Vaginal Cancer: Symptoms and Diagnosis

There are three types of vaginal cancer, depending on the type of cell affected:

• squamous cell carcinoma,
• agenocarcinoma, and
• rhabdomyosarcoma (which occurs primarily in children).

Squamous cell carcinoma is the most common type, accounting for about 95% of malignant tumors. These tumors develop in the outermost layer of vaginal tissue. A distinction is also made between primary and secondary vaginal cancer.

Primary vaginal cancer occurs when the cancer develops directly from cells in the vagina. In many cases, however, malignant tumors of the vagina develop secondarily. This means that the tumor originated in other organs and then metastasized to the vagina from there.

In particular, cervical cancer (cervical carcinoma) and tumors of the labia often spread to the vagina. In about 30% of cases, vaginal cancer is associated with cervical cancer. If vaginal cancer is detected early, the prognosis for a complete cure is good.

Unfortunately, as with many other types of cancer, the symptoms of vaginal cancer do not appear until relatively late in the disease’s progression. Early symptoms may include vaginal bleeding, which occurs primarily after sexual intercourse. Bloody discharge can also be a sign of vaginal cancer.

If the tumor has already spread more extensively, pain in the lower abdomen may occur. Bowel or bladder dysfunction may also be among the symptoms.

Vaginal cancer is usually discovered by chance during a routine gynecological exam. Often, affected women have no symptoms at all at the time of diagnosis.

During the examination, the doctor takes individual cells from the mucous membrane as part of a Pap test. These cells are then examined under a microscope. If the cells show abnormal changes, the diagnosis is confirmed with a tissue sample (biopsy).

In addition, the doctor can examine the mucous membrane more closely using a colposcope (a special microscope).

If vaginal cancer is suspected, the doctor must assess how far the tumor has progressed. This assessment is important because the exact stage of the tumor determines the treatment options.

Using imaging techniