Vaginal Cancer

M.K. Guess and A. Sohaib


Primary vaginal cancer is a rare malignancy, representing approximately 2% of gynaecological malignancies and only approximately 0.1-0.2% of all cancers.1 The vast majority (85%) of vaginal cancers are of squamous origin: however, adenocarcinomas, clear cell carcinomas, melanomas and sarcomas are infrequently identified. Although secondary vaginal carcinomas are more common than primary tumours, the keen pathologist can distinguish between the two using conventional standards. Specifically, a primary vaginal cancer should be diagnosed only when the cervix is uninvolved with an obvious focus of tumour origin in the vagina. When an apparent malignancy is found in the vagina and these conditions are not met, secondary vaginal cancer should be considered. Secondary vaginal cancer may represent an extension from a cervical cancer or metastatic disease from a uterine, ovarian, vulvar, bladder or colon primary tumour.


Many authors deem the stage of disease at the time of diagnosis as the most important prognostic factor. However, other factors, such as the initial tumour volume, extent of vaginal tissue involvement, histological grade and lymphatic involvement, may also impact on survival.2-5 According to the accepted standard of the staging of the International Federation of Gynecology and Obstetrics (Federation Internationale Gynecologique Obstetrique or FIGO)6 (Table 3.1) vaginal cancers are staged clinically. A thorough history and physical examination should be coupled with diagnostic studies so that local and distant disease spread can be readily identified and treatment can be tailored to the individual.

Stage 0 is carcinoma in situ or high grade vaginal intra-epithelial neoplasia (VAIN3). The slightly imprecise nature of the margins of the vagina make the staging more arbitrary. As a result the staging of this tumour involves close collaboration between gynaecologist, radiologist and pathologist. The definitions of stages 0-IV are shown in the figures on page 9.

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