Cross-sectional imaging plays a crucial role in the evaluation of patients with known or suspected vaginal cancer recurrence, in which physical examination is of limited value in determining disease extent. In one retrospective study of patients with primary vaginal cancer who underwent definitive radiation and experienced recurrence, the mechanism of recurrence was locoregional alone in 56% for disease stages I and II and 71% for disease stages III to IVA, whereas the remainder of recurrences were distant [46]. Once locoregional recurrence is identified, the presence or absence of distant recurrence becomes a discriminating factor in eligibility for salvage pelvic exenteration. In the presence of distant recurrence, exenteration confers morbidity without significantly improving oncologic outcomes, whereas in the absence of distant recurrence, exenteration can potentially eradicate pelvic tumor burden. When distant disease has been excluded by imaging and a patient is deemed eligible for pelvic exenteration, the degree of local organ invasion determines whether partial (anterior or posterior) or total exenteration is indicated [32]. Therefore, imaging findings in patients with known or suspected vaginal cancer recurrence can influence both the appropriateness and type of salvage therapy, in addition to predicting prognosis. Staging and Follow-up of Primary Vaginal Cancer CT Chest Although thoracic metastases are known to occur in vaginal cancer, no studies specifically address their incidence or the incremental value of chest CT for suspected recurrence. Pulmonary metastases have been studied to a limited degree in cervical cancer, occurring in approximately 5% to 10% of patients at diagnosis [13,14]. Pulmonary metastases appear to occur slightly more frequently as a site of recurrent disease, with one large study of recurrent cervical cancer indicating an overall incidence of 13% and the lungs representing the only site of recurrence in 6% of cases [15].
Staging and Follow up of Primary Vaginal Cancer. Cross-sectional imaging plays a crucial role in the evaluation of patients with known or suspected vaginal cancer recurrence, in which physical examination is of limited value in determining disease extent. In one retrospective study of patients with primary vaginal cancer who underwent definitive radiation and experienced recurrence, the mechanism of recurrence was locoregional alone in 56% for disease stages I and II and 71% for disease stages III to IVA, whereas the remainder of recurrences were distant [46]. Once locoregional recurrence is identified, the presence or absence of distant recurrence becomes a discriminating factor in eligibility for salvage pelvic exenteration. In the presence of distant recurrence, exenteration confers morbidity without significantly improving oncologic outcomes, whereas in the absence of distant recurrence, exenteration can potentially eradicate pelvic tumor burden. When distant disease has been excluded by imaging and a patient is deemed eligible for pelvic exenteration, the degree of local organ invasion determines whether partial (anterior or posterior) or total exenteration is indicated [32]. Therefore, imaging findings in patients with known or suspected vaginal cancer recurrence can influence both the appropriateness and type of salvage therapy, in addition to predicting prognosis. Staging and Follow-up of Primary Vaginal Cancer CT Chest Although thoracic metastases are known to occur in vaginal cancer, no studies specifically address their incidence or the incremental value of chest CT for suspected recurrence. Pulmonary metastases have been studied to a limited degree in cervical cancer, occurring in approximately 5% to 10% of patients at diagnosis [13,14]. Pulmonary metastases appear to occur slightly more frequently as a site of recurrent disease, with one large study of recurrent cervical cancer indicating an overall incidence of 13% and the lungs representing the only site of recurrence in 6% of cases [15].