Accounts for 1 to 3% of all gynecological malignancies.
A estimated 8070 new cases of vaginal and other genital cancers will be diagnosed in the US in 2025, and 1950 people estimated to estimated to die of the disease.
70% of cases occur to women over the age of 60 years.
80 to 90% are squamous cell type:The second most common type is melanoma.
Peak incidence occurs in the sixth and seventh decades.
Only 10% of cancers occur in women less than 40 years of age (Creasman WT).
The most significant signs of vaginal cancer ()) are bleeding, discharge, urine retention, and rectal symptoms, such as constipation or blood in the stool.
Up in to 20% of individuals may be asymptomatic and have the disease discovered on pelvic or cervical exam.
Risk factors suggested include: vaginal damage from ring pessaries, chronic vaginitis, sexual behavior, birthing trauma, obesity, exposure to chemicals in the vagina, and HPV.
Cofactors for vaginal cancer include immunosuppression, prior hysterectomy, and cigarette smoking.
VC is frequently found in combination with cervical cancer as a synchronous or metachronous tumor.
Only a minority of vaginal cancers originate in the vagina, the remaining are generally metastatic from other sites.
Majority of cases arise in the upper third of the vagina, and most commonly in the posterior wall.
In a study of 156 women with vaginal intraepithelial cancer or invasive vaginal cancer HPV DNA was detected in 80% of patients with in situ disease and 6% of patients with invasive disease (Daling DR).
The majority of vaginal squamous cell cancers are HPV associated with a non-keratinizing morphology and are in the proximal or intermediate third portion of the vagina.
Distal squamous cell carcinomas, generally lack HPV associations and are often keratinizing squamous cell cancers.
Dissemination is rare at the time of diagnosis.
Patients with previous cervical carcinoma, have a substantial risk of developing vaginal carcinoma as they share exposure and/or susceptibility to endogenous or exogenous carcinogenic stimuli.
Epidemiologic risk factors associated with cervical cancer, are also shared risk factors for vaginal cancer, including history of smoking, parity, oral contraceptive use, early age of onset of coitus, large number of sexual partners, history of sexually transmitted disease, certain autoimmune diseases, and chronic immunosuppression.
Most series report lower cure rates and substantially higher complications rates for vaginal carcinoma compared to comparably staged patients with carcinoma of the cervix.
Lymphatic drainage of the proximal one third of the vagina parallels that of the cervix, along the path of the obturator lymph nodes to the hypogastric lymph nodes, and then to the external and common iliac lymph nodes.
The distal one third of the vagina follows vulva or lymphatic patterns to drain to the femoral lymph nodes and subsequently to pelvic lymph nodes.
The pattern lymphatic metastases is not accurately predicted by the location of the primary tumor within the vagina.
VC is staged clinically like cervical cancer based on the results of physical examination, biopsy and imaging.
Stage IA the cancer is only in the vagina and is 2 cm or less : stage IB the tumor is confined to the vagina measuring greater than 2 cm: Stage IIA cancer has grown through the vaginal wall, but not as far as the pelvic wall and is 2 cm or less. Stage IIB the cancer has grown through the vaginal wall, but not as far as a pelvic wall and is greater than 2 cm: Stage III the tumor extends the pelvic sidewall or skeletal portions of the bony pelvis and or causing hydronephrosis or non-functioning kidney and Stage IVA invades the mucosa of the bladder or rectum and or is extending beyond the true pelvis and stage IVB there are distant metastases.
Five year overall survival for stage III and IV disease reported as 30% and less than 10%, respectively (Hansen E).
Radiotherapy is the treatment of choice: because of the close proximity of the vagina to the urethra, bladder and rectum is difficult to get adequate surgical margins for any cancer other than small ones located in the upper, posterior region.
Radiation therapy , usually involves treating the whole pelvis with external beam therapy and breaking therapy with the combination of a vaginal cylinder and interstitial therapy.
Presently, authorities recommend concurrent platinum-based radiation be administered along with radiation.
Adenocarcinoma of the vagina associated with in utero exposure to a synthetic nonsteroidal estrogen, diethylstilbestrol (DES).
Clear cell adenocarcinoma of the vagina reported 143 cases per 97,831 person-years among women exposed to in utero DES.
Clear cell adenocarcinoma incidence among DES exposed women range from 1 in 1000 to 1 in 10,000.
Clear cell adenocacinoma in DES exposed women occurred at a median age of 19 years.
The primary treatment with curative intent, for patient’s with vaginal cancer typically consists of radiation, surgery, chemo, radiation, or a combination of these treatments.