Squamous-cell carcinoma of the vagina is a potentially invasive type of cancer that forms in the tissues of the vagina. Though uncommon, squamous-cell cancer of the vagina (SCCV) is the most common type of vaginal cancer. It is further subdivided into the following subtypes: keratinizing, nonkeratinizing, basaloid, and warty.^[1] It forms in squamous cells, the thin, flat cells lining the vagina. Squamous cell vaginal cancer spreads slowly and usually stays near the vagina, but may spread to the lungs, liver, or bone. This is the most common type of vaginal cancer.^[2] SCCV accounts for approximately 85% of vaginal cancer cases and initially spreads superficially within the vaginal wall. It can later invade other vaginal tissues. The carcinoma can metastasize to the lungs, and less frequently in liver, bone, or other sites. SCC of the vagina is associated with a high rate of infection with oncogenic strains of human papillomavirus (HPV) and has many risk factors in common with cervical cancer.^[3]

Signs and symptoms

SCCV may not cause early signs or symptoms and may be found during a routine pelvic exam and Pap test. Signs and symptoms may be caused by other types of vaginal cancer or by other conditions:

• bleeding or discharge not related to menstrual period
• pain during sexual intercourse
• pain in the pelvic area
• lump in the vagina
• pain when urinating
• constipation^[2]

Risks

• multiple sex partners
• age > 60 years
• smoking
• human papillomavirus (HPV) infection
• early age at first intercourse^[1]

Diagnosis

Diagnosis includes a complete assessment of medical history and physical examination. A pelvic exam is typically performed. Other diagnostic procedures used are the pap test, colposcopy and biopsy.^[2] Other procedures are used to aid in diagnosis: chest x-ray, CT scan (CAT scan), MRI (magnetic resonance imaging), PET scan (positron emission tomography scan), and cystoscopy.^[4]

Treatment

Treatment depends upon the following:

• stage and size of the cancer
• Whether the cancer is close to other organs that may be damaged by treatment
• Whether the patient has a uterus or has had a hysterectomy
• Whether the patient has had past radiation treatment to the pelvis^[2]

Epidemiology

Those most affected are:

• older women
  • peak incidence 60-79 years
  • < 15% in women < 50 years old
  • < 10% in women < 40 years old
• Fifty percent of SCCV associated with hysterectomy
• Incidence may increase with pelvic organ prolapse
• More prevalent in black and Hispanic women
• accounts for 80%-90% of all vaginal cancers^[1]