Malignant tumors of the vagina are often secondary, which can directly spread from cervical cancer or originate from carcinoma of the endometrium, ovarian cancer, or choriocarcinoma. Additionally, bladder, urethral, or rectal cancers often metastasize to the vagina. Primary malignant tumors of the vagina are very rare, accounting for about 1% of female genital tract malignancies. The main types are squamous cell carcinoma and choriocarcinoma, while others such as adenocarcinoma, sarcoma, and malignant melanoma are even rarer. Many gynecologists have encountered only a few cases in their practice. Since secondary vaginal cancers are more common, the possibility of secondary vaginal cancer should be considered and ruled out before diagnosing a primary tumor.

bubble_chart Pathological Changes

Since primary vaginal cancer most commonly occurs in the posterior fornix, it may be related to chronic irritation. In summary, its exact disease cause and precursor conditions remain unclear. Pathologically, there are generally three types: ① The cauliflower type, if treatment is delayed, the cauliflower-like mass can fill the entire vagina. It often initially occurs in the upper one-third of the posterior vaginal wall, with highly differentiated cancer cells, belonging to the exophytic type, rarely infiltrating inward. ③ The infiltrative or ulcer type, where the cancer forms an ulcer, mainly seen on the anterior vaginal wall, often rapidly infiltrating surrounding vaginal tissues. ③ The mucous membrane type, which develops slowly and may remain confined to the mucous membrane layer for a long time, representing vaginal carcinoma in situ. However, vaginal carcinoma in situ is more often associated with or secondary to cervical carcinoma in situ or peripheral changes of invasive cervical cancer. Histologically, primary vaginal cancer is almost always squamous cell carcinoma, with adenocarcinoma being extremely rare.

bubble_chart Clinical Manifestations

In the early stages, there may be no symptoms. Later symptoms include vaginal bleeding and abnormal vaginal discharge. Pain usually occurs in the advanced stage of the cancer. Tumors in the lower part of the vagina may cause bladder irritation symptoms earlier. The diagnosis of vaginal cancer is basically the same as that of cervical cancer, including a thorough speculum examination, vaginal cytology, and biopsy.

During the three-way examination, in addition to checking the local lesion, attention should also be paid to the elasticity of the entire vaginal membrane and whether the paravaginal tissues are involved.

bubble_chart Treatment Measures

1. Treatment Principles: Vaginal cancer can be treated with surgery or radiation therapy. Cancers in the upper part of the vagina are treated similarly to cervical carcinoma, those in the lower part are treated like vulva cancer, and those in the middle part require a combination of both. If the bladder or rectum is involved, organ resection and diversion procedures are necessary.

2. Surgical Treatment: ① Radical hysterectomy, partial vaginectomy, and pelvic lymphadenectomy are suitable for early-stage cancers in the upper vagina. ② Radical vulvectomy and vaginectomy with inguinal or additional pelvic lymphadenectomy are appropriate for small and localized lesions in the lower vagina. ③ The above procedures (① or ②) combined with organ resection and diversion. These surgeries are extensive, with significant surgical trauma and a higher risk of complications, and should only be used when absolutely necessary.

3. Radiation Therapy: The radiation treatment plan depends on the location and extent of tumor infiltration. Tumors in the vaginal fornix are treated similarly to cervical cancer. If there is infiltration in the vaginal wall, whole pelvic external irradiation followed by local radium therapy is administered. The five-year survival rate for vaginal cancer is generally 35%. The primary causes of death are uremia or infection due to urinary tract obstruction.

Due to the unique anatomical features of the vagina (loose connective tissue, thin walls, rich lymphatic supply), cancer is more prone to spread. The main routes of spread include direct extension, lymphatic metastasis, and occasionally distant metastasis. The lymphatic metastasis pathways for cancer in the upper vagina are essentially the same as those for cervical cancer; for the lower third of the vagina, they resemble those of vulvar cancer; and for the middle third, metastasis can occur via both upper and lower pathways.