Clear-cell carcinoma of the vagina
|Clear-cell adenocarcinoma of the vagina (and/or cervix)|
Clear-cell carcinoma of the vagina (CCC) is a type of glandular vaginal cancer that presents with vaginal bleeding or discharge typically in older females, though was formerly seen in younger women linked to prenatal to diethylstilbestrol (DES), a drug which was once prescribed in pregnancy. Since the discontinuation of DES, associated conditions include adenomyosis and endometriosis.
CCC most frequently occurs in the upper third of the front of the vagina.
It is a rare.
After age 30 it was thought that women exposed prenatally, "DES daughters", were no longer at risk for the disease, but as they age into their 40s and 50, cases continue to be reported.
Clear-cell adenocarcinoma of the vagina is a rare cancer, occurring in up to 10% of primary vaginal malignancies. It is all but confirmed if maternal use of DES is established. Even though it was once thought to no longer occur past the age of 30, it is still seen in the 40s and 50s. Some of the main signs and symptoms for clear-cell adenocarcinoma of the vagina are spotting between menstrual cycles, bleeding post-menopause, abnormal bleeding, and malignant pericardial effusion or cardiac tamponade.
Low grade cancer is treated by surgical resection. High grade will require neoadjuvant chemotherapy and resection. Long-term surveillance will be required.
The synthetic estrogen DES was given to millions of pregnant women in the United States and other countries. Use in the US was primarily from 1938 to 1971 but not limited to those years. Internationally, DES use continued until the early 1980s. DES was given if a woman had a previous miscarriage, diabetes, or a pregnancy with bleeding, threatened miscarriage or premature labor.
In the late 1960s through 1971 a cluster of young women, from their teens into their twenties, was mysteriously diagnosed with clear-cell adenocarcinoma (CCA), a cancer not generally found in women until after menopause. Doctors at Massachusetts General Hospital eventually linked DES exposure before birth to the development of CCA in these young women. They determined the risk for developing CCA among DES daughters is estimated at 1 in a 1,000.
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- "Annual Exam for DES Daughters" (PDF). Centers for Disease Control and Prevention. Archived from the original (PDF) on 4 October 2013. Retrieved 18 June 2013.
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- Gera S. Clear cell adenocarcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/vaginaclearcelladeno.html Archived 2018-01-05 at the Wayback Machine. Accessed May 25th, 2019
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