A malignancy of the birth canal (BC) can be difficult to detect. Even though it is uncommon, it contributes to significant morbidity and mortality. The symptoms can be non-specific but any abnormal bleeding, unusual discharge or genital mass warrants further evaluation by an experienced clinician.

The majority of cancers of the birth canal derive from squamous cells. They are usually associated with human papilloma virus (HPV) infection and tend to be slow growing. There is a small chance that a malignancy is present in other sites within the BC or in other areas of the genital tract. Other types of cancers of the BC include sarcoma, melanoma and adenocarcinoma. Adenocarcinoma represents the major type of BC cancer in young women and the major factor for this is in-utero exposure to diethylstilbestrol (DES). Adenocarcinoma can also develop at the site of adenosis, endometriosis, periurethral glands or other embryonic elements. The anterior wall of the BC is the usual site.

The appearance of an early cancer of the BC can be a nodule, ulcer or a mass. A biopsy of the area of concern can confirm the diagnosis. Once this is done then a thorough evaluation is required to see if the cancer has spread and how far. This is called staging. The staging is based on a physical examination, pelvic examination, cystoscopy, proctoscopy, imaging and lymph node biopsy.

The majority of BC cancers are early stage: 26% Stage 1 and 37% Stage 2. Stage 3 is seen 24% of the time and Stage 4 13%. Treatment is determined based on the stage. Stage 1 is usually treated with surgery, which includes resection of upper BC, radical hysterectomy and lymph node dissection. Intracavitary radiation therapy is also an option for this stage. Stage 2 is usually treated with chemotherapy followed by radical surgery. The treatment of advanced stage cancers is determined by a number of factors and is beyond the scope of this article.

The survival rates are dependent on the stage of the disease and the treatment. Survival rates for Stage 1 range from 77-92%, Stage 2 52-68%, Stage 3 is around 44% and Stage 4 is around 14%. The best chance for survival is with an early diagnosis.

Cancers of the BC can be difficult to detect early due to their location. Women should have a routine gynecologic examination, which includes an inspection of this area. Any abnormal bleeding, discharge or growth should prompt an immediate visit to a health care provider. In most cases, the cause will be easily managed and is usually due to a benign process but being pro-active and seeking early care could make the difference between life and death.


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