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Primary vaginal cancer is rare and mostly caused by HPV, the virus behind cervical cancer. It is treated like cervical cancer, with weekly cisplatin alongside external and internal radiotherapy, which controls most tumours while preserving the organ; HPV vaccination and cervical screening, which also detects vaginal precursors, are steadily reducing it.
Primary vaginal carcinoma is defined as a tumour confined to the vagina without involvement of the cervix or vulva; tumours touching either are classified as cervical or vulvar. Most are HPV-related squamous cell carcinomas arising from vaginal intraepithelial neoplasia (VAIN), often in women with prior cervical neoplasia or hysterectomy for CIN. Adenocarcinoma is uncommon: clear cell adenocarcinoma in young women was the signature harm of in-utero diethylstilboestrol (DES) exposure between the 1940s and 1971, and the cohort is now ageing out. Melanoma and, in young children, embryonal rhabdomyosarcoma (sarcoma botryoides) complete the differential.
Because randomised trials are impossible at this rarity, treatment is extrapolated from cervical cancer. Small stage I lesions of the upper vagina can be excised or treated with brachytherapy alone; most patients receive definitive external beam radiotherapy with concurrent weekly cisplatin followed by image-guided brachytherapy, which preserves the vagina and gives local control comparable to cervical cancer series. Radical surgery (vaginectomy, exenteration) is reserved for radiotherapy failures or selected early lesions. Metastatic or recurrent disease is treated with platinum-based chemotherapy and, since 2018 for PD-L1-positive HPV-associated tumours by extension from cervical data, pembrolizumab; the KEYNOTE-A18 chemoradiation-plus-pembrolizumab result in cervical cancer is being extrapolated to locally advanced vaginal cancer. VAIN is treated with laser, topical imiquimod or fluorouracil, or excision, and surveillance after hysterectomy for CIN 3 is recommended.
Prevention rests on HPV vaccination and on cervical screening programmes, which detect VAIN incidentally.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
About one to two percent of gynaecological cancers; most vaginal tumours are actually spread from the cervix, vulva or endometrium, and true primary vaginal cancer is rare (SEER).
Most high-grade ovarian cancers begin at the tip of the fallopian tube; endometrial cancer lines the uterus, cervical cancer starts at the transformation zone; each drains to a different node group.
Same organ: Adenosquamous carcinoma of the cervix, Small cell neuroendocrine carcinoma of the cervix, Bartholin gland carcinoma, Vulvar melanoma, Vaginal melanoma, High-grade serous ovarian cancer, Low-grade serous ovarian cancer, Clear cell ovarian cancer, Mucinous ovarian cancer, Adult granulosa cell tumour of the ovary, Ovarian cancer, Endometrial cancer, Cervical cancer, Vulvar cancer, Gestational trophoblastic neoplasia, Uterine sarcoma, POLE-ultramutated endometrial cancer, Mismatch-repair-deficient endometrial cancer, p53-abnormal endometrial cancer, including uterine serous carcinoma, Endometrial cancer with no specific molecular profile, Advanced or recurrent endometrial cancer, Uterine carcinosarcoma, Early cervical cancer and fertility-sparing surgery, Locally advanced cervical cancer, Recurrent or metastatic cervical cancer, Platinum-sensitive ovarian cancer, Platinum-resistant ovarian cancer, HPV-associated vulvar squamous cell carcinoma, HPV-independent vulvar squamous cell carcinoma (p53-mutant), Vaginal squamous cell carcinoma (HPV-associated), Vaginal adenocarcinoma (including DES-associated clear cell adenocarcinoma), Low-risk gestational trophoblastic neoplasia (FIGO score 0 to 6), High-risk gestational trophoblastic neoplasia (FIGO score 7 or more, including ultra-high-risk), Placental-site trophoblastic tumour and epithelioid trophoblastic tumour
Nothing recorded yet.
Nothing recorded yet.
Also on OnCo: Symptoms and red flags · Early detection roadmap.
Laser ablation, topical imiquimod or fluorouracil, or excision; surveillance after treatment of CIN 3 or hysterectomy for CIN.
Wide excision or brachytherapy alone in selected cases.
External beam radiotherapy with concurrent weekly cisplatin followed by image-guided brachytherapy, extrapolated from cervical cancer.
Platinum-based chemotherapy; pembrolizumab for PD-L1-positive disease by extension from cervical cancer; salvage exenterative surgery for isolated central recurrence after radiotherapy.
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Query for this cancer: (TITLE:"Vaginal cancer" OR ABSTRACT:"Vaginal cancer" OR TITLE:"Vaginal squamous cell carcinoma" OR ABSTRACT:"Vaginal squamous cell carcinoma" OR TITLE:"Primary vaginal carcinoma" OR ABSTRACT:"Primary vaginal carcinoma" OR TITLE:"VAIN vaginal intraepithelial neoplasia; precursor" OR ABSTRACT:"VAIN vaginal intraepithelial neoplasia; precursor") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Vaginal cancer, not a curated reading list.
Herbst and colleagues (NEJM 1971) report the association; DES is withdrawn for pregnancy the same year.
Five randomised trials; the approach is extrapolated to vaginal cancer.
Protects against the HPV types that cause most vaginal, cervical and vulvar cancers.
Extended in practice to HPV-associated vaginal cancer.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
Eyebrows and eyelashes usually fall later than scalp hair and come back later, and their absence is felt more than people expect, because they frame the face and keep dust and sweat out of the eyes.
Taxane and anthracycline chemotherapy for triple-negative breast cancer causes hair loss in most people, usually starting after the first or second cycle and almost always growing back; scalp cooling kept more than half the hair in about half of women in a randomised trial and is offered in many UK units.
See all on the product pages:CisplatinPaclitaxel / nab-paclitaxelPembrolizumab·Printable cards in the navigator
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