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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.
Primary vaginal cancer is rare and mostly caused by HPV, the virus behind cervical cancer. It is treated like cervical cancer, with weekly cisplatin alongside external and internal radiotherapy, which controls most tumours while preserving the organ; HPV vaccination and cervical screening, which also detects vaginal precursors, are steadily reducing it.
Primary vaginal carcinoma is defined as a tumour confined to the vagina without involvement of the cervix or vulva; tumours touching either are classified as cervical or vulvar. Most are HPV-related squamous cell carcinomas arising from vaginal intraepithelial neoplasia (VAIN), often in women with prior cervical neoplasia or hysterectomy for CIN. Adenocarcinoma is uncommon: clear cell adenocarcinoma in young women was the signature harm of in-utero diethylstilboestrol (DES) exposure between the 1940s and 1971, and the cohort is now ageing out. Melanoma and, in young children, embryonal rhabdomyosarcoma (sarcoma botryoides) complete the differential.
Because randomised trials are impossible at this rarity, treatment is extrapolated from cervical cancer. Small stage I lesions of the upper vagina can be excised or treated with brachytherapy alone; most patients receive definitive external beam radiotherapy with concurrent weekly cisplatin followed by image-guided brachytherapy, which preserves the vagina and gives local control comparable to cervical cancer series. Radical surgery (vaginectomy, exenteration) is reserved for radiotherapy failures or selected early lesions. Metastatic or recurrent disease is treated with platinum-based chemotherapy and, since 2018 for PD-L1-positive HPV-associated tumours by extension from cervical data, pembrolizumab; the KEYNOTE-A18 chemoradiation-plus-pembrolizumab result in cervical cancer is being extrapolated to locally advanced vaginal cancer. VAIN is treated with laser, topical imiquimod or fluorouracil, or excision, and surveillance after hysterectomy for CIN 3 is recommended.
| Setting | Approach | Guideline |
|---|---|---|
| VAIN 2 to 3 | Laser ablation, topical imiquimod or fluorouracil, or excision; surveillance after treatment of CIN 3 or hysterectomy for CIN. | not mapped |
| Stage I, small upper-vaginal lesion | Wide excision or brachytherapy alone in selected cases. | NCCN Category 2A |
| Stage I to IVA, most patients | External beam radiotherapy with concurrent weekly cisplatin followed by image-guided brachytherapy, extrapolated from cervical cancer. | not mapped |
| Recurrent or metastatic | Platinum-based chemotherapy; pembrolizumab for PD-L1-positive disease by extension from cervical cancer; salvage exenterative surgery for isolated central recurrence after radiotherapy. | not mapped |