The vagina can be a common site of secondary involvement, either through direct extension from the cervix and vulva or by lymphatic and vascular spread.
Invasive cancers most commonly present with irregular vaginal bleeding or discharge (often postcoital), followed by vaginal discharge or dysuria. Vaginal intraepithelial neoplasia (VaIN) is diagnosed on routine screening.
Diagnostic workup should include a thorough examination under anesthesia, as secondary involvement from the cervix or vulva is more common than primary cancer is. Biopsy is the mainstay for diagnosis, and staging is clinical. Whole-body fluorodeoxyglucose-positron-emission tomography/computed tomography (FDG-PET/CT) scans can provide information on the nodal status, and magnetic resonance imaging (MRI) of the pelvis helps to determine the depth of invasion and assessment of extent of disease.
There is a lack of prospective randomized studies of patients with vaginal cancer because of the rarity of the disease. Treatment decisions are thus based on retrospective data and individual assessment.
Carcinoma in situ of the vagina and highly selected early-stage patients with tumors in the upper vagina can be treated with surgery alone (there are reported local control rates of 75–100%).
In more advanced stages, radiation therapy is chosen as the standard treatment to avoid exenterative surgery, preserve anatomy and function, and to treat known or presumed lymph node metastasis.
Because the etiology and epidemiology of vaginal carcinoma appears identical to those of patients with invasive cervical carcinoma, patients with advanced vaginal carcinoma are treated with radiation and cisplatin-based chemotherapy.