Vaginal cancer

Risk factors: carcinoma in situ, HPV, chronic irritation, previous abnormal Pap smears, early hysterectomy, multiple partners, early first intercourse, smoking, in-utero DES, partner with penile cancer.
Presentation: irregular (often post-coital) bleeding or discharge, dysuria, vaginal mass.
Investigations: FBC, LFT, urea, creatinine, HIV test; Pap smear; chest X-ray; CT/MRI abdomen and pelvis; colposcopy; cystoscopy/urethroscopy in advanced stages; biopsy; PET/CT.

Stage	Management
Carcinoma in situ	Wide local excision; brachytherapy to the whole vaginal mucosa for recurrence
Stage I	Wide local excision, total or radical vaginectomy with lymphadenectomy (pelvic if upper two-thirds, inguinal if lower third), post-operative RT for close margins; OR brachytherapy ± pelvic EBRT
Stage II	EBRT to the pelvis ± inguinal nodes (45 Gy) with brachytherapy boost
Stage III	EBRT 45–50 Gy (inguinal nodes if lower third) with boost to 75–80 Gy; consider exenteration if fistula
Metastatic	Palliative RT ± chemotherapy
Recurrent	Pelvic exenteration if no sidewall invasion; brachytherapy ± EBRT salvage

Chemotherapy (radiosensitiser or palliative)

S: Cisplatin IV 40 mg/m² (maximum 70 mg) weekly during radiotherapy; 30 mg/m² (maximum 60 mg) if HIV-positive or mild renal impairment.
Palliative: S: cisplatin 50 mg/m² IV day 1 AND S: 5-FU 500 mg/m² IV day 1 AND S: filgrastim 5 micrograms/kg SC days 3–12, every 21 days for 4–6 cycles.

Imeandikwa:

18 Oktoba 2026, 21:05:21

References:

Ministry of Health, United Republic of Tanzania. Standard Treatment Guidelines and National Essential Medicines List for Tanzania Mainland (STG & NEMLIT). 7th ed. Dodoma: Ministry of Health; 2026. Chapter 22, Malignant Disease Conditions: section 22.2.4 Vaginal Cancer (Table 22.4), pp. 573–574.