Vaginal carcinoma is a rare malignancy comprising 1% of genital cancers. Risk factors include HPV, a history of cervical cancer, or exposure to diethylstilbestrol in utero. Symptoms include abnormal vaginal bleeding or discharge. On examination, an ulcerative or exophytic growth is usually seen in the upper third of the posterior vaginal wall. Squamous cell carcinoma is most common. Spread is usually local but may occur via lymph nodes or blood to distant sites like lungs or bones. Diagnosis involves cytology, colposcopy, and biopsy of any abnormal areas.

1. VAGINAL CARINOMA

2. INCIDEN
CE
1 percent of genital malignancies.

4. ETIOLO
GY
 HPV
 Progression from vaginal intraepithelial neoplasia
 Women with history of cervical cancer
 Diethyl stilboesterol (DES)

5. PATHOLO
GY
Site:
The commonest site is in the upper-third of the posterior wall.
Naked eye:
The growth may be ulcerative or fungative.

6. TYP
E
 Squamous cell
 Adeno carcinoma
 Fibrosarcoma
 Melanoma

7. SPREA
D
 Direct spread- ascending / descending
Lymphatics - inguinofemoral lymph nodes and pelvic
lymph nodes
Blood borne (rare) – lungs, liver and bones

8. CLINICAL
FEATURES
 Age: 55 years
 SYMPTOMS
 Asymptomatic
 Abnormal vaginal bleeding including post coital bleeding
 Foul smelling discharge per vaginum.

9. SIGNS
Speculum examination reveals an ulcerative, nodular or
exophytic growth.
The cervix looks apparently normal.

10. DIAGNO
SIS
 Cytology – screening procedure – to detect abnormal cells
Colposcopy and targeted biopsy – abnormal cytology /
unexplained vaginal discharge
 Cystourethroscopy
 Proctosigmoidoscopy,
 CT/ MRI (for nodes)

12. CARCINO
MA

13. INCIDEN
CE
MAJOR HEALTH
PROBLEM
ONE OF THE LEADING
SITE

14. Gross Pathology:
Thesite of the lesion is
predominantly in the
ecto-cervix (80%) and
the rest (20%) are in the
endo-cervix.

15. Exophytic: These arise from
the ecto-cervix and form friable
masses almost filling up the
upper vagina in late cases.

16. Ulcerative: The lesion excavates the
cervix and often involves the vaginal
fornices
Infiltrative: These are found in
endo-cervical growth. They cause
expansion of the cervix, so that it
becomes barrel-shaped.

18. Squamous cell carcinoma most commonest – (80%) - ectocervix
Adenocarcinoma (10–15%) develops from the endo-cervical canal,
either from the lining epithelium or from the glands.

19. MODE OF
SPREAD
Direct extension: to vagina, and to the body of the uterus
Lymphatic: parametrial nodes, internal iliac nodes,
obturator, external iliac nodes and sacral nodes

20. Hematogenous: Blood borne metastasis is late. Lungs, liver or
bone are usually involved.

21. STAGE INVASIVE CARCINOMA
Stage – I The carcinoma is strictly confined to the cervix.
Stage – IA CA which can be only diagnosed by microscopy with
deepest invasion < 5mm and largest extension < 7mm
Stage – IB Clinically visible lesions limited to the cervix uteri or
preclinical cancers greater than IA

24. Stage – IV
The carcinoma has extended beyond the true
pelvis or has involved the mucosa of the
bladder or rectum.
Stage – IVA Spread of the growth to adjacent
organs.
Stage – IVB Spread to distant organs.

25. SIGN
S
 A red granular area extending from the external os
 A nodular growth or an ulcer.
The lesion bleeds on friction
 Friable

27. Bladder symptoms include frequency of micturition, dysuria,
haematuria or even true incontinence due to fistula formation.
Rectal involvement is evidenced by diarrhoea, rectal pain, bleeding per
rectum or even recto-vaginal fistula.
Ureteral obstruction is due to progressive growth of tumour laterally.
There may be frequent attacks of pyelonephritis due to ureteric
obstruction.
Ultimately, the patient may be cachectic, anaemic with oedema legs.