Vaginal carcinoma

Vaginal carcinoma is rare, accounting for less than 2% of all genital tract cancer in women. Primary squamous cell carcinoma mainly presents in postmenopausal women and usually, affects the upper posterior wall. Occasionally, it follows chronic ulceration that accompanies complete uterovaginal prolapse, or from a long retained pessary.

Secondary deposits are more common and are often from the cervix, endometrium, or ovary.

Adenocarcinoma is rare in the UK, but has been known to occur in women whose mothers were treated with large doses of stilboestrol during pregnancy. It is usually preceded by vaginal adenosis. Regular vaginal cytological smears and colposcopy is warranted in those at risk.

• incidence:
  • around 240 new vaginal cancer cases in the UK every year, that's more than 4 every week (2013-2015)
  • in females in the UK, vaginal cancer is not among the 20 most common cancers, with around 230 new cases in 2015
  • vaginal cancer accounts for less than 1% of all new cancer cases in females in the UK (2015)
  • incidence rates for vaginal cancer in the UK are highest in females aged 80-84 (2013-2015)
  • since the early 1990s, vaginal cancer incidence rates have remained stable in females in the UK
    
    
• prognosis:
  • more than half (53%) of women diagnosed with vaginal or vulval cancer in England survive their disease for ten years or more (2009-13)
  • almost two-thirds (64%) of women diagnosed with vaginal or vulval cancer in England survive their disease for five years or more (2009-2013)
  • more than 8 in 10 (82%) women diagnosed with vaginal or vulval cancer in England survive their disease for one year or more (2009-2013)
  • vagina and vulva cancer survival in England is highest for women diagnosed aged under 50 years old (2009-2013)
  • more than 8 in 10 women in England diagnosed with vagina or vulva cancer aged 15-49 survive their disease for five years or more, compared with almost 6 in 10 women diagnosed aged 70-89 (2009-2013).

NICE recommends considering a suspected cancer pathway referral (for an appointment within 2 weeks) for vaginal cancer in women with an unexplained palpable mass in or at the entrance to the vagina. (2)

Urgent investigations/referral should also be considered for any woman presenting with abnormal vaginal bleeding or unexplained vaginal discharge. (2)

References:

1. CRUK. Vaginal cancer statistics (Accessed 29/5/19)
2. Suspected cancer: recognition and referral. NG12. NICE guideline (2015 - last updated October 2023)