Vaginal Cancer

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This blog is for informational purposes only and should not be taken as medical advice. Content is sourced from third parties, and we do not guarantee accuracy or accept any liability for its use. Always consult a qualified healthcare professional for medical guidance.

What is Vaginal Cancer?

Vaginal cancer is a rare malignancy arising in the vaginal tissues, typically squamous cell carcinoma (85%, linked to HPV) or adenocarcinoma (10%, often clear cell in younger women exposed to diethylstilbestrol in utero). It affects the vaginal canal, a muscular tube connecting the cervix to the vulva, and is classified by stages 0-IV. In 2025, it accounts for 1-2% of gynecologic cancers, with approximately 1,300 US cases annually, primarily in women over 60, though HPV-related cases occur in younger women. Vaginal intraepithelial neoplasia (VAIN) is a precursor, progressing to invasive cancer in 5-10% of untreated cases.

Symptoms

Early vaginal cancer is often asymptomatic, detected via Pap smear or colposcopy for VAIN. Symptoms include abnormal vaginal bleeding (post-coital, intermenstrual, postmenopausal, in 60% of cases), watery or bloody vaginal discharge (often foul-smelling), pelvic pain, pain during intercourse, urinary symptoms (frequency, urgency, or obstruction), and constipation or rectal pain (from posterior wall invasion). Advanced disease causes leg swelling, weight loss, fatigue, and symptoms from metastases (e.g., bone pain, cough). Symptoms may mimic vaginitis or cervical cancer, delaying diagnosis by 6-12 months in 30% of cases.

Causes

High-risk HPV infection (types 16, 18) is the primary cause of squamous cell carcinoma (70-80% of cases), with cofactors including smoking (doubles risk), multiple sexual partners, early sexual debut, immunosuppression (HIV, transplant recipients), and prior cervical cancer or VAIN. Adenocarcinoma links to DES exposure (historical, 1950s-1970s). Other risks include age over 60, chronic vaginal irritation, and pelvic radiation history. In 2025, genetic studies highlight HPV-driven PIK3CA mutations and immune suppression as key drivers, with HPV vaccination preventing 90% of cases in younger cohorts.

Diagnosis

Diagnosis involves pelvic exam, colposcopy to visualize lesions, and biopsy (punch or excisional) for histological confirmation. HPV testing identifies high-risk strains. Imaging includes MRI for local extent, CT/PET for lymph node or distant metastases, and cystoscopy/proctoscopy for bladder/rectal invasion. Blood tests (SCC antigen) monitor advanced disease. Staging uses FIGO classification (I-IV). In 2025, AI-assisted colposcopy improves lesion detection by 20%, and liquid biopsies enhance recurrence monitoring, particularly for HPV-negative adenocarcinomas.

Treatment

Early-stage (I-II) vaginal cancer is treated with radiation (external beam and brachytherapy, achieving 80% local control) or surgery (wide local excision, partial vaginectomy, or radical hysterectomy for upper vaginal tumors). Advanced stages (III-IV) use chemoradiation (cisplatin-based, 60% response rate), with immunotherapy (pembrolizumab for PD-L1-positive) for recurrent/metastatic cases. Pelvic exenteration is considered for select advanced cases, though morbid. In 2025, HPV-targeted therapies (e.g., therapeutic vaccines) and minimally invasive techniques reduce treatment-related complications by 10-15%. Palliative care addresses pain and urinary/bowel obstructions.

Future Outlook

In 2025, 5-year survival is 70% overall, 90% for stage I, 50% for stage III, and 15% for metastatic disease. HPV vaccination has reduced incidence by 80% in vaccinated populations, and chemoradiation advances improve local control. Research on therapeutic HPV vaccines, checkpoint inhibitors, and AI-driven screening aims to further decrease incidence and improve early detection. By 2030, survival could reach 80% overall, with metastatic survival at 25%, driven by personalized immunotherapy and reduced toxicity from precision radiation.

Sources

NCI’s “Vaginal Cancer Treatment (PDQ®)”; Mayo Clinic’s “Vaginal Cancer: Symptoms and Causes”; Cleveland Clinic’s “Vaginal Cancer”; PMC’s “Vaginal Cancer: Epidemiology and Treatment 2025”; Cancer Research UK’s “Vaginal Cancer”.