- Amer Karam, MD
Amer Karam, MD
- Clinical Associate Professor
- Associate Director and Director of Outreach
- Division of Gynecologic Oncology
- Department of Obstetrics and Gynecology
- Stanford University School of Medicine
- Jonathan S Berek, MD, MMS
Jonathan S Berek, MD, MMS
- Laurie Kraus Lacob Professor
- Director, Stanford Women's Cancer Center
- Stanford Comprehensive Cancer Institute
- Chair, Department of Obstetrics & Gynecology
- Stanford University School of Medicine
- Elizabeth A Kidd, MD
Elizabeth A Kidd, MD
- Assistant Professor
- Department of Radiation Oncology
- Stanford University
- Section Editors
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
- Arno J Mundt, MD
Arno J Mundt, MD
- Section Editor — Radiation Therapy
- Chairman of Radiation Oncology
- University of California, San Diego
- Don S Dizon, MD, FACP
Don S Dizon, MD, FACP
- Section Editor – Gynecologic Oncology
- Clinical Co-Director, Gynecologic Oncology
- Founder and Director, The Oncology Sexual Health Clinic
- Massachusetts General Hospital Cancer Center
- Associate Professor of Medicine
- Harvard Medical School
- Deputy Editors
- Sadhna R Vora, MD
Sadhna R Vora, MD
- Deputy Editor — Oncology
- Instructor in Medicine
- Harvard Medical School
- Sandy J Falk, MD, FACOG
Sandy J Falk, MD, FACOG
- Senior Deputy Editor — UpToDate
- Deputy Editor — Obstetrics, Gynecology and Women's Health
- Clinical Instructor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
Primary cancer of the vagina comprises approximately three percent of all malignant neoplasms of the female genital tract. In the United States for example, vaginal cancer accounts for approximately 4000 cases and over 900 deaths annually .
Most of these tumors are squamous cell carcinomas, but melanoma, sarcoma, adenocarcinoma, and other histologic types also occur (table 1). Although primary vaginal cancer is rare, metastatic disease to the vagina or local extension from adjacent gynecologic structures is not uncommon. As a result, the majority of vaginal malignancies are metastatic, often arising from the endometrium, cervix, vulva, ovary, breast, rectum, and kidney [2-5]. Vaginal metastases may occur by direct extension (eg, cervix, vulva, endometrium) or by lymphatic or hematogenous spread (eg, breast, ovary, kidney).
The clinical manifestations, evaluation, and therapy of invasive vaginal cancer are reviewed here. Vaginal intraepithelial neoplasia is discussed elsewhere. (See "Vaginal intraepithelial neoplasia".)
EPIDEMIOLOGY AND RISK FACTORS
Approximately 1 in 100,000 women will be diagnosed with in situ or invasive vaginal cancer (typically of squamous cell histology) [6,7]. The mean age at diagnosis of squamous cell carcinoma, the most common histologic type of vaginal cancer, is approximately 60 years, although the disease is seen occasionally in women in their 20s and 30s. Squamous carcinoma is more common as the age of the patient increases .
Most cases of vaginal cancer are likely mediated by human papillomavirus (HPV) infection, as with cervical cancer . In a case-control study of 156 women with in situ or invasive vaginal cancer, over 50 percent were positive for antibodies to HPV subtypes 16 or 18 . Thus, vaginal cancer has the same risk factors as cervical neoplasia: multiple lifetime sexual partners, early age at first intercourse, and being a current smoker [9,10].
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- EPIDEMIOLOGY AND RISK FACTORS
- CLINICAL MANIFESTATIONS
- DIAGNOSTIC EVALUATION
- Physical examination
- Vaginal cytology
- Vaginal colposcopy
- Vaginal biopsy
- Imaging studies
- DIFFERENTIAL DIAGNOSIS
- Squamous cell carcinoma
- Routes of spread
- Stage I tumors
- - Surgery
- - Radiation therapy
- Stage II to IV tumors
- - Chemoradiation
- - Radiation therapy
- - Is there a role for surgery?
- - Neoadjuvant therapy
- TREATMENT-RELATED COMPLICATIONS
- RECURRENT DISEASE
- POSTTREATMENT SURVEILLANCE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS