B-QuiCK: Vaginal cancer

B-QuiCK: Vaginal cancer – early detection and referral

Early detection

• Most tumours in the vagina are secondary to another gynaecological cancer. Primary vaginal cancers are rare and typically arise from pre-cancerous vaginal lesions which occur from infection with HPV. Recommend prophylactic HPV vaccination (funded for females and males aged 9 – 26 years inclusive).
  • Vaccination is most effective when administered prior to the onset of sexual activity but vaccinating those who have already commenced sexual activity is still recommended
  • The vaccine can be administered (not funded) to people aged 27 years and older if they have not been vaccinated before and are likely to benefit, e.g. people who are newly sexually active
• There are no screening programmes for the early detection of vaginal cancer, so diagnosis relies on recognising and investigating suspicious symptoms. Some people are diagnosed incidentally after an examination for other reasons, e.g. cervical screening.
  • Symptoms and signs of vaginal cancer may include abnormal vaginal bleeding or malodorous discharge, pelvic pain and urinary or bowel dysfunction, mass or lesion in the vagina

Patients with suspicion of vaginal cancer

• Take a focused history, considering relevant risk factors (e.g. personal history of cervical cancer or pre-cancerous cervical lesions)
• Perform a physical examination, including palpation of relevant lymph nodes and bimanual and speculum examinations. Take a vaginal sample for cytology/HPV testing.
  • Ideally use a clear plastic disposable speculum and gently move it around to see the whole vagina; pay close attention to the upper one-third and apex as this is the most common site of vaginal cancer
  • Offer cervical screening to patients who are due
    • Swabs for sexually transmitted infections, e.g. chlamydia, gonorrhoea, trichomoniasis, are not usually required if a tumour is present, but may be useful to exclude other potential causes of symptoms if the diagnosis is uncertain
• Request laboratory tests depending on individual factors to assess other aspects of the patient’s health and to identify any other potential underlying cause of the symptoms:
  • Tests may include full blood count, ferritin, liver function tests, coagulation tests, thyroid stimulating hormone, urine pregnancy test or serum hCG
• Refer directly for a colposcopy or to gynaecology if cytology results are abnormal, or if the vagina is visually abnormal upon examination (irrespective of cytology results). Note “urgent” on the referral if there are specific concerns on examination. Patients will undergo further investigations, e.g. vaginal biopsy, and management in secondary care if required.