Vaginal Cancer

Primary vaginal cancer is rare, comprising 1-2% of all female reproductive tract cancers. The vagina is a 7 to 10-centimeter-long fibromuscular tube extending from the cervix to the vulva, sitting posterior to the urethra and bladder and anterior to the rectum. It is divided into three parts, which are essential for classifying tumor location and lymphatic drainage. The lower third is below the level of the bladder base with the urethra anteriorly, the middle third is adjacent to the bladder base, and the upper third is at the level of the vaginal fornices, denoted as anterior, posterior, and lateral to the cervix.

Primary vaginal cancer is strictly defined as a disease without evidence of cervical or vulvar cancer or a history of either within the past five years. Most vaginal lesions (80-90%) originate from cervical or vulvar lesions or other local sites such as the endometrium, bladder, rectosigmoid, or ovary. Distant sites of metastasis include the colon, breast, and pancreas. When primary vaginal cancer is suspected, a biopsy is done for histopathologic confirmation.

While current estimates of vaginal cancer are higher than vulvar cancer, these estimates include primary and other genital lesions. Currently, there are no randomized trials for the treatment of vaginal cancers due to the rarity of the disease, and guidelines are generally based on limited studies.