Vaginal cancer overview

Vaginal cancer is a type of cancer that forms in the tissues of the vagina. The vagina leads from the cervix (the opening of the uterus) to the outside of the body.

Carcinomas of the vagina are uncommon tumors comprising 1% to 2% of gynecologic malignancies. They can be effectively treated, and when found in early stages, are often curable. The histologic distinction between squamous cell carcinoma and adenocarcinoma is important because the two types represent distinct diseases, each with a different pathogenesis and natural history. Squamous cell vaginal cancer (approximately 85% of cases) initially spreads superficially within the vaginal wall and later invades the paravaginal tissues and the parametria. Distant metastases occur most commonly in the lungs and liver.

Adenocarcinoma (approximately 15% of cases) has a peak incidence between 17 and 21 years of age and differs from squamous cell carcinoma by an increase in pulmonary metastases and supraclavicular and pelvic node involvement. Rarely, melanoma and sarcoma are described as primary vaginal cancers. Adenosquamous carcinoma is a rare and aggressive mixed epithelial tumor comprising approximately 1% to 2% of cases.

Vaginal cancer may be classified according to histopathology into squamous cell carcinoma, adenocarcinoma, and vaginal sarcoma.

On gross pathology, an ulcerating or fungating mass , or an annular constricting lesion is characteristic finding of vaginal cancer.

Vaginal cancer must be differentiated from cervical carcinoma, rectal carcinoma, uterine carcinoma, vaginal lymphoma, vaginal cyst, vaginal node of endometriosis, and uterine fibroids.

In 2015, the incidence of vaginal cancer is approximately 2-3 per 100,000 individuals with a death number of 910.

The risk factors of vaginal cancer may include vaginal adenosis, cervical cancer, diethylstilbestrol, human papillomavirus infection, HIV infection, unhealthy lifestyle, and age.

Depending on the extent of the tumor at the time of diagnosis, the prognosis of vaginal cancer may vary. However, the prognosis is generally regarded as good.

Common symptoms of vaginal cancer include vaginal bleeding, abnormal vaginal discharge, mass, and pain during intercourse.

Vaginal cancer may be classified into 4 subtypes based on FIGO or AJCC staging system.

Pelvic MRI may be helpful in the diagnosis of vaginal cancer.

Cystoscopy, ureteroscopy, proctoscopy, lymphangiogram, and cone biopsy may be helpful to detect the spread of vaginal cancer.

Medical therapies of vaginal cancer include surgery, radiation, and chemotherapy. The optimal therapy depends on the stage at diagnosis.