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Metastatic patterns of vaginal cancer

Vaginal cancer spreads by direct invasion of surrounding tissue, and fistula formation can occur to the bladder and/or intestines. 

In lymphatic spread, the upper 2/3 of the vagina drains to the iliacal lymph nodes and the distal 1/3 of the vagina drains to inguinal lymph nodes. Further lymphatic spread can occur to paraaortic lymph nodes.

Hematogenic spread to the lungs can occur.

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