Primary vaginal cancer is rare (1%–2% of female genital tract cancers), strictly defined by the absence of prior/concurrent cervical or vulvar cancer. Increasing incidence in younger women is linked to HPV infection.
The pathogenesis is largely HPV-dependent, progressing from HSIL to invasive cancer (2%−12% risk). Diagnosis requires biopsy and a thorough exam, typically after a patient presents with bleeding/discharge. Accurate classification relies on histology and HPV/p16 testing.
Prevention includes HPV vaccination. HSIL treatment options are individualized: surgical excision (unifocal), CO2laser vaporization (multifocal, requires pre-biopsy), or topical imiquimod. Long-term follow-up is essential due to high recurrence.
Invasive cancer is primarily managed with radiation (EBRT + brachytherapy). The standard of care for locally advanced disease is concomitant chemoradiation (CCRT), which improves survival. Surgery is limited to small, early-stage lesions (≤2 cm). Staging is clinical (FIGO), supplemented by imaging (MRI/PET-CT) for treatment planning. The most critical prognostic factor is the stage at diagnosis. Rare subtypes include DES-linked adenocarcinoma and sarcoma botryoides.