Diagnosis and management of vaginal cancer

Abstract

Primary malignancies of the vagina are rare, comprising only about 1-4% of all gynecologic malignancies. The majority of vaginal cancers are metastases from other sites. Among primary vaginal tumors, squamous cell carcinoma (SCC) is the most common, followed by adenocarcinoma, melanoma, and other rare histologies. Squamous cell carcinomas are frequently associated with chronic human papillomavirus (HPV) infection, whereas adenocarcinomas are associated with in utero diethylstilbestrol (DES) exposure. Vaginal intraepithelial neoplasia (VAIN) is a premalignant condition thought to progress to invasive squamous cell carcinoma if untreated. Vaginal intraepithelial neoplasia is generally asymptomatic and diagnosed by abnormal vaginal cytology followed by vaginal colposcopy and biopsies. Most vaginal cancers present with abnormal vaginal bleeding or a vaginal mass. Diagnosis is made by physical exam and confirmatory biopsy. Treatment of vaginal cancer depends on the primary histology, stage at diagnosis, and patient characteristics. Treatment options include surgical excision, radiation therapy, and chemotherapy. The majority of vaginal cancers are treated with radiation, frequently in combination with chemotherapy. Prognosis varies depending on underlying histology and stage at presentation; however, with advances in radiation techniques, survival rates are similar to those seen in cervical cancer.