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Vaginal Cancer

Definition:
Vaginal cancer is a rare cancer that occurs in the vagina — the muscular tube that connects the uterus with the outer genitals. Vaginal cancer most commonly occurs in the cells that line the surface of the vagina, which is sometimes called the birth canal.

Vaginal cancer most commonly affects women older than 60. However, vaginal cancer can occur at any age.

While several cancers can spread to the vagina from other places in the body, cancer that begins in the vagina (primary vaginal cancer) is rare. Vaginal cancer comprises only 1 percent to 3 percent of gynecologic cancers. About 2,400 women are diagnosed with vaginal cancer each year in the United States, according to the American Cancer Society.

Women with early-stage vaginal cancer have the best chance for a cure. Vaginal cancer that spreads beyond the vagina is much more difficult to treat.

Causes:
In general, cancer begins when healthy cells acquire a genetic mutation that turns normal cells into abnormal cells. Healthy cells grow and multiply at a set rate, eventually dying at a set time. Cancer cells grow and multiply out of control, and they don't die. The accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby tissues and can break off from an initial tumor to spread elsewhere in the body (metastasize).

It isn't clear what causes the genetic mutation that leads

to vaginal cancer. Researchers have identified factors that may increase your risk of vaginal cancer.

The majority of vaginal cancers begin in the squamous cells. These thin, flat cells line the surface of the vagina. Other less common types of vaginal cancer include:
  • Vaginal adenocarcinoma, which begins in the glandular cells on the surface of the vagina
  • Vaginal melanoma, which develops in the pigment-producing cells (melanocytes) of the vagina
  • Vaginal sarcoma, which develops in the connective tissue cells or smooth muscles cells in the walls of the vagina

Risk Factor:
Certain factors may raise your risk of vaginal cancer, including:
  • Atypical cells in the vagina. Women with vaginal intraepithelial neoplasia (VAIN) have an increased risk of vaginal cancer. In women with VAIN, cells in the vagina appear different from normal cells, but not different enough to be considered cancer. A small number of women with VAIN will eventually develop vaginal cancer, though doctors aren't sure what causes some cases to develop into cancer and other cases to remain benign.
  • Exposure to miscarriage prevention drug. Women whose mothers took a drug called diethylstilbestrol (DES) while pregnant may have an increased risk of a certain type of vaginal cancer called clear cell adenocarcinoma. DES was used in the 1950s to prevent miscarriage in early pregnancy.
  • Human papillomavirus (HPV). HPV is a sexually transmitted virus that can increase the risk of vaginal cancer and other cancers. HPV causes the majority of cervical cancers and precancerous changes in the cervix. Even if you've had your uterus and ovaries removed (hysterectomy), you may still have an increased risk of vaginal cancer if you have HPV. The Food and Drug Administration (FDA) approved a vaccine to prevent HPV in 2006.
  • Previous gynecologic cancer. Women who've been treated for a different gynecologic cancer, especially cervical cancer, may have an increased risk of vaginal cancer.
Other risk factors that have been linked to an increased risk of vaginal cancer include:
  • Multiple sexual partners
  • Early age at first intercourse
  • Smoking
When to seek medical advice:
See your doctor if you have any unusual signs and symptoms, such as abnormal vaginal bleeding. Vaginal cancer is more easily treated when discovered at an early stage. Since vaginal cancer doesn't always cause signs and symptoms, follow your doctor's recommendations about when you should have routine pelvic exams.

Symptoms:
Early vaginal cancer may not have any signs and symptoms. As it progresses, vaginal cancer may cause signs and symptoms such as:
  • Unusual vaginal bleeding, such as after intercourse or after menopause
  • Watery vaginal discharge that may be bloody and foul-smelling
  • Lump or mass in the vagina
  • Frequent urination
  • Blood in urine
  • Constipation
  • Pelvic pain

Dignosis:
Screening
While there is no general screening test for vaginal cancer, it is sometimes detected during a routine pelvic exam before any signs and symptoms become evident. During a pelvic exam, your doctor carefully inspects the outer part of your vagina, and then inserts two fingers of one hand into your vagina and simultaneously presses the other hand on your abdomen to feel

your uterus and ovaries. He or she also inserts a device called a speculum into your vagina. The speculum widens your vagina so that your doctor can check your vagina and cervix for abnormalities.

Your doctor usually also conducts a pap test to screen for cervical cancer, but sometimes vaginal cancer cells can be detected on a pap test. Pap tests and pelvic exams are generally recommended every three years. How often you undergo these screenings depends on your risk factors for cancer and whether you've had abnormal pap tests in the past. Talk to your doctor about whether you should have this health screening.

