UK Vaginal Cancer incidence statistics

This page presents vaginal cancer incidence statistics by age, trends over time, geographical variation and socio-economic status. The lCD codes for vaginal cancer ICD9 184.0 and ICD10 C52.

Vaginal cancer incidence in the UK

A diagram of the site of the vagina is shown in Figure 1.1

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Cancer of the vagina is rare with 252 new cases diagnosed in 2006. ( Table 1.1). 1-,4 This gives a European age-standardised incidence rate for vaginal cancer of 0.6 per 100,000 female population. 1-,4

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Cancer of the vagina accounts for less than 1% of all cancer cases (excluding non-melanoma skin cancer  NMSC) and less than 2% of gynaecological cancers in the UK.

Vaginal cancer incidence by age

The incidence of vaginal cancer increases with age. Rates are less than 0.5 per 100,000 females under 45, around 1 for women aged 45-64, rising to almost 3 per 100,000 in women over 65 ( Figure 1.2). 1-,4

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Trends in vaginal cancer incidence

The incidence of vaginal cancer has remained stable in Britain over the last 25 years. The age-standardised rate has stayed at around 0.6 per 100,000 females ( Figure 1.3). 1-,4

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Figure 1.4 shows the vaginal cancer incidence trend for the UK.

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Geographical variation in vaginal cancer incidence

Each year an estimated 13,200 women are diagnosed with vaginal cancer worldwide. 5 Rates vary from about 0.2 per 100,000 females in eastern and western Asia to about 0.7 per 100,000 females in southern Asia and the Caribbean ( Figure 1.4). 5

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Higher rates of vaginal cancer reflect high levels of HPV infection, but probably also a lack of cervical screening programmes, which can pick up pre-cancerous lesions in the vagina.

Vaginal cancer incidence and socio-economic status

Several case-control studies have reported an increased risk of vaginal cancer associated with lower socio-economic status and fewer years of education. 6-,12

Vaginal Cancer histology

More than 90% of primary tumours in the vagina are carcinomas, and, of these, almost 80% are squamous cell carcinoma and about 14% are adenocarcinomas. 13,14. Adenocarcinomas are more common in childhood and early adulthood, accounting for the vast majority of carcinomas diagnosed in women under 20. 13,14 A small proportion of adenocarcinomas are clear cell carcinomas arising in women exposed to diethylstilboestrol (DES) in utero (see Risk factors). The highest incidence of clear cell carcinoma arises in young women in their late teens and early 20s. 15 Melanomas and sarcomas account for about 7% of primary vaginal tumours. 13

Pre-cancerous lesions

A substantial proportion of vaginal invasive tumours are found with adjacent evidence of pre-cancers, known collectively as vaginal intraepithelial neoplasia (VAIN).

VAIN - caused by infection with HPV - is most frequently found in the upper third of the vagina, often with concomitant vulval or cervicallesions. Progression rates of treated VAIN of 2-5% have been reported, although these rates vary according to treatment used (see Symptoms and treatment). 16,17

UK Vaginal Cancer mortality statistics

This page presents vaginal cancer mortality statistics by age and trends over time.

Vaginal cancer mortality in the UK

Each year in the UK, there are around 100 deaths from vaginal cancer ( Table 2.1). 1-,3 The European  age-standardised death rate for vaginal cancer is 0.2 per 100,000 female population. 1-,3

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Vaginal cancer mortality by age

The mortality rate for vaginal cancer is less than 0.1 per 100,000 females up to the age of 44, 0.3 per 100,000 women aged 45-64, 1.3 per 100,000 women aged 65 and over, reaching 2 per 100,000 women aged over 80 ( Figure 2.1). 1-,3

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Vaginal cancer mortality trends

The age-standardised mortality rate has remained stable since 2001 at 0.2 per 100,000 ( Figure 2.2). 1-3 In the early 1970s, the rate was 0.4 per 100,000.

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The vaginal cancer mortality rate in the UK for women in their seventies fell from 2.4 per 100,000 women in 1971 to 0.6 per 100,000 in 2007. The rate for women over 80 also fell over the same period, from 3.5 per 100,000 to 2.1 per 100,000. 1-3

Vaginal Cancer survival statistics

This page presents vaginal cancer survival statistics by trends, deprivation, age and stage at diagnosis.

