What Are the Treatments for Clear Cell Cancer?

Clear cell cancer. otherwise known as clear cell adenocarcinoma, derives its name from its appearance under a microscope. It is a rare form of cancer of the vagina and/or cervix that historically had only been seen in post-menopausal women. In the early 1970s clear cell cancer was discovered in groups of young women who had been exposed to the drug diethylstilbestrol or DES before birth. Several treatment options exist for clear cell cancer, depending on its stage and location.

DES

• DES is a synthetic form of the female hormone estrogen; it was prescribed to pregnant women between 1938 and 1971 to avoid certain complications of pregnancy including miscarriage. It was found to be ineffective for its intended use in the 1950s, and its use declined after that point. The National Cancer Institute states that in 1971 clear cell cancer occurrence was reported in the daughters of mothers who had taken DES during pregnancy, and a link was established.

Symptoms and Diagnosis

• Possible symptoms of clear cell cancer include abnormal vaginal bleeding, continual discharge and vaginal pain. It is important to note that not all women experience symptoms, and were diagnosed following routine examination where a lesion was felt by the physician, or abnormal results from a Pap smear warranted further investigation. In DES exposed women, the age of diagnosis is most frequently seen between 15 and 25 years of age, though some women are diagnosed in their 30s and 40s.

Treatment

• The most common treatment for early stage clear cell cancer is the surgical removal of the uterus, part or all of the vagina and pelvic lymph nodes. Typically the ovaries remain intact according to the National Cancer Institute. Radiation treatment, on its own or in combination with surgery may be recommended. Different protocols for radiation therapy may be recommended, involving both external and internal treatment where radioactive seeds are surgically implanted. Infrequently, chemotherapy may be used in conjunction with surgery and/or radiation as well.

Side Effects

• Surgical side effects will depend on how radical the surgery was. Removal of the uterus precludes women from being able to have children; removal of lymph nodes may cause chronic swelling of the leg. Vaginal reconstructive surgery may be necessary based on how much of the vagina was removed. Other surgical complications reported include loss of vaginal sensation, bladder incontinence and vaginal pain. Radiation treatment may cause long term bowel complications and vaginal dysfunction.

Ongoing Care

• The survival rate for clear cell cancer is high; the National Cancer Institute reports an 87 percent survival rate 10 years after diagnosis. Recurrence of clear cell cancer is rare but has been reported; therefore it is important to ensure adequate follow-up care after treatment. Exams should occur every three to six months for the first five years after surgery and/or radiation, followed by yearly exams after that. Most recurrences occur in the first three years, though some have been reported decades after its first appearance.