Vaginal Cancer

What is the vagina?

The vagina is the passageway through which fluid passes out of the body during menstrual periods. It is also called the "birth canal." The vagina connects the cervix (the opening of the womb, or uterus) and the vulva (the external genitalia).

What is vaginal cancer?

Cancer of the vagina, a rare kind of cancer in women, is a disease in which malignant cells are found in the tissues of the vagina. According to the American Cancer Society (ACS), about 4,810 cases of vaginal cancer will be diagnosed in the U.S. in 2017.

There are several types of cancer of the vagina. The two most common are:

• squamous cell cancer (squamous carcinoma)
  • Squamous carcinoma is most often found in women between the ages of 60 and 80, and accounts for 85 percent to 90 percent of all vaginal cancers.
• adenocarcinoma
  • Adenocarcinoma is more often found in women older than 50 and accounts for 5 percent to 10 percent of all vaginal cancers.
  • A rare form of cancer called clear cell adenocarcinoma results from the use of the drug DES (diethylstilbestrol) given to pregnant women between 1945 and 1970 to keep them from miscarrying.

Other types of vaginal cancer include:

• malignant melanoma
• leiomyosarcoma
• rhabdomyosarcoma

What are risk factors for vaginal cancer?

The following have been suggested as risk factors for vaginal cancer:

• age Over two-thirds of women are 60 or older when diagnosed.
• exposure to diethylstilbestrol (DES) as a fetus (mother took DES during pregnancy)
• history of cervical cancer
• history of cervical precancerous conditions
• human papillomavirus (HPV) infection
• vaginal adenosis
• vaginal irritation
• uterine prolapse
• smoking

What are the symptoms of vaginal cancer?

The following are the most common symptoms of vaginal cancer. However, each individual may experience symptoms differently. Symptoms may include:

• bleeding or discharge not related to menstrual periods
• difficult or painful urination
• pain during intercourse
• pain in the pelvic area
• constipation
• a mass that can be felt

Even if a woman has had a hysterectomy, she still has a chance of developing vaginal cancer. The symptoms of vaginal cancer may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is vaginal cancer diagnosed?

There are several tests used to diagnose vaginal cancer, including:

• pelvic examination of the vagina, and other organs in the pelvis, checking for tumors, lumps, or masses (i.e., may include colposcopy)
• colposcopy - a procedure that uses an instrument with magnifying lenses, called a colposcope, to examine the cervix for abnormalities. If abnormal tissue is found, a biopsy is usually performed (colposcopic biopsy).
• Pap test (also called Pap smear) - test that involves microscopic examination of cells collected from the cervix, used to detect changes that may be cancer or may lead to cancer, and to show noncancerous conditions, such as infection or inflammation.
• computed tomography scan (CT or CAT scan) - a diagnostic imaging procedure using a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• positron emission tomography (PET) scan - radioactive-tagged glucose (sugar) is injected into the bloodstream. Tissues that use the glucose more than normal tissues (such as tumors) can be detected by a scanning machine. PET scans can be used to find small tumors or to check if treatment for a known tumor is working.
• biopsy - a procedure in which tissue samples are removed from the vagina for examination under a microscope; to determine if cancer or other abnormal cells are present. The diagnosis of cancer is confirmed only by a biopsy.

Treatment for vaginal cancer

Specific treatment for vaginal cancer will be determined by your physician based on:

• your overall health and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Generally, there are three kinds of treatment available for patients with cancerous or precancerous conditions of the vagina:

• surgery, including:
  • laser surgery to remove the cancer, including LEEP (loop electroexcision procedure)
  • local excision to remove the cancer
  • (partial) vaginectomy to remove the vagina
• chemotherapy - 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.
• radiation therapy - the use of high-energy radiation to kill cancer cells and to shrink tumors. There are two ways to deliver radiation therapy, including the following:
  • external radiation (external beam therapy) - a treatment that precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes.
  • internal radiation (brachytherapy, implant radiation) - radiation is given inside the body as close to the cancer as possible. Tiny tubes that contain substances that produce radiation, called radioisotopes, are inserted through the vagina and left in place for a few days. Internal radiation involves giving a higher dose of radiation in a shorter time span than with external radiation. Hospitalization is required when an internal implant is in place. In some cases, both internal and external radiation therapies are used.