Fact-sheet: Primary vaginal carcinoma


Updated on 07/01/2026 at 3:32 PM

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Definition

Neoplasm arising primarily from the vagina, not resulting from loco-regional extension of a cervical or vulvar carcinoma

Clinical features

60-80 years.

Ulcerating, exophytic, or constrictive lesion, most often involving the posterior wall and upper third of the vagina

CT

Reference examination for staging workup

MRI

Reference examination for assessment of loco-regional extension

Lesion iso- to hypointense on T1 and of intermediate to high signal intensity on T2

Enhancement following IV injection.

  • Assessment of size, parametrial extension, and extension to the pelvic sidewall
  • Assessment of extension to the lower third of the vagina
  • Assessment of bladder, rectal, and extrapelvic extension
  • Assessment of ureteral extension and upstream Hydronephrosis
  • Assessment of pelvic and inguinal lymphadenopathy

--> See classifications below

Classification

Histologic types:

  • Squamous cell carcinoma (80-85%)
  • Adenocarcinoma: 15%, younger population
  • Melanoma
  • Rhabdomyosarcoma (pediatric)

AJCC, TNM, and FIGO classifications:

AJCC StageTNM StageFIGO StageDescriptionIAT1a N0 M0ICancer confined to the vagina and <= 2 cm (T1a) No lymphadenopathy (N0) or distant metastasis (M0)IBT1b N0 M0ICancer confined to the vagina and > 2 cm (T1b) No lymphadenopathy (N0) or distant metastasis (M0)IIAT2a N0 M0IISubvaginal infiltration into the parametrium without extension to the pelvic sidewall and <= 2 cm (T2a) No lymphadenopathy (N0) or distant metastasis (M0)IIBT2b N0 M0IISubvaginal infiltration into the parametrium without extension to the pelvic sidewall and > 2 cm (T2b) No lymphadenopathy (N0) or distant metastasis (M0)IIIT1 to T3 N1 M0IIIExtension to the pelvic sidewall and/or the lower third of the vagina and/or ureteral involvement with Hydronephrosis (T1 to T3) Pelvic or inguinal lymphadenopathy (N1) without metastatic involvement (M0)ORT3 N0 M0IIIExtension to the pelvic sidewall and/or the lower third of the vagina and/or ureteral involvement with Hydronephrosis (T3) Pelvic or inguinal lymphadenopathy (N1) without metastatic involvement (M0)IVAT4 Any N M0IVABladder or rectal involvement or extension beyond the pelvis ± pelvic or inguinal lymphadenopathy (± N+) without metastatic involvement (M0)IVBAny T Any N M1IVBDistant metastatic involvement, regardless of size. With or without loco-regional extension, ± pelvic or inguinal lymphadenopathy (± N+).

Differential diagnosis

Cervical carcinoma

Anorectal cancer

Uterine carcinoma

Vulvar carcinoma