Gynecologic Cancers

Vaginal Cancer

Background

Vaginal cancer is a rare cancer that occurs in the cells that line the surface of the vagina. There are two types of cancer of the vagina: Squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma is the most common type of vaginal cancer and is usually found in women between the ages of 60 and 80. Adenocarcinoma begins in glandular cells in the vagina and is more often found in women between the ages of 12 and 30.

It's possible to develop vaginal cancer even after a radical hysterectomy in which both ovaries and the uterus are removed. Thus, it is important for every woman to have an annual pelvic exam and Pap smear, even if she's had a hysterectomy.

Symptoms

Symptoms of vaginal cancer can include:

  • Abnormal vaginal bleeding, especially after menopause
  • Abnormal vaginal discharge (watery, bloody, foul smelling)
  • An obvious vaginal lump or mass
  • Pain during sexual intercourse
  • Pelvic pain

Risk Factors

Risk factors for vaginal cancer include:

  • Smoking
  • Age. Most women who are diagnosed with vaginal cancer are over 60 years old.
  • Atypical cells in the vagina. Women with vaginal intraepithelial neoplasia (VAIN) have an increased risk of vaginal cancer.
  • Exposure to diethylstilbestrol (DES), which was used from the late 1940s until 1971 to prevent miscarriage in early pregnancy. Women whose mothers took DES during pregnancy have an increased risk of a certain type of vaginal cancer called clear cell adenocarcinoma.
  • History of sexually transmitted diseases (STDs). HPV is a sexually transmitted virus that can increase the risk of vaginal cancer and cervical cancers. HIV/AIDs infection can also increase the risk of cancer.
  • Previous gynecologic cancer. Women who've been treated for a different gynecologic cancer, especially cervical cancer, may have an increased risk.

Staging

Stage I: Cancer has formed and is found in the vagina only.

Stage II: Cancer has spread from the vagina to the tissue around the vagina.

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: This stage is divided into Stages IVA and IVB.

    • Lining of the bladder or rectum.
    • Beyond the pelvis.
  • Stage IVA: Cancer may have spread to lymph nodes in the pelvis or groin and has spread to one or both of the following:

    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.

Treatment

The types of standard therapy in the treatment of vaginal cancer include:

Surgery
Surgery is the most common treatment of vaginal cancer. The following surgical procedures may be used:

  • Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion, such as a tumor.
  • Wide local excision: A surgical procedure that removes the cancer and some of the healthy tissue around it.
  • Vaginectomy: Surgery to remove all or part of the vagina.
  • Total hysterectomy: Surgery to remove the uterus and cervix. If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision in the abdomen using a laparoscope, the operation is called a total laparoscopic hysterectomy.
  • Lymphadenectomy: A surgical procedure in which lymph nodes are removed and checked under a microscope for signs of cancer. This procedure is also called lymph node dissection. If the cancer is in the upper vagina, the pelvic lymph nodes may be removed. If the cancer is in the lower vagina, lymph nodes in the groin may be removed.
  • Pelvic exenteration: Surgery to remove the lower colon, rectum, and bladder. In women, the cervix, vagina, ovaries, and nearby lymph nodes are also removed. Artificial openings (stoma) are made for urine and stool to flow from the body into a collection bag.

Even if a doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy after surgery to kill any cancer cells that remain. Treatment given after the surgery, to lower the risk of the cancer returning, is called adjuvant therapy.

Radiation therapy
Radiation therapy may be used after or during surgery to kill any remaining cancer cells. External radiation therapy uses a machine outside the body to deliver radiation to a designated region/area of the body. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The method of radiation therapy depends on the type and stage of the cancer being treated.

Chemotherapy
Chemotherapy, which may also be used after surgery, can be given topically, orally, intravenously, or directly to the affected area. The method of delivery depends on the type and stage of the cancer being treated.

References
National Cancer Institute, Mayo Clinic, Cancer Treatment Centers of America.