been envisioned, most of the current research is focusing in the development of nano-formulations with the potential to inhibit the vaginal transmission of HIV upon sexual intercourse. The present work focuses its discussion on the potential and perils of polymer-based nanocarriers for the vaginal administration of different pharmacologically active molecules.

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Management of Vaginal Intraepithelial Neoplasia

Cited by 60 publications

References 37 publications

Laser-skinning colpectomy for extended vaginal intraepithelial neoplasia and microinvasive cancer

Laser-skinning colpectomy for extended vaginal intraepithelial neoplasia and microinvasive cancer

A common clinical dilemma: Management of abnormal vaginal cytology and human papillomavirus test results

Polymer-based nanocarriers for vaginal drug delivery

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