Vaginal cancer: the DES story
There is now no doubt that there is increased risk of a rare type of vaginal and cervical cancer in the daughters of women who took diethylstilbestrol (DES) during pregnancy.
During the 1940s and early ’50s it was believed that DES could save some pregnancies at risk of miscarriage. By the mid-1950s the usefulness of DES in preventing miscarriage was in doubt, but some doctors continued to use it in the hope that it might help.
At the time it was used nobody had any suspicion of the problems DES might cause. Suspicion was aroused in the late 1960s when reports of vaginal cancer occurring in women in their late teens and early twenties began to appear. The majority of these women had been exposed to DES while their mothers were pregnant.
As soon as the alarm was raised the drug was withdrawn. Records were examined and all young women whose mothers had DES treatment were asked to have regular examinations. Though the risk of developing vaginal cancer was only three in ten thousand, other abnormalities of the uterus, cervix and vagina were found in young women who had been exposed to DES before birth.
The most common abnormality found has been vaginal adenosis, which is the replacement of the normal lining of the vagina with glandular epithelium. Vaginal adenosis is not a malignant condition, but it is suspected that it could become so. Though so far no women who have been exposed to DES and have vaginal adenosis have developed vaginal cancer, all are advised to be checked at least once a year. In some cases the adenosis has disappeared spontaneously.
Other DES daughters have been found to have abnormalities of the uterine cavity and cervical canal that have caused problems in pregnancy such as miscarriage and pre-term labour. DES daughters are advised to have a hysterosalpingogram before planning pregnancy so that these problems can be anticipated. Every effort has been made to trace all women who may have been exposed to DES before 1969 (no risk after that), but it’s possible that a few may have been missed – another good reason for all women to have regular gynaecological examinations.
Vaginal cancer not related to DES is rare (less than one in each hundred pelvic cancers) and almost always occurs after the menopause. The main symptom is postmenopausal bleeding, and treatment is by surgery or radiotherapy.
The fallopian tubes
The most common tubal disorder is infection, called salpingitis, which is almost always a part of pelvic inflammatory disease (PID). The tubes can also be affected by endometriosis.
Cancer of the tube is extremely rare. It affects older women, the most common symptom being postmenopausal bleeding. Like ovarian cancer, it rarely causes symptoms before it has spread to other organs. Treatment is by surgery and radiotherapy, but the outlook isn’t good because diagnosis comes late.
*239/31/5*
