Vaginal Cancer

Overview

Vaginal cancer is a rare form of cancer that originates in the vagina, which is the muscular tube connecting the uterus to the outside genitals. It typically occurs in the cells lining the surface of the vagina. Primary vaginal cancer, which starts in the vagina, is uncommon. When cancer spreads to the vagina from other parts of the body, it is more difficult to treat. Early-stage vaginal cancer has the best chance for a cure. Symptoms may include unusual vaginal bleeding, watery discharge, lumps or masses in the vagina, painful urination, frequent urination, constipation, and pelvic pain. The exact cause of vaginal cancer is unknown, but it may be related to genetic mutations that cause normal cells to become abnormal. Different types of vaginal cancer include squamous cell carcinoma, adenocarcinoma, melanoma, and sarcoma, each starting in different types of cells in the vagina. Risk factors for vaginal cancer include increasing age, as most cases occur in people over 60, and atypical cells called vaginal intraepithelial neoplasia (VAIN), which may be caused by the human papillomavirus (HPV).

Understanding the disease

Symptoms

The symptoms of vaginal cancer may include unusual vaginal bleeding, watery vaginal discharge, a lump or mass in the vagina, painful urination, frequent urination, constipation, and pelvic pain. If you experience any of these symptoms, it is important to see a doctor for a proper evaluation.

Risk Factors

Risk factors that have been linked to an increased risk of vaginal cancer include:

1. Increasing age: Your risk of vaginal cancer increases as you age, with most cases diagnosed in people over 60.
2. Multiple sexual partners
3. Early age at first intercourse
4. Smoking
5. HIV infection
6. Atypical cells in the vagina called vaginal intraepithelial neoplasia (VAIN) VAIN occurs when cells in the vagina appear different from normal cells but are not cancerous. It is often caused by the sexually transmitted human papillomavirus (HPV) and can increase the risk of developing vaginal cancer.

Development

Vaginal cancer develops when healthy cells in the vagina acquire genetic mutations that cause them to grow and multiply uncontrollably. These abnormal cells form a tumor, which can invade nearby tissues and potentially spread to other parts of the body (metastasize). There are different types of vaginal cancer, including vaginal squamous cell carcinoma, vaginal adenocarcinoma, vaginal melanoma, and vaginal sarcoma. Each type develops from a specific type of cell in the vagina. For example, vaginal squamous cell carcinoma begins in the thin, flat cells (squamous cells) that line the surface of the vagina, while vaginal adenocarcinoma begins in the glandular cells on the surface of the vagina. The risk factors for vaginal cancer include increasing age, a condition called vaginal intraepithelial neoplasia (VAIN), and human papillomavirus (HPV) infection. VAIN is often caused by HPV and can increase the risk of developing vaginal cancer. Regular pelvic exams can help detect vaginal cancer at an early stage, when it's more likely to be treatable.

Assessment and Diagnosis

Triage

You should see a doctor if you have signs and symptoms related to vaginal cancer, such as abnormal vaginal bleeding. It is important to follow your doctor's recommendations for routine pelvic exams as vaginal cancer may not always cause signs and symptoms.

Diagnosis

To diagnose vaginal cancer, your doctor may conduct a pelvic exam and Pap test as initial screening procedures. If abnormalities are detected, further tests such as colposcopy and biopsy may be performed. Colposcopy involves inspecting the vagina with a special magnifying instrument, while a biopsy involves removing a sample of suspicious tissue for laboratory testing. Staging of the cancer is then determined using imaging tests, procedures with tiny cameras, or both. It's important to consult a specialist (gynecologic oncologist) if vaginal cancer is suspected, and to be well-prepared for your appointment by making a list of symptoms, personal information, and medications.

Management and Treatment

Complications

Complications of vaginal cancer may include:

1. Metastasis: Vaginal cancer can spread (metastasize) to distant areas of your body, such as your lungs, liver, and bones, making it more difficult to treat.
2. Incontinence and bowel dysfunction: Vaginal cancer or its treatment may damage the muscles and nerves surrounding the bladder and rectum, leading to incontinence or bowel dysfunction.
3. Lymphedema: The removal of lymph nodes during surgery or radiation therapy may cause swelling (lymphedema) in the legs or pelvis, which can be painful and may lead to infections.
4. Pain: Vaginal cancer or its treatment may cause pain, which may be managed with pain medications or other therapies.
5. Sexual dysfunction: Vaginal cancer or its treatment may cause changes in sexual function, such as vaginal dryness or pain during intercourse, which may require medical intervention or counseling to address.
6. Emotional and psychological impact: A diagnosis of vaginal cancer and its treatment can be emotionally challenging and may affect a person's mental health and quality of life. It is essential to receive appropriate psychological support throughout the treatment process. It is important to discuss potential complications with your healthcare provider, who can provide guidance and support in managing any issues that may arise during the course of treatment.

Treatment

Treatment options for vaginal cancer depend on various factors, including the stage of the cancer, the patient's overall health, and personal preferences. Some possible treatment options include:

1. Surgery: The primary treatment for early-stage vaginal cancer is often surgical removal of the tumor along with surrounding tissue. Additional procedures may be necessary, such as a hysterectomy (removal of the uterus) or removal of lymph nodes.
2. Radiation therapy: This treatment uses high-energy X-rays or other types of radiation to kill cancer cells. It can be delivered externally (from a machine outside the body) or internally (using radioactive substances placed inside the vagina).
3. Chemotherapy: Chemotherapy uses drugs to kill cancer cells. It may be given as an injection, pill, or through a tube inserted into a vein. Chemotherapy can be used before surgery to shrink a large tumor, after surgery to kill any remaining cancer cells, or in combination with radiation therapy.
4. Hormone therapy: This treatment involves the use of drugs or other substances to block or reduce the effects of hormones on cancer cells. It may be an option for some types of vaginal cancer that are sensitive to hormones.
5. Targeted therapy: Targeted therapy uses drugs or other substances to identify and attack specific types of cancer cells with less harm to normal cells. This may be an option for certain types of vaginal cancer that have specific genetic mutations. It is important to consult with a healthcare professional to determine the most appropriate treatment plan for each individual case of vaginal cancer.

Preparing for medical consultation

To prepare for an appointment for vaginal cancer, you should:

1. Make an appointment with your family doctor or a gynecologist if you have any signs or symptoms that worry you. If necessary, you may be referred to a gynecologic oncologist who specializes in cancers of the female reproductive system.
2. Gather information about your symptoms, including any that may seem unrelated to the reason for your appointment.