Introduction

Primary carcinoma of the vagina is a rare condition that mainly affects older women. One of the main risk factors is persistent human papilloma virus (HPV) infection. Treatments are individualised, and treatment decisions are based on factors that include the site, size and stage of the tumour, and which adjacent structures are involved.

Tumours affecting the vagina

The most common malignant tumours affecting the vagina are tumours that have spread from adjacent structures (cervix and vulva). Table 25.1 shows the range of tumours that can affect the vagina (adapted from WHO Classification, 2003).

Anatomy

The vagina is a muscular tube about 8 cm long, and it extends upwards and backwards from the vulva to the uterus. The apex of the vagina, into which the cervix projects, is divided into four fornices: anterior, posterior, and two lateral.

The relations of the vagina from superior to inferior are as follows:

• Anterior – bladder, urethra.

• Posterior – pouch of Douglas, rectum, perineal body (separates lower vagina from anus).

• Lateral – ureter, pelvic floor and perineal muscles.

The lymphatic drainage from the upper two-thirds is to the pelvic nodes, and from the lower third to the inguinal nodes.

Incidence and epidemiology

Vaginal cancer is rare; the annual disease incidence in the UK is 0.7 in 100,000 women. Approximately 180 new cases are diagnosed per year in England (National Statistics, 2005), and vaginal cancer accounts for approximately 1 to 2% of all gynaecological malignancy. The mortality-to-incidence ratio is 0.53 (National Statistics, 2005).