The first 60 days: Vaginal squamous cell carcinoma (HPV-associated)
Vaginal squamous cell carcinoma is the commonest form of vaginal cancer, caused by the same HPV infection as cervical cancer and often following earlier cervical disease. It is treated much as cervical cancer is, with radiotherapy, brachytherapy and cisplatin for most stages and surgery only for small upper-vaginal tumours, and it is prevented by HPV vaccination and cervical screening. Below, week by week, is what OnCo's record of Vaginal squamous cell carcinoma (HPV-associated) says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- SurgeonNamed in the standard of care for: Precursor (VAIN), Stage I, upper vagina.
- Medical oncologistNamed in the standard of care for: Precursor (VAIN), Stage I, upper vagina, Stage II to IVA, Recurrent or metastatic disease.
- Clinical oncologist (radiotherapy)Named in the standard of care for: Precursor (VAIN), Stage I, upper vagina, Stage II to IVA, Recurrent or metastatic disease.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
Radical upper vaginectomy with pelvic lymphadenectomy, or brachytherapy with or without external beam radiotherapy.
External beam radiotherapy to the pelvis (and groins for lower-third tumours) with concurrent weekly cisplatin, followed by brachytherapy, extrapolating from cervical cancer.
Laser ablation or excision; topical imiquimod or fluorouracil; brachytherapy for extensive vault disease; HPV vaccination and screening for prevention.
Colposcopy and excisional treatment (LEEP/LLETZ, cone)Thermal ablation and cryotherapy for cervical precancerFluorouracil (5-FU)BrachytherapyHPV & HBV vaccinationNonavalent HPV vaccineEvaluate the Efficacy, Immunogenicity and Safety of 9-valent HPV Recombinant Vaccine in Chinese Healthy FemalesImmunogenicity and Safety of Quadrivalent HPV Vaccine in Healthy Chinese Female Subjects Aged 9 to 19 YearsCarboplatin and paclitaxel with or without bevacizumab; pembrolizumab for PD-L1-positive tumours (KEYNOTE-826 extrapolated); pelvic exenteration for isolated central recurrence after radiotherapy.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example HPV DNA and p16 immunohistochemistry, FIGO stage, Prior cervical neoplasia or hysterectomy, PD-L1 combined positive score, Brachytherapy dose delivered), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include High-grade vaginal intraepithelial neoplasia, Stage I vaginal squamous cell carcinoma, Stage II to IVA vaginal squamous cell carcinoma.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
Precursor (VAIN)
- For my situation (precursor (vain)), which of the standard options do you recommend and why?Guideline options include: Laser ablation or excision; topical imiquimod or fluorouracil; brachytherapy for extensive vault disease; HPV vaccination and screening for prevention.
- Am I a candidate for Fluorouracil (5-FU), Nonavalent HPV vaccine, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of Evaluate the Efficacy, Immunogenicity and Safety of 9-valent HPV Recombinant Vaccine in Chinese Healthy Females and Immunogenicity and Safety of Quadrivalent HPV Vaccine in Healthy Chinese Female Subjects Aged 9 to 19 Years apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Stage I, upper vagina
- For my situation (stage i, upper vagina), which of the standard options do you recommend and why?Guideline options include: Radical upper vaginectomy with pelvic lymphadenectomy, or brachytherapy with or without external beam radiotherapy.
Stage II to IVA
- For my situation (stage ii to iva), which of the standard options do you recommend and why?Guideline options include: External beam radiotherapy to the pelvis (and groins for lower-third tumours) with concurrent weekly cisplatin, followed by brachytherapy, extrapolating from cervical cancer.
- Am I a candidate for Cisplatin, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Recurrent or metastatic disease
- For my situation (recurrent or metastatic disease), which of the standard options do you recommend and why?Guideline options include: Carboplatin and paclitaxel with or without bevacizumab; pembrolizumab for PD-L1-positive tumours (KEYNOTE-826 extrapolated); pelvic exenteration for isolated central recurrence after radiotherapy.
- Am I a candidate for Carboplatin, Paclitaxel / nab-paclitaxel, Pembrolizumab, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of KEYNOTE-826 apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Any stage
- Are there clinical trials I could join, for example of Pembrolizumab, HPV & HBV vaccination, Phase II Study of Dysplasix™ Intravaginal Suppositories in Patients Patients With High-Risk HPV and Mild Cervical Cytologic Abnormalities?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
- I read that “No randomised trial has ever been conducted in vaginal cancer”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “Radiotherapy causes vaginal stenosis and sexual morbidity that are poorly addressed”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.
- Evaluate the Efficacy, Immunogenicity and Safety of 9-valent HPV Recombinant Vaccine in Chinese Healthy FemalesPhase 3 · recruiting · NCT04422366A Multicenter,Randomized,Blind and Positive-Controlled Phase Ⅲ Study to Evaluate the Efficacy, Immunogenicity and Safety of the 9-valent Human Papillomavirus (Types 6, 11, 16, 18,31,33,45,52 and 58) Recombinant Vaccine (Hansenula Polymorpha) in Chinese Female Subjects Aged 20-45 Years
- Immunogenicity and Safety of Quadrivalent HPV Vaccine in Healthy Chinese Female Subjects Aged 9 to 19 YearsPhase 3 · recruiting · NCT05027776Evaluating the Immunogenicity and Safety of Quadrivalent Human Papillomavirus Recombinant Vaccine (Type 6, 11, 16, 18) in Healthy Chinese Female Subjects Aged 9 to 26 Years: A Phase 3, Open-label, Non-randomized Clinical Trial
- Phase II Study of Dysplasix™ Intravaginal Suppositories in Patients Patients With High-Risk HPV and Mild Cervical Cytologic AbnormalitiesPhase 2 · recruiting · NCT07572396A Phase II, Randomized, Double-blind, Placebo-Controlled, Proof of Concept Study to Assess the Safety and Efficacy of Dysplasix™ Intravaginally-Administered Suppositories in Patients With High-Risk Human Papillomavirus (Hr-HPV) as Determined by HPV Testing, and Accompanied by Either (1) Atypical Squamous Cells of Undetermined Significance (ASC-US) or (2) Low-Grade Squamous Intraepithelial Lesions (LSIL), as Determined by Cytology
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Vaginal squamous cell carcinoma (HPV-associated): the full pageVaginal squamous cell carcinoma is the commonest form of vaginal cancer, caused by the same HPV infection as cervical cancer and often following earlier cervical disease. It is treated much as cervical cancer is, with radiotherapy, brachytherapy and cisplatin for most stages and surgery only for small upper-vaginal tumours, and it is prevented by HPV vaccination and cervical screening.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Cervical precancer (CIN, HSIL/LSIL): Abnormal cervical cells caused by HPV that can turn into cancer over 10-20 years.
- HPV status (HPV-positive / HPV-negative): Whether a cancer is caused by human papillomavirus.
- HPV-positive (p16) head and neck cancer: Throat cancers caused by the human papillomavirus, identified by a p16 stain.
- Lymphadenectomy (lymph node dissection): Surgically removing the lymph nodes that drain a tumour, both to stage the cancer and to clear any spread.
- Chemoradiation (chemoradiotherapy, CRT): Radiotherapy given at the same time as chemotherapy, which sensitises the cancer to radiation.
Every term links to the glossary.