19th April 2022

A 75-year-old woman presents to her GP with some vaginal symptoms she is concerned with

A 75-year-old woman presents to her GP with some vaginal symptoms she is concerned with. She has a 3 month history of vaginal bleeding she describes as ‘spotting’, as well as some pelvic discomfort. She reports no bladder or bowel dysfunction. She is still sexually active with her husband, and on questioning reports experiencing dyspareunia. She doesn’t report any weight loss or night sweats, she doesn’t report any itching. She went through her menopause when she had a total hysterectomy for fibroids. Ovaries were spared, and she attended cervical screening until this surgery. In terms of her past medical history, she has hypertension, for which she takes amlodipine.

On examination, she appears well and her abdomen is soft, non-tender. On speculum examination, the vulva appears to be dry, you note a lack of cervix, and a small irregular white lesion that appears to have some bloody exudate in the lower third of the vaginal wall. You feel around the lymph nodes in the groin, and notice a single firm rubbery nodule. A biopsy of the lesion comes back as vaginal squamous cell carcinoma.

Based on the clinical history and examination, what is the FIGO stage of this cancer?

Select the SINGLE most appropriate option from the list below. Select ONE option only.