What Is Vaginal Cancer?
Primary vaginal cancer — cancer that originates in the vagina rather than spreading to it from another site — is one of the rarest gynaecological malignancies, accounting for approximately 1–2% of all gynaecological cancers. Because of its rarity, it is often managed sub-optimally when it falls outside specialist oncology centres.
The most common type is squamous cell carcinoma (SCC), which accounts for around 85–90% of cases and shares a strong aetiological association with HPV infection — particularly strains 16 and 18.
Who Is at Risk?
- Previous cervical cancer or cervical intraepithelial neoplasia (CIN)
- HPV infection (particularly HPV 16)
- Vaginal intraepithelial neoplasia (VAIN) — a precancerous condition
- In utero diethylstilboestrol (DES) exposure
- Immunosuppression (HIV infection, post-transplant)
- History of pelvic radiation for another cancer
What Are the Symptoms?
- Abnormal vaginal bleeding (post-coital, postmenopausal, or irregular)
- Watery or blood-stained vaginal discharge
- A painless lump or ulcer in the vagina
- Pelvic pain or dyspareunia (pain during intercourse) — in more advanced disease
- Urinary symptoms or rectal symptoms if the tumour involves adjacent structures
Diagnosis: What to Expect
Diagnosis requires direct visualisation of the vagina (colposcopy) and tissue biopsy. MRI of the pelvis is the gold standard for assessing tumour extent and is essential for staging and planning radiotherapy fields.
Because vaginal cancer is rare, it is critical that management takes place at a centre with gynaecological oncology expertise. Treatment decisions involve a multidisciplinary team of gynaecological oncologists, radiation oncologists, and medical oncologists.
Is Screening Available?
There is no population-level screening programme for vaginal cancer. However, women who have been treated for cervical cancer or high-grade CIN should continue with vault smears for life. Women who have had a hysterectomy for benign disease are generally not at risk and do not need vault smears.
Dr. Nishtha Tripathi Patel is a gynaecological oncologist in Ahmedabad treating all gynaecological cancers. For specialist consultation: +91 76988 00333.