This information supports clinicians to manage vaginal cancer using the latest evidence-based information to inform diagnosis, treatment and follow-up care.
Histological features, staging and classification
Clinicians define primary vaginal cancer as disease without evidence of cervical or vulvar cancer, or a history of either, in the past 5 years.
Vaginal cancer is rare, accounting for 1 to 2% of gynaecological malignancies and 0.15% of cancer overall.1 Human papillomavirus (HPV) increases risk in younger patients but not older patients.2
Between 80% to 90% of vaginal lesions arise from the cervix, vulva or other nearby organs, e.g. the endometrium, bladder, rectosigmoid or ovary.1 Less commonly, metastases occur from distant sites, e.g. the colon, breast and pancreas.
Clinicians confirm suspected primary vaginal cancer with a biopsy. Squamous cell cancer accounts for over 90% of cases.1 Rare types include primary adenocarcinoma, clear cell adenocarcinoma, melanoma, sarcoma and lymphoma.
Staging and classification
Clinicians should classify cases as carcinoma of the vagina only when the primary site of growth is in the vagina. They should not regard tumours located in the vagina as primary vaginal cancer if those tumours are secondary extensions or metastases from other genital or extra-genital sites.
The International Federation of Gynecology and Obstetrics (FIGO) nomenclature for carcinoma of the vagina:3
| FIGO stage | Extent of disease |
|---|---|
| Stage I | The carcinoma is limited to the vaginal wall. |
| Stage II | The carcinoma has involved the subvaginal tissue but has not extended to the pelvic wall. |
| Stage III | The carcinoma has spread to the pelvic wall. |
| Stage IV | The carcinoma has spread beyond the true pelvis or has clinically involved the bladder or rectal mucosa. Do not assign State IV based on bullous oedema alone. |
| Stage IVA | Tumour invades bladder and/or rectal mucosa and/or direct spread beyond the true pelvis. |
| Stage IVB | Spread to distant organs. |
References
- Kaltenecker B, Dunton CJ, Tikaria R. Vaginal cancer. StatPearls. Treasure Island (FL): StatPearls Publishing; Jan 2025 [updated 1 Mar 2023; cited 9 Sep 2025]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559126/
- Hellman K, Silfverswärd C, Nilsson B, et al. Primary carcinoma of the vagina: factors influencing the age at diagnosis. The Radiumhemmet series 1956–96. Int J Gynecol Cancer. 2004;14(3):491–501.
- PDQ Adult Treatment Editorial Board. Vaginal Cancer Treatment (PDQ®): Health Professional Version. 3 Apr 2025. PDQ Cancer Information Summaries. Bethesda (MD): National Cancer Institute (US); 2002 [cited 28 May 2026]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK65801/