Diagnosis
Based on any signs and symptoms you have, your doctor may conduct a pelvic exam and pap test to check for abnormalities that may indicate vaginal cancer. Based on those findings, your doctor may conduct other procedures to determine whether you have vaginal cancer, such as:
  • Colposcopy. Colposcopy is an examination of your vagina with a special lighted microscope called a colposcope. Colposcopy allows your doctor to magnify the surface of your vagina to see any areas of abnormal cells.
  • Biopsy. Biopsy is a procedure to remove a sample of suspicious tissue to test for cancer cells. Your doctor may take a biopsy of tissue during a colposcopy exam. Your doctor sends the tissue sample to a laboratory for testing.
Staging
Once your doctor diagnoses vaginal cancer, he or she takes steps to determine the extent of the cancer — a process called staging. The stage of your cancer helps your doctor decide what treatments are appropriate for you. In order to determine the stage of your cancer, your doctor may use:
  • Biopsy. Tissue samples from your cervix or vulva may show whether cancer has spread to those areas.
  • Imaging tests. Your doctor may order imaging tests to determine whether cancer has spread. Imaging tests may include X-rays, computerized tomography (CT) scans or magnetic resonance imaging (MRI).
  • Tiny cameras to see inside your body. Procedures that use tiny cameras to see inside your body may help your doctor determine if cancer has spread to certain areas. Cameras help your doctor see inside your bladder (cystoscopy) and your rectum (proctoscopy).
Once your doctor determines the extent of your cancer, he or she assigns your cancer a stage. The stages of vaginal cancer are:
  • Stage I. Cancer is limited to the vaginal wall.
  • Stage II. Cancer has spread to tissue next to the vagina.
  • Stage III. Cancer has spread to nearby lymph nodes, or to the pelvic wall or both.
  • Stage IVA. Cancer has spread to nearby lymph nodes, and has also spread to bladder, rectum or pelvis.
  • Stage IVB. Cancer has spread to areas away from the vagina, such as the lungs.

Complications:
Vaginal cancer that progresses may spread (metastasize) to distant areas of the body. Vaginal cancer most commonly spreads to the lungs, the liver and the pelvic bones.

Treatment:
Your treatment options for vaginal cancer depend on several factors, including the type of vaginal cancer you have and its stage. Because vaginal cancer is rare, no standard treatment guidelines have been developed. You and your doctor work together to determine what treatments are best for you based on your goals of treatment and the side effects you're willing to endure. Treatment for vaginal cancer typically includes surgery and radiation.

Surgery
Surgery to remove the cancer from your body is primarily used for early-stage vaginal cancer that's limited to the vagina or, in selected cases, nearby tissue. Because many important organs are located in your pelvis, surgery to remove larger tumors would require removal of these organs. For this reason, your doctor may attempt to control your cancer through other treatment methods first. Types of surgery that may be used in women with vaginal cancer include:
  • Removal of small tumors or lesions. Cancer limited to the surface of the vagina may be cut away using a scalpel or a laser. Your surgeon may also remove a small amount of healthy tissue to ensure that all of the cancer cells have been removed.
  • Removal of the vagina (vaginectomy). Removing part of the vagina (partial vaginectomy) or the entire vagina (radical vaginectomy) may be necessary to remove all of the cancer. Depending on the extent of your cancer, your surgeon may recommend surgery to remove your uterus and ovaries (hysterectomy) and nearby lymph nodes (lymphadenectomy) at the same time as your vaginectomy.
  • Removal of the majority of the pelvic organs (pelvic exenteration). This extensive surgery may be an option if cancer has spread throughout your pelvic area or if your vaginal cancer has recurred. During pelvic exenteration, the surgeon removes many of the organs in the pelvic area, including the bladder, ovaries, uterus, vagina, rectum and the lower portion of the colon. Openings are created in your abdomen to allow urine (urostomy) and waste (colostomy) to exit your body and collect in ostomy bags.
If your vagina is completely removed, you may choose to undergo surgery to construct a new vagina. Surgeons use pieces of skin, sections of intestine or flaps of muscle from other areas of your body to form a new vagina. With some adjustments, a reconstructed vagina allows you to have vaginal intercourse. However, a reconstructed vagina won't be the same as your own vagina. For instance, a reconstructed vagina lacks natural lubrication and creates a different sensation when touched due to changes in surrounding nerves.

Radiation therapy

Radiation therapy is the most common treatment for vaginal cancers. Radiation therapy uses high-powered energy beams to kill cancer cells. Radiation can be delivered two ways:
  • External radiation. External beam radiation is directed at your entire abdomen or just your pelvis, depending on the extent of your cancer. During external beam radiation, you're positioned on a table and a large radiation machine is maneuvered around you in order to target the treatment area. Nearly everyone with vaginal cancer receives external beam radiation.
  • Internal radiation. During internal radiation (brachytherapy), devices containing radiation — radioactive seeds, wires, cylinders or other materials — are placed in your vagina or the surrounding tissue. After a set number of days, the devices are removed. Women with very early stage vaginal cancer may receive internal radiation only. Other women may receive internal radiation after undergoing external radiation.

Radiation therapy kills quickly growing cancer cells, but it may also damage nearby healthy cells, causing side effects. Side effects of radiation depend on the radiation's intensity and where it's aimed. Complications include bladder irritation, inflammation of the lining of the rectum, narrowing of the vagina, thinning of the lining of the vagina, premature menopause and infertility.

Other options
If surgery and radiation can't control your cancer, you may be offered other treatments, including:
  • Chemotherapy. Chemotherapy uses chemicals to kill cancer cells. It isn't clear whether chemotherapy is useful in women with vaginal cancer. Some small studies have had mixed results. Chemotherapy may be used during radiation therapy to enhance the effectiveness of radiation.
  • Clinical trials. Clinical trials are experiments to test new treatment methods. While a clinical trial gives you a chance to try the latest treatment advances, a cure isn't guaranteed. Discuss available clinical trials with your doctor to better understand your options.
Prevention:
No sure way to prevent vaginal cancer exists. However, you can increase the chance that vaginal cancer is discovered early by having routine pelvic exams and pap tests. When discovered in its earliest stages, vaginal cancer is more likely to be cured. Doctors recommend women receive pelvic exams and pap tests soon after they've begun having sexual intercourse or by age 21. Ask your doctor how often you need to have pelvic exams and pap tests.
 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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