Although the relation is unclear, certain factors predispose the patient to the development of squamous cell carcinoma of the vagina. These include trauma, chronic pessary use, and chemical carcinogen use, such as those in some sprays and douches. The most likely risk factor appears to be advanced age with any of the above factors.

Cancer in this area may also be an extension of a previous cancer of the endometrium, vulva, or cervix. Vaginal adenocarcinoma has also been associated with the use of diethylstilbestrol (DES) by the patient’s mother during pregnancy.

Because the vagina is a thin-walled structure with rich lymphatic drainage, vaginal cancer varies in severity, depending on its exact location and effect on lymphatic drainage. Vaginal cancer resembles cervical cancer in that it may progress from an intraepithelial tumor to an invasive cancer. It spreads more slowly than cervical cancer, however.

A lesion in the upper third of the vagina, the most common site, usually metastasizes to the groin nodes; a lesion in the lower third, the second most common site, usually metastasizes to the hypogastric and iliac nodes. A lesion in the middle third metastasizes erratically. A posterior lesion displaces and distends the vaginal posterior wall before spreading to deep layers. By contrast, an anterior lesion spreads more rapidly into other structures and deep layers because, unlike the posterior wall, the anterior vaginal wall isn’t flexible.

Metastasis may affect the cervix, uterus, and rectum.

The patient’s history may reveal one or more risk factors and the most frequent presenting signs—bloody vaginal discharge and irregular or postmenopausal bleeding. The patient may also complain of urine retention or urinary frequency if the lesion is close to the neck of the bladder. Vaginal examination may reveal a small or large ulcerated lesion in any area of the vagina.

Several tests help identify and stage vaginal cancer.