Carcinoma or epithelioma rarely occurs as a primary affection in the vagina; it is generally secondary, extending from the neck of the uterus. The author has met with only three cases which were primary cancer.
In a recent work Kustner8 has collected statistics of twenty-two cases of primitive cancer of the vagina. The result of the analysis of these observations is, that nearly always the posterior wall is first affected in primary cancer, while in secondary cancer the anterior wall is the first to be attacked.
8 "Ueber den Primären Scheidenkrebs," Arch. f. Gyn., t. ix. p. 279.
The symptoms after the disease is somewhat advanced are similar to uterine cancer—viz. a sanious, watery discharge of an offensive odor or sometimes a veritable hemorrhage. There is no pain peculiar to or pathognomonic of the disease. It is not until infiltration causes pressure on nerves or there is considerable ulceration that pain is experienced; in either of these conditions the sufferings are often excruciating. Occasionally in women of advanced age, in consequence of cancerous infiltration before ulceration has occurred, the vagina is found to be contracted and there is roughness and induration of the walls.
Epithelioma generally occurs in young women. The early symptoms are pain and hemorrhage following coition. A digital examination will show the friable nature of the formation and an indurated base: the examination will cause blood to flow. In the early part of this stage, before there has been much ulceration, the disease is sometimes mistaken for syphilis and the growths for syphilitic condylomata. It is not an uncommon occurrence for the disease to propagate itself by contact, the opposite wall from which it primarily appeared becoming in this way affected. Later, deeper tissues are infiltrated, the bladder or rectum becomes implicated, ulceration occurs, and subsequently perforation. The progress and terminations are similar to uterine cancer.
TREATMENT.—In carcinoma there seems to be no opportunity for anything more than a palliative course of treatment. Medicine or surgery is here of but little avail. If epithelioma be detected sufficiently early, there is some hope of cure, but this lies only in complete removal. For this purpose the knife or scissors or the galvano- or thermo-cautery can be used. When there is much hemorrhage, some styptic, like the perchloride of iron, should be applied, or the cautery or curette may be of service. Unfortunately, the physician is seldom consulted early enough—prior to the cellular tissue being too much infiltrated—for the thorough eradication of the disease.
Death occurs from exhaustion, hemorrhage, septicæmia, uræmia, or from infiltration interfering mechanically with the function of the bladder, kidneys, or intestine.
For the purpose of correcting the offensive odor and lessening pain there seems to be nothing superior to chloral and glycerin (drachm j-drachm ij ad ounce ij) on a tampon of cotton; the fluid extract of eucalyptus combined with the chloral and glycerin (ounce ss ad ounce ij) has proven an excellent deodorizer in the author's hands.
Vaginismus.