Snapshot A 62-year-old women presents with abnormal vaginal bleeding. She underwent menopause at the age of 50. Pelvic examination is unremarkable. Vaginal cytology is abnormal, and she undergoes vaginal colposcopy. A biopsy is taken which is positive for vaginal squamous cell carcinoma. Introduction Overview malignancy affecting the vagina most common histologic type is squamous cell carcinoma most commonly secondary to squamous cell carcinoma of the cervix Epidemiology Incidence comprises ~3% of all malignancies involving the female genital tract mean age of diagnosis is ~60 years Risk factors human papillomavirus (HPV) infection extension from malignant cervical disease diethylstilbestrol (DES) associated with adenocarcinoma of the vagina Presentation Symptoms vaginal bleeding (most common) may be postcoital, intermenstrual, or postmenopausal Physical exam vaginal mass may be noted Studies Lab studies vaginal cytology Invasive studies vaginal colposcopy indication performed if cytology is abnormal vaginal biopsy indication confirms the diagnosis Histology squamous cell carcinoma most common histological type clear cell adenocarcinoma secondary to DES exposure in utero typically presents in women < 20 years of age sarcoma botryoides ("botrys" is Greek for "grapes") affecting girls < 4 years of age appears as a polypoid (or grape-like) mass that emerges from the vagina contains spindle-shaped cells and are positive for desmin Differential Cervical cancer differentiating factors evidence of dysplastic or malignat cells in the cervix only Treatment Treatment planning should be individualized depending upon the location, size, and clinical stage of the tumor Complications Treatment-related complications rectal and vaginal strictures urethral, bladder, and/or rectal injury