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 login to view 2 more bullets 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) login to view 1 more bullet Presentation Symptoms vaginal bleeding (most common) login to view 1 more bullet Physical exam vaginal mass may be noted Studies Lab studies vaginal cytology Invasive studies vaginal colposcopy login to view 2 more bullets vaginal biopsy login to view 2 more bullets Histology squamous cell carcinoma login to view 1 more bullet clear cell adenocarcinoma login to view 2 more bullets sarcoma botryoides ("botrys" is Greek for "grapes") login to view 3 more bullets Differential Cervical cancer differentiating factors login to view 1 more bullet 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