Survival data is only available for cancers of the vagina and vulva combined. Five-year relative survival rates for vulval and vaginal cancers vary significantly by stage of disease and age at diagnosis. The overall five-year relative survival rate for women diagnosed with cancers of the vulva and vagina in England and Wales in 1996-99 was 58%, and the one-year survival rate was 76%. 1

Vaginal cancer survival trends

One- and five-year relative survival rates for vaginal and vulval cancer among women diagnosed in England and Wales improved by an average of 3% every five years between 1971 and 1990. This trend continued for patients diagnosed in the 1990s. Rates improved from 62% to 76% for one-year survival and from 40% to 58% for five-year survival between the periods 1971-75 and 1996-99 (Figure 3.1). 1, 2

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Vaginal cancer survival and deprivation

Evidence suggests that survival rates for the most deprived women are significantly lower than rates for the most affluent patients. 3

Vaginal cancer survival rates by age

Survival rates decrease with increasing age at diagnosis. Among women diagnosed between 1996-99 in England and Wales, the five-year relative survival rates for those aged 15-49 was 83%, for women aged 50-69 it was 65% and for those aged 70+ it was 52% ( Figure 3.2). 1

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Vaginal cancer survival rates by stage at diagnosis

Five-year survival is 95% for patients diagnosed with in situ vaginal tumours or grade 3 VAIN, falling to 39% for patients diagnosed with FIGO stage II tumours, and 19% for patients diagnosed with stage IVa tumours. 4

Vaginal Cancer risk factors

This page presents information on the risk factors for vaginal cancer including HPV infection, other sexually transmitted infections, Genital washing, Diethylstilboestrol (DES), trauma and smoking.

Vaginal cancer is caused primarily by infection with the human papillomavirus (HPV) and some other sexually transmitted infections (STIs) but, unlike other reproductive tract cancers - with the exception of cervical cancer and vulval cancer- risk of vaginal cancer is not related to reproductive factors or exogenous hormones.

Human papillomavirus and vaginal cancer risk

HPV is present in the majority of vaginal tumours, and HPV 16 is the most commonly detected type. 1, 2 According to recent surveys, about 60% of invasive and 80-90% of in situ vaginal squamous cell carcinomas contain HPV DNA. 3, 18

Presence of HPV16 antibodies increases risk for invasive tumours by up to six times and by 13 times for in situ tumours 1, 3 A doubling in risk has been reported for in situ but not invasive tumours in women with HPV 18 seropositivity. 1, 3

Women with a previous cervical cancer or cervical intraepithelial neoplasia have up to a 50-fold increased risk for vaginal cancer. 4, 5,19-21

Increased risks for vaginal cancer have also been reported for women diagnosed with cancers at other anogenital sites, 6 or with a family history of anogenital cancer. 3,22

Genital warts (associated with infection with HPV 6 and HPV 11) have been shown to increase risk for in situ vaginal cancer by almost six-fold, but the association with invasive tumours is less clear. 23, 24

Increased risk is also reported for individuals with a prior SCC of the skin, which may be related to HPV infection. 9

Other sexually transmitted infections, medical conditions and vaginal cancer risk

Presence of antibodies to the herpes simplex virus type 2 in blood samples is associated with an increased risk of vulval and vaginal cancer and pre-cancer, after HPV infection is controlled for. 3,7,10,11

There is an increased risk for vaginal cancer and pre-cancer in HIV-positive women, with a particularly strong relationship for women under the age of 30. 12, 13

One study has shown a more than three-fold increased risk of vaginal and vulval cancers in women with systemic lupus erythematosus. 25

Genital washing and vaginal cancer risk

One study has shown that genital washing before and after intercourse can reduce risk of vaginal cancer by two-thirds. 24

Diethylstilboestrol (DES) and Vaginal cancer risk

DES was used in the 1940s-60s to prevent miscarriage, and has been linked to risk of clear cell adenocarcinomas of the vagina in daughters of women who were treated with the drug. The risk increase is as great as 40-fold, 14 and is highest for women whose mothers were exposed to DES in the first trimester of pregnancy. 15

Trauma and Vaginal cancer risk

Trauma due to vaginal prolapse or long-term wearing of vaginal pessaries is a causative factor in a small proportion of SCC of the vagina in elderly women. 16

Smoking and Vaginal cancer risk

A recent case-control study reported that current smokers had double the risk of vaginal SCC of non-smokers, 3 but this association remains uncertain. 8,17,24

Vaginal Cancer molecular biology and genetics

There are only a few reports describing the genetic changes associated with vaginal cancer.

Gene copy number is thought to be important, with gain of gene copies more commonly reported than loss of gene copies. One study analysed 51 samples from vulval and vaginal tumours and found genetic abnormalities in 37 of them. The most common changes were gains to chromosomes 3q, 5p, 8q, 9q, and 19q and losses from 11q. 1

Another study of 16 vaginal tumour samples reported gains at chromosome 3q in 75% of samples, and gains at 5p and 19p were also common. 2

Further studies will help to define the genes that are involved in vulval and vaginal carcinogenesis, and this will help with diagnosis, prognosis and treatment of vagina and vulva cancers.

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Vaginal Cancer symptoms and treatment

This page presents information on the symptoms and treatment of vaginal cancer.

Table 6.1 shows the FIGO staging guidelines for vaginal cancer.

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The majority of women diagnosed with vaginal cancer present with discharge or bleeding, but asymptomatic women often present with other gynaecological problems.

Up to 20% of vaginal cancer patients have no symptoms and may be diagnosed during routine examination or smear. 1 In more advanced disease there may be pelvic or suprapubic pain. Lesions involving the anterior vaginal wall may cause urinary symptoms or urethral obstruction and retention of urine. Other symptoms include pain during intercourse, a palpable lump or persistent vaginal itching.

Fluorodeoxyglucose-positron emission tomography (FDG-PET) scanning may have a useful role in staging vaginal malignancy and may be more sensitive than CT scanning. 2

Women with adenocarcinomas are most likely to present either at a very early or very advanced stage (35% at stage I and 30% at stage IV), while the greatest proportion of women with squamous cell carcinoma (SCC) present with stage II tumours (31%). Six per cent of SCC and 9% of adenocarcinomas are diagnosed as in situ. 3

Patients with HPV only or grade 1 VAIN (vaginal intraepithelial neoplasia) often regress spontaneously and so usually receive no treatment.

Most VAIN patients are treated with ablative therapies such as laser or loop diathermy. 4, 5 However grade 3 VAIN is more likely to include invasive lesions, so in these cases wide local excision, or even total vaginectomy may be given. 1 There should be regular follow-up after treatment, as recurrences are relatively common. 6, 7

Survival from vaginal cancer is similar whether radical surgery or chemoradiotherapy is used and therefore organ-sparing treatment is preferred in the majority of cases.

Radiotherapy is delivered using a combination of external beam radiotherapy and either interstitial or intracavity brachytherapy. 8 Local control depends on the volume of the tumour and the dose of radiation delivered. 9, 10

With small localised tumours it is sometimes possible to deliver high doses of radiation with brachytherapy and obtain a high probability of local control. 11 When treating more advanced disease, the radiotherapy treatment volume includes the pelvic nodes (in upper vaginal tumours) or the inguino-femoral nodes (lower vaginal tumours). 12 If patients are fit enough for systemic chemotherapy, cisplatin may be given with radiotherapy. 13

Surgery may be preferred in small tumours of the upper third of the vagina involving the posterior wall where hysterectomy and partial vaginectomy give good results. Similarly some localised tumours of the lower third of the vagina can be satisfactorily excised with a partial vulvectomy and inguinal lymphadenectomy.

Adjuvant radiotherapy may be used after surgery for vaginal cancer to reduce the likelihood of recurrence. Where radical radiotherapy has failed exenterative (an operation in which all the contents of a body cavity are removed) surgery may result in cure for a small number of patients. 14 Where total vaginectomy is given reconstructive surgery is possible.

Vaginal Cancer screening and prevention

The International Society for the Study of Vulvovaginal Disease recommends monthly self-examination for all women. 15 The pap smear test can detect VAIN, but the rarity of vaginal cancer means population screening programmes for vaginal cancer are an inefficient use of resources, even in increased risk groups such as women with a previous cervical cancer. 16

Preliminary trials of immunotherapies have been promising for VAIN, although numbers of trial participants have been small and larger-scale trials are needed to confirm results. 17

The recent European Union approval of Gardasil, an HPV vaccine would help to reduce the numbers of women affected by vaginal cancer.