 Introduction/Background Primary vaginal cancer is rare, comprising 1% to 2% of gynecologic malignancies and 20% of all malignancies involving the vagina [1,2]. More frequently, the vagina is involved secondarily either by direct invasion from malignancies originating in adjacent organs, most commonly the cervix or vulva, or by metastases from other pelvic or extrapelvic primary malignancies [1,2]. Additionally, any vaginal tumor involving the cervix or vulva, whether or not the lesion is centered in the vagina, is classified by the International Federation of Gynecology and Obstetrics (FIGO) system as a primary cervical or vulvar cancer, respectively. Squamous cell carcinoma is the most common underlying histology in primary vaginal cancer, representing 80% to 90% of primary vaginal cancer [3] and occurs most frequently in postmenopausal women, with adenocarcinoma representing around 5% to 10% of cases and even rarer histologies such as sarcoma, melanoma, and lymphoma accounting for the remainder [1,2]. Primary vaginal cancer is staged according to two systems, FIGO and the American Joint Committee on Cancer (AJCC). FIGO stipulates a clinical staging paradigm, whereby features derived from bimanual and/or rectovaginal examination, cystoscopy, proctoscopy, and radiography are permissible for incorporation into staging [4]. Although FIGO encourages the use of advanced imaging modalities such as CT, MRI, and PET to guide management, information derived from these examinations does not alter the formal clinical FIGO stage [4]. Given the rarity of primary vaginal cancer, treatment principles are derived from retrospective data in addition to extrapolation from more established management paradigms for cervical and anal squamous cell cancers. Surgical management for vaginal cancer is limited primarily to small (<2 cm) early stage lesions, with larger lesions posing greater difficultly for achieving negative surgical margins.
Staging and Follow up of Primary Vaginal Cancer.  Introduction/Background Primary vaginal cancer is rare, comprising 1% to 2% of gynecologic malignancies and 20% of all malignancies involving the vagina [1,2]. More frequently, the vagina is involved secondarily either by direct invasion from malignancies originating in adjacent organs, most commonly the cervix or vulva, or by metastases from other pelvic or extrapelvic primary malignancies [1,2]. Additionally, any vaginal tumor involving the cervix or vulva, whether or not the lesion is centered in the vagina, is classified by the International Federation of Gynecology and Obstetrics (FIGO) system as a primary cervical or vulvar cancer, respectively. Squamous cell carcinoma is the most common underlying histology in primary vaginal cancer, representing 80% to 90% of primary vaginal cancer [3] and occurs most frequently in postmenopausal women, with adenocarcinoma representing around 5% to 10% of cases and even rarer histologies such as sarcoma, melanoma, and lymphoma accounting for the remainder [1,2]. Primary vaginal cancer is staged according to two systems, FIGO and the American Joint Committee on Cancer (AJCC). FIGO stipulates a clinical staging paradigm, whereby features derived from bimanual and/or rectovaginal examination, cystoscopy, proctoscopy, and radiography are permissible for incorporation into staging [4]. Although FIGO encourages the use of advanced imaging modalities such as CT, MRI, and PET to guide management, information derived from these examinations does not alter the formal clinical FIGO stage [4]. Given the rarity of primary vaginal cancer, treatment principles are derived from retrospective data in addition to extrapolation from more established management paradigms for cervical and anal squamous cell cancers. Surgical management for vaginal cancer is limited primarily to small (<2 cm) early stage lesions, with larger lesions posing greater difficultly for achieving negative surgical margins.