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10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
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.
Squamous cell carcinoma makes up most primary vaginal cancers and shares its cause and precursor with cervical cancer: persistent high-risk HPV infection leading to vaginal intraepithelial neoplasia (VAIN), which is commonest at the vaginal vault after hysterectomy for cervical precancer. The strict definition excludes tumours that reach the cervix or vulva, which are classified as cervical or vulvar, and metastases from the cervix, endometrium and bowel outnumber true primaries. Diagnosis is by biopsy at colposcopy, staging is clinical and by MRI and PET-CT under the FIGO system shared with cervical cancer, and p16 confirms HPV association.
Because the disease is rare, no randomised trial has ever been run in it, and treatment is extrapolated from cervical cancer. High-grade VAIN is treated with laser ablation, excision, topical imiquimod or fluorouracil, or brachytherapy for extensive vault disease. Small stage I tumours of the upper vagina can be removed by radical upper vaginectomy with pelvic lymphadenectomy, but most patients receive external beam radiotherapy to the pelvis and groins followed by brachytherapy, with concurrent weekly cisplatin for stage II and above by analogy with cervical chemoradiotherapy; brachytherapy dose is the strongest determinant of local control. Recurrent or metastatic disease is treated as cervical cancer, with carboplatin and paclitaxel with or without bevacizumab and with pembrolizumab for PD-L1-positive tumours, extrapolating KEYNOTE-826. HPV vaccination and cervical screening prevent the disease, and Chinese vaccine trials list vaginal cancer among their endpoints.
| Setting | Approach | Guideline |
|---|---|---|
| Precursor (VAIN) | Laser ablation or excision; topical imiquimod or fluorouracil; brachytherapy for extensive vault disease; HPV vaccination and screening for prevention. | not mapped |
| Stage I, upper vagina | Radical upper vaginectomy with pelvic lymphadenectomy, or brachytherapy with or without external beam radiotherapy. | not mapped |
| Stage II to IVA | External beam radiotherapy to the pelvis (and groins for lower-third tumours) with concurrent weekly cisplatin, followed by brachytherapy, extrapolating from cervical cancer. | not mapped |
| Recurrent or metastatic disease | Carboplatin and paclitaxel with or without bevacizumab; pembrolizumab for PD-L1-positive tumours (KEYNOTE-826 extrapolated); pelvic exenteration for isolated central recurrence after radiotherapy. | not mapped |