Vaginal cancer: Clinical

Vaginal cancer is a rare gynecologic malignancy.

The most frequent histologic subtype is squamous carcinoma, which develops from the squamous epithelium of the vagina, in which case, it’s in relation to an HPV infection, particularly high risk strains, like HPV 16 and 18.

Sometimes, however, clear cell adenocarcinoma can occur, which develops from the glandular cells of the vagina, in which case it’s almost always because of exposure to a medication called diethylstilbestrol, or DES for short.

So, risk factors for vaginal cancer depend on the histologic subtype.

For vaginal squamous cell carcinoma, they’re the same as for cervical cancer: multiple lifetime sexual partners, early age at first sexual intercourse, as well as smoking, and immunocompromising conditions, like an HIV infection.

For vaginal adenocarcinoma, the only known risk factors are in utero exposure to DES.

This medication was prescribed to females between 1940 and 1970 to prevent pregnancy complications, like miscarriage - so their daughters would be at risk for developing vaginal adenocarcinoma.

Most of the time, vaginal cancer is asymptomatic.

If there are symptoms, abnormal postcoital or postmenopausal vaginal bleeding are the most common ones, and a watery, blood-tinged or foul-smelling vaginal discharge may be present as well.

In later stages, when the cancer has spread further than the vagina, pelvic pain may be present.

When the bladder is involved, there may also be symptoms like urinary frequency, and if the cancer has spread to the rectum, there may be constipation.

The speculum examination can usually identify any suspicious or abnormal looking masses inside the vagina, most commonly located on the upper third of the posterior vaginal wall.