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Vaginal Cancer

Vaginal cancer is a disease in which malignant (cancer) cells form in the vagina.

The vagina is the canal leading from the cervix (the opening of uterus) to the outside of the body. At birth, a baby passes out of the body through the vagina (also called the birth canal).


Who gets Vaginal Cancer?

Typically this is a condition affecting older women, with a median age of 65 – 70 years old at diagnosis. The greatest number of cases are diagnosed in women over 70 years of age. Adenocarcinomas of the vagina, particularly the clear cell variant mentioned above, can be seen in younger women and commonly present before the age of 20.


Types of Vaginal Cancer

Vaginal cancer is not common. When found in early stages, it can often be cured. There are several types of vaginal cancer;

  • Squamous Cell Carcinoma - Cancer that forms in squamous cells, the thin, flat cells lining the vagina. Squamous cell vaginal cancer spreads slowly and usually stays near the vagina, but may spread to the lungs and liver. This is the most common type of vaginal cancer. It is found most often in women aged 60 or older.

  • Adenocarcinoma - Cancer that begins in glandular (secretory) cells. Glandular cells in the lining of the vagina make and release fluids such as mucus. Adenocarcinoma is more likely than squamous cell cancer to spread to the lungs and lymph nodes. It is found most often in women aged 30 or younger.

  • Melanoma - Melanomas develop from pigment-producing cells that give skin its color. These cancers usually are found on sun-exposed areas of the skin but can form on the vagina or other internal organs. About 9 of every 100 cases of vaginal cancer are melanomas. Melanoma tends to affect the lower or outer portion of the vagina. The tumors vary greatly in size, color, and growth pattern. More information about melanoma can be found in our document called Melanoma Skin Cancer.

  • Sarcoma - A sarcoma is a cancer that begins in the cells of bones, muscles, or connective tissue. Up to 4 of every 100 cases of vaginal cancer are sarcomas. These cancers form deep in the wall of the vagina, not on its surface. There are several types of vaginal sarcomas. Rhabdomyosarcoma is the most common type of vaginal sarcoma. It is most often found in children and is rare in adults. A sarcoma called leiomyosarcoma is seen more often in adults. It tends to occur in women older than 50.

  • Other Cancers - Cancers of the vagina are much less common than cancers that start in other organs (such as the cervix, uterus, rectum, or bladder) and then spread to the vagina. These cancers are named after the place where they started. Also, a cancer that involves both the cervix and vagina is considered a cervical cancer. Likewise, if the cancer involves both the vulva and the vagina, it is considered a vulvar cancer.


Symptoms of Vaginal Cancer

Early vaginal cancer may not cause any signs and symptoms. As it progresses, vaginal cancer may cause signs and symptoms such as:

  • Unusual vaginal bleeding, for example, after intercourse or after menopause

  • Watery vaginal discharge

  • A lump or mass in your vagina

  • Painful urination

  • Constipation

  • Pelvic pain


Risk Factors of Vaginal Cancer

The risk factors for vaginal cancer include:

  • Advancing age, because most women with vaginal cancer are aged over 50 years

  • Prior history of gynaecological cancer, such as cancer of the cervix or vulva

  • Previous treatment for dysplasia (abnormal cells on the cervix).

  • Genital warts (human papillomaviral infection)

  • Cigarette smoking, since women with vaginal cancer are at increased risk of lung cancer, which is strongly associated with tobacco use

  • Some research suggests that using a pessary to treat a prolapsed uterus may, over time, irritate the vagina.

  • Prenatal exposure to the synthetic hormone diethylstilbestrol (DES). (This has not been prescribed since 1972)

  • Vaginal adenosis, which means cells that should be confined to the internal cervix lining (endocervix) are also found on the vaginal walls (almost all DES daughters have vaginal adenosis


Test and Diagnosis

The following tests and procedures may be used:

  • Physical Exam and History - An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

  • Pelvic Exam - An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. The doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. Aspeculum is also inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test or Pap smear of the cervix is usually done. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.

  • Pap Smear - A procedure to collect cells from the surface of the cervix and vagina. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the cervix and vagina. The cells are viewed under a microscope to find out if they are abnormal. This procedure is also called a Pap test.

  • Biopsy - The removal of cells or tissues from the vagina and cervix so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a Pap smear shows abnormal cells in the vagina, a biopsy may be done during a colposcopy.

  • Colposcopy - A procedure in which a colposcope (a lighted, magnifying instrument) is used to check the vagina and cervix for abnormal areas. Tissue samples may be taken using a curette (spoon-shaped instrument) and checked under a microscope for signs of disease.

  • CT scan (CAT scan) - A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

  • MRI (magnetic resonance imaging) - A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

 

Stages of Vaginal Cancer

The three ways that cancer spreads in the body are:

  • Through tissue. Cancer invades the surrounding normal tissue.

  • Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.

  • Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

  • When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.


The following stages are used for vaginal cancer:

  • Stage 0 (Carcinoma in Situ) - In stage 0, abnormal cells are found in tissue lining the inside of the vagina. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

  • Stage I - In stage I, cancer has formed and is found in the vagina only.

  • Stage II - In stage II, cancer has spread from the vagina to the tissue around the vagina.

  • Stage III - In stage III, cancer has spread from the vagina to the lymph nodes in the pelvis or groin, or to the pelvis, or both.

  • Stage IV - Stage IV is divided into stage IVA and stage IVB:

  • Stage IVA - Cancer may have spread to lymph nodes in the pelvis or groin and has spread to one or both of the following areas:

    • The lining of the bladder or rectum.

    • Beyond the pelvis.

  • Stage IVB - Cancer has spread to parts of the body that are not near the vagina, such as the lungs. Cancer may also have spread to the lymph nodes.


Vaginal Cancer Treatment and Surgery

Surgery, radiation therapy and chemotherapy are the typical treatment options, and can be used as single modality therapies or in combination.

The optimal treatment regimen should ultimately be individualized as much as possible. It should take into account the patient’s stage of disease, other medical history, and personal preference, among other things.

Surgery can be done to remove either part or all of the vagina. Generally, small lesions in the upper vagina are the best candidates for surgery. Surgical methods include:

  • Laser surgery for very early stage disease, using a narrow beam of light to kill cancer cells

  • Wide local excision to excise the cancer and some surrounding tissue

  • Vaginectomy, where the surgeon removes the vagina and usually some pelvic lymph nodes

  • Radical hysterectomy if cancer has spread outside of the vagina, with removal of the uterus, ovaries and fallopian tubes, as well as lymph nodes

  • Pelvic exenteration for extremely advanced disease, especially if an abnormal connection (fistula) has formed between the vagina and the bladder or rectum

Radiation Therapy - Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy – Chemotherapy is the use of anticancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cell’s ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. The oncologist will recommend a treatment plan for each individual.


Recurrent Vaginal Cancer

If a cancer comes back after treatment it is called recurrent. If the cancer comes back in the same area as it was in the first place, it is called a local recurrence. If it comes back in another area (like the liver or lungs), it is called a distant recurrence.

A local recurrence of a stage I or stage II vaginal cancer may be treated with radical surgery (such as pelvic exenteration). If the cancer was originally treated with surgery, radiation therapy is an option. Surgery is the usual choice when the cancer has come back after radiation therapy.

Higher-stage cancers are difficult to treat when they recur. They usually cannot be cured by currently available treatments. Care focuses mostly on relieving symptoms, although participation in a clinical trial of new treatments may be helpful.

For a distant recurrence, the goal of treatment is to help the woman feel better. Surgery, radiation, or chemotherapy may be used. Again, a clinical trial is a good option.


Prevention of Vaginal Cancer

Research has shown that certain factors may reduce a woman's risk of vaginal cancer:

  • If young, delaying having sexual intercourse

  • Avoiding sex with many partners and avoiding sex with someone who has had many partners

  • Practicing safe sex

  • Having regular Pap tests to detect and treat precancerous conditions

  • Not starting to smoke

  • Quitting smoking, if a smoker

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