Diagnosis of a primary vaginal cancer is rare because most of these lesions will be
metastatic from another primary site. Although cancer of the vagina is more common
in postmenopausal women, an increase in young women being diagnosed with primary
vaginal cancer has been reported, especially in countries with a high HIV prevalence.
This will be associated with persistence of high-risk HPV infection. The emphasis
should be on primary prevention with prophylactic HPV vaccination. Once there is a
suspicion of a primary vaginal cancer, this should be confirmed histologically with
biopsy. Staging has been done clinically, similar to cervical cancer; however, there is a
role for imaging in assisting with staging as this is often a difficult assessment.
Treatment should be individualized and depends on stage as well as histologic subtype.
It is prudent to refer cases to centers of excellence with experience in dealing with this
rare gynecological cancer.