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National Cervical Cancer Coalition


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 Post subject: have questions
PostPosted: Mon Apr 09, 2007 12:16 pm 

Joined: Mon Apr 09, 2007 12:04 pm
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I recently have been diagnosed with HPV. I had a hysterectomy in 2001 and have no cervix. But the type of HPV I have could cause vaginal cancer. I do have some cell changes and my doctor has told me that those changes were caused by the HPV. Well, a few months ago I recently discovered my husband has been having an affair. He claims it was only emotionally. ANyways, I am 36 years old and right before my hysterectomy they tested me for everything under the sun. Everyone wants to tell me that my husband didn't give this to me but I know I would have had other changes before now. How soon can HPV start making cell changes??? I am desparate for answers.........help!!!


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PostPosted: Tue Apr 10, 2007 9:30 am 
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Hello Elizabeth,

Welcome to our online forum. It could take weeks, months, or even years after exposure before cell changes develop or are detected, so it's really hard in most cases to figure out when HPV was contracted, or from whom. There is no real test used clinically that would detect HPV of the vagina or vulva - diagnosis is usually made when cell changes are found.

Abnormal cervical cell changes are sometimes referred to as CIN - cervical intraepithelial neoplasia. Vaginal and vulvar cell changes are often known as VaIN and VIN, respectively.

Fortunately, VaIN rarely leads to vaginal cancers, but you should follow your healthcare providers instructions closely. I'm posting an article below on this topic that I hope all who read this post will find insightful.

Take care and let us know if you'd like to talk over anything else.

Fredo

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PostPosted: Tue Apr 10, 2007 9:36 am 
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Interview with Dr. Mark Einstein

Reprinted from the July 2006 HPV News. Copyright, 2007 - American Social Health Association. All Rights Reserved. To subscribe go to www.ashastd.org


The link between “high-risk” HPV types and cervical cancer has understandably been the focus of recent media attention due to the approval in June by the FDA of the first HPV/cervical cancer vaccine. Diseases related to HPV aren’t limited to the cervix, of course, and the News Desk section of this issue of HPV News has an article on the promise HPV vaccines have in preventing other diseases related to HPV, such as precancers of the vulva and vagina (known as vulvar intraepithelial neoplasia and vaginal intraepithelial neoplasia, or VIN and VAIN, respectively).

To learn more about how these diseases are diagnosed and managed, HPV News spoke with Mark Einstein, MD, assistant professor, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women’s Health at Albert Einstein College of Medicine and Montefiore Medical Center in New York. In addition to caring for patients, Dr. Einstein is a researcher who investigates potential therapies for gynecologic cancers.

HPV News: How common are VIN and VAIN?

Mark Einstein: The best estimates are about 1 to 2 cases per 100,000 for VIN and even less for VAIN. There seem to be some differences based on geography, what kind of patient population, etc. [editor’s note: the American Cancer Society estimates there are approximately 9,700 cases of cervical cancer annually in the U.S., and about 3,700 deaths]

Speaking of patient populations is there a specific demographic in which VIN or VAIN is more common?

Let’s split it up because there is some difference between the two. Certainly, “high-risk” HPV status is highly correlated with VIN and the disease is typically more common in older women; mean age is reported around 52. There seems to be an increased risk in patients with lichens sclerosis [LS, a condition where affected skin develops white spots that become shiny and smooth], and this could be because LS often “hides” the VIN, as these patients have very thick skin in this area.

With VAIN, it’s also found in older women and the average age seems to be somewhat higher than that of VIN. These patients also have a lot of the similar characteristics as patients with VIN; while they don’t get LS there is a high correlation with previous HPV infection. There also seems to be an increased risk of both VIN and VAIN related to smoking.

Is it safe to say VIN and VAIN are usually related to “high risk” HPV?

Absolutely. I think the relationship between HPV and VIN/VAIN is less than that of HPV and cervical precancers, but there certainly is a high relationship here - I’d say 60-70% of VIN/VAIN have “high risk” HPV status.

How are VIN and VAIN diagnosed clinically?

We’ll perform a vaginoscopy [using a special microscope called a colposcope] to look thoroughly at the vagina and vulva and then perform a biopsy on any lesions that are detected.

If there are no obvious lesions we often perform random biopsies; for VAIN, as an example, we most often perform those biopsies in the upper third of the vagina, which is the most common place where these types of lesions form.

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Last edited by Fredo on Fri Jun 20, 2008 8:27 am, edited 1 time in total.

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PostPosted: Tue Apr 10, 2007 9:37 am 
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What about clinical management? Does either disease tend to resolve without treatment?

I think it depends on the grade [extent] of the disease. Even with “high grade” disease like VIN-3, the incidence of progression to invasive cancer is only around 3%. In terms of the natural regression rate, though, most of us who treat a lot of these will be very uncomfortable allowing “high grade” disease like VIN-3 to regress for a couple of reasons: first of all it takes awhile, upwards of a few years and secondly even though we may have biopsied in one area there can be cancer in another area, so we’ll do a surgical procedure such as a wide local excision [removing the affected skin with a surgical blade] not only to treat, but also to get a tissue sample for diagnostic purposes.

In VAIN, while the risk of progression to invasive cancer is still fairly low, the rate at which this occurs is actually much higher compared to VIN; it’s been reported anywhere from 25-30%. Things can be missed with the vaginoscopy, though, so it’s important to biopsy to get a tissue sample for analysis. Similar to “high grade” VIN, I don’t feel comfortable depending on the immune response to resolve more extensive VAIN.

Now with lower grade lesions, we will often do what’s known as “active observation”. With VIN-1 or VIN-2, for example, we’ll have patients come in regularly, sometimes every 3 or 4 months, for vaginoscopies and potentially for biopsies.

What are treatment options for VIN and VAIN?

A lot of times with “low grade” lesions we’ll attempt medical management, such as using a topically applied cream like Efudex® [topical 5-fluorouracil, an anti-cancer agent] or Imiquimod [an immune response modifier sold as the brand Aldara™].

The steadfast and probably best treatment is often surgery, or removing affected tissue with a surgical blade [scalpel]. The benefit to that is we’ll have a tissue sample to send to the lab. For the higher grade lesions this is the preferred method and the data shows that recurrence rates seem to be less.

There are also tissue destructive techniques. Cryotherapy, or freezing the affected area, is not easy to do with either VIN or VAIN. Both involve very sensitive areas and it’s difficult to control the depth of tissue that’s impacted with this approach. The approaches we more often use are things we have full control over regarding the depth of the treatment, such as laser therapy.

Are recurrences pretty high with both conditions?

Recurrence rates of VAIN are reported at anywhere from 25-35%, and with VIN it’s estimated to be around 20-25%. Recurrence rates are higher in immunocompromised patients such as those with HIV.

Recurrence rates, then, are high and regardless of the therapy used, there’s aggressive active observation with follow-up exams.

Are there symptoms of VIN or VAIN a patient would likely notice?

With VIN, besides seeing a skin growth (lesion) or bump, patients often report they’ve had itching for a while. They also often haven’t seen a gynecologist or other health care provider in awhile to have the area examined; we’ve had patients say they’ve felt something there “for years” but have never had anybody see what was going on down there.

VAIN is relatively asymptomatic. Some patients may have increased vaginal discharge or may actually feel something, but most don’t feel anything and the skin lesions are usually picked up as an incidental finding on the gynecological exam.

Is there no basic screening for either beyond the standard gynecological exam?

Unfortunately there isn’t, which is why annual pelvic exams are still recommended even though Pap smear screening intervals have been extended in many cases.

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