Guest Author - Dr. Denise Howard
Malignancy of the birth canal (BC) is extremely rare, representing 3% of cancers of the female genital tract. This is probably one of the least discussed reproductive organ cancer yet it too can be devastating causing significant morbidity and mortality. The risk factors and symptoms are discussed in this article.
The incidence of cancer of the BC is about 1 per 100,000 women. There are approximately 2900 new cases per year in the U.S. and 800 deaths. It is unusual for cancers to occur here as a primary site. The majority of these are metastasis from other sites such as the cervix, endometrium, vulva, ovary, breast and other organs.
The mean age of women who develop cancer of the BC is 60. Women who are older are at a higher risk of developing this malignancy. Other risk factors include smoking and multiple lifetime sexual partners. As with genital tract cancers, human papilloma virus (HPV) appears to contribute to a significant number of these cancers. HPV antibodies have been identified in more than 50% of women with this malignancy. Thus, women with a history of severe cervical dysplasia, HPV infection and vulvar cancer are also at higher risk of developing cancer of the BC.
The symptoms of this cancer are variable and typically reflect its site of involvement. Postmenopausal bleeding and postcoital bleeding are common early symptoms. Other complaints include a watery, blood tinged or malodorous discharge. A genital mass maybe noted by the woman or she might report symptoms of the urinary or gastrointestinal tract. These symptoms may include pain with urination or defecation, blood in the urine or stool and frequent urination or constipation. Pelvic pain maybe described in 5% of the cases and this is usually a reflection of spread beyond the BC.
Interestingly, 20% of women will not have symptoms and the cancer might be found on routine gynecologic examination. The examiner may unexpectedly find a mass, plaque, or an ulcer. The masses maybe nodular or fleshy and may grow beneath or above the surface. Any suspicious lesion should be biopsied and a thorough assessment of the entire genital tract needs to be done since these cancers can be multifocal and multicentric.
There is also a tendency for these to occur at specific sites in the canal. 50% occur on the posterior wall as opposed to the anterior wall while 50% occur in the upper canal, 20% in the mid-canal and 30% in the lower portion. The importance of a routine gynecologic examination cannot be overstressed. Many early cancers of the female genital tract are detected on routine screening. Every woman, even those past the reproductive age should have a gynecologic exam on a regular basis.
I hope this article has provided you with information that will help you make wise choices, so you may:
Live healthy, live well and live long!