The treatment is usually radical surgery, i.e., radical vulvectomy for an attempted cure. It is almost always seen in postmenopausal females. The tumor on MRI appears as a solid mass that interrupts the normal zonal anatomy of the vaginal canal. Vaginal carcinomas tend to spread by direct extension into the endometrium, or they can extend inferiorly into the lower part of the vaginal canal. The lesions that are in the upper vaginal canal usually behave like cervical cancer and can spread to the obturator and internal iliac nodes, whereas the vaginal lesions that are in the lower half to lower third tend to spread like vulvar cancer to inguinal nodes.
Vaginal recurrence can be difficult to detect.
On enhanced scans, the perivaginal venous plexus normally enhances brightly, but so can recurrent tumor. There may be little contrast between enhancing recurrent tumor compared with the brightly enhanced background venous plexus. If a time-intensity curve for vulvovaginal cancer were plotted, the optimum time for scanning after dynamic contrast injection could be known. Then optimal contrast between the tumor and the surrounding venous plexus would be achieved during scanning. This has not yet been performed prospectively in a large series.