Causes

GENDER, ETHNIC/RACIAL, AND LIFE SPAN CONSIDERATIONS

930 Vaginal Cancer

^ ASSESSMENT

HISTORY. A complete reproductive history of the patient and the patient's mother is important. Evaluate the patient for any risk factors. Ask if the patient's mother was taking DES when pregnant with the patient. Determine a thorough history of the patient's physical symptoms. One of the symptoms of VC is spontaneous vaginal bleeding after either intercourse or a pelvic examination. Vaginal discharge of a watery nature may also be present. Other symptoms include pain, urinary or rectal symptoms, pruritus, dyspareunia (pain during sexual intercourse), and groin masses.

Question the patient about any pain. Assess the use and effectiveness of any analgesics for pain. Document the location, onset, duration, and intensity of the pain. The patient may also describe urinary retention or urinary frequency if the lesion is near the bladder neck.

PHYSICAL EXAMINATION. Inspection of any bleeding or vaginal discharge, with particular attention to the characteristics and amount of bleeding, is imperative. Palpate the groin area to detect any masses. An internal pelvic exam may reveal an ulcerated vaginal lesion.

PSYCHOSOCIAL. A thorough assessment of each woman's perception of the disease process and her coping mechanisms is required. Changes in sexual patterns and body image present stressors to patients. The family of the patient should also be included in the assessment to examine the extent of support they can provide. Her partner may experience anxiety over the potential loss of his mate or fear about altered patterns of sexuality.

Diagnostic Highlights

General Comments: VC Is often well advanced before diagnosis Is made.

Test

Normal Result

Abnormality with Condition

Explanation

Lugol's solution applied to vaginal areas Colposcopy

Normal structures visualized

Benign

Areas that do not stain indicate suspect areas

Lesions noted Malignant

Identifies areas to be biopsied

A magnifying lens is used to view the walls of the vagina to identify areas that should be biopsied.

Confirms the diagnosis

Other Tests: Papanicolaou (Pap) test, barium enema, and Imaging and endoscopic tests to check for metastasis

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