They may spread as follows: By direct extension (into the local paravaginal tissues, bladder, or rectum) Through inguinal lymph nodes from lesions in the lower vagina Through pelvic lymph nodes from lesions in the upper vagina Hematogenously Symptoms and Signs of Vaginal Cancer Most patients with vaginal cancer present with abnormal intermenstrual vaginal bleeding, often postmenopausal or postcoital.