Pediatric Vagina Pediatric
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Pediatric Vagina Pediatric
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https://doi.org/10.1542/peds.62.1.57
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Copyright © 1978 by the American Academy of Pediatrics
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Margaret R. Hammerschlag, Susan Alpert, Ingrid Rosner, Pauline Thurston, Deborah Semine, Dorothy McComb, William M. McCormack; Microbiology of the Vagina in Children: Normal and Potentially Pathogenic Organisms. Pediatrics July 1978; 62 (1): 57–62. 10.1542/peds.62.1.57
Vaginal cultures from 100 healthy girls, 2 months to 15 years of age, were examined for the presence of normal and potentially pathogenic microorganisms. Corynebacterium vaginale , yeast species, and genital mycoplasmas were isolated from vaginal cultures from 13.5%, 28%, and 28% of the girls examined, respectively. Colonization with these organisms was not associated with signs or symptoms of vaginitis. Neisseria gonorrhoeae was isolated from a 4-year-old with purulent vaginitis. Trichomonas naginalis was recovered from two 13-year-olds, both of whom had an abnormal vaginal discharge. Vaginal antibody to Chlamydia trachoinatis was found in two girls, 4 and 13 years of age. In neither girl was the organism recovered from the vaginal culture. Chlamydia trachoniatis was recovered from the vaginal culture of another 4-year-old who had no abnormal findings on examination. Cultures from 59 of the girls were examined for aerobic and facultatively anaerobic bacteria. Diphtheroids and Staphylococcus epidermidis were the most frequently isolated organisms. Lactobacilli were isolated most frequently from the older girls, whereas enteric organisms were isolated most frequently from the younger girls.
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Surgery. Radiation therapy, for residual microscopic disease or lymphatic metastases.
Primary care physicians. Pediatric surgeons. Radiation
oncologists. Pediatric medical oncologists/hematologists. Rehabilitation
specialists. Pediatric nurse specialists. Social workers. Child-life professionals. Psychologists. Fertility specialists.
be discussed at a meeting, be cited with text, or replace or update an existing article that is already cited.
Denise Adams, MD (Children's Hospital Boston) Karen J. Marcus, MD, FACR (Dana-Farber Cancer Institute/Boston Children's Hospital) Paul A. Meyers, MD (Memorial Sloan-Kettering Cancer Center) Thomas A. Olson, MD (Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta - Egleston Campus) Alberto S. Pappo, MD (St. Jude Children's Research Hospital) Arthur Kim Ritchey, MD (Children's Hospital of Pittsburgh of UPMC) Carlos Rodriguez-Galindo, MD (St. Jude Children's Research Hospital) Stephen J. Shochat, MD (St. Jude Children's Research Hospital)
Updated:
July 20, 2022
National Cancer Institute
at the National Institutes of Health
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Adenocarcinoma of the cervix and vagina is rare in childhood and adolescence.[ 1 , 2 ] Two-thirds of cases in previous reports have been associated with exposure to diethylstilbestrol (DES) in utero .[ 3 ] However, the few case reports of vaginal cancer in children in the last decade have not been associated with exposure to DES in utero .[ 4 ]
The median age at presentation is 15 years, with a range of 7 months to 18 years. Most patients present with vaginal bleeding. Adults with adenocarcinoma of the cervix or vagina will present with stage I or stage II disease 90% of the time.[ 1 ] In children and adolescents, there is a high incidence of stage III and stage IV disease (24%). This difference may be explained by the practice of routine pelvic examinations in adults and the hesitancy to perform pelvic exams in children.
Treatment options for childhood carcinoma of the cervix and vagina include the following:
The treatment of choice is surgical resection,[ 1 ] followed by radiation therapy for residual microscopic disease or lymphatic metastases. The role of chemotherapy in management is unknown, although drugs commonly used in the treatment of gynecological malignancies, such as carboplatin and paclitaxel, have been used.[ 2 ]
In a retrospective report, 37 patients with cervical clear cell adenocarcinoma or cervical mesonephric adenocarcinoma were treated with various modalities (surgery, radiation therapy, and/or chemotherapy). The 3-year event-free survival rate was 71% (± 11%) for patients with all stages of tumors, 82% (± 11%) for patients with stage I and stage II tumors, and 57% (± 22%) for patients with stage III and stage IV tumors.[ 3 ]
Information about National Cancer Institute (NCI)–supported clinical trials can be found on the NCI website . For information about clinical trials sponsored by other organizations, see the ClinicalTrials.gov website .
The following is an example of a national and/or institutional clinical trial that is currently being conducted:
Patients with tumors that have molecular variants addressed by treatment arms included in the trial will be offered treatment on Pediatric MATCH. Additional information can be obtained on the NCI website and ClinicalTrials.gov website .
Cancer in children and adolescents is rare, although the overall incidence has been slowly increasing since 1975.[ 1 ] Referral to medical centers with multidisciplinary teams of cancer specialists experienced in treating cancers that occur in childhood and adolescence should be considered. This multidisciplinary team approach incorporates the skills
of the following health care professionals and others to ensure that children receive treatment, supportive care, and rehabilitation
that will achieve optimal survival and quality of life:
For information about supportive care for children and adolescents with cancer, see the summaries on Supportive and Palliative Care .
The American Academy of Pediatrics has outlined guidelines for
pediatric cancer centers and their role in the treatment of pediatric patients
with cancer.[ 2 ] At
these pediatric cancer centers, clinical trials are available for most types of cancer that occur in children and adolescents, and the opportunity
to participate is offered to most patients and their families. Clinical
trials for children and adolescents diagnosed with cancer are generally
designed to compare potentially better therapy with current standard therapy. Most of the progress made in identifying curative
therapy for childhood cancers has been achieved through clinical trials.
Information about ongoing clinical trials is available from the NCI website .
Dramatic improvements in survival have been achieved for children and adolescents with cancer. Between 1975 and 2010, childhood cancer mortality decreased by more than 50%.[ 3 ] Childhood and adolescent cancer survivors require close monitoring because side effects of cancer therapy may persist or develop months or years after treatment. For information about the incidence, type, and monitoring of late effects in childhood and adolescent cancer survivors, see Late Effects of Treatment for Childhood Cancer .
Childhood cancer is a rare disease, with about 15,000 cases diagnosed annually in the United States in individuals younger than 20 years.[ 4 ] The U.S. Rare Diseases Act of 2002 defines a rare disease as one that affects populations smaller than 200,000 people. Therefore, all pediatric cancers are considered rare.
The designation of a rare tumor is not uniform among pediatric and adult groups. In adults, rare cancers are defined as those with an annual incidence of fewer than six cases per 100,000 people. They account for up to 24% of all cancers diagnosed in the European Union and about 20% of all cancers diagnosed in the United States.[ 5 , 6 ] Also, the designation of a pediatric rare tumor is not uniform among international groups, as follows:
Most cancers in subgroup XI are either melanomas or thyroid cancer, with other types accounting for only 1.3% of cancers in children aged 0 to 14 years and 5.3% of cancers in adolescents aged 15 to 19 years.
These rare cancers are extremely challenging to study because of the low number of patients with any individual diagnosis, the predominance of rare cancers in the adolescent population, and the lack of clinical trials for adolescents with rare cancers.
Information about these tumors may also be found in sources relevant to
adults with cancer, such as Cervical Cancer Treatment and Vaginal Cancer Treatment .
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
This summary is written and maintained by the PDQ Pediatric Treatment Editorial Board , which is
editorially independent of NCI. The summary reflects an independent review of
the literature and does not represent a policy statement of NCI or NIH. More
information about summary policies and the role of the PDQ Editorial Boards in
maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® - NCI's Comprehensive Cancer Database pages.
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of pediatric cerv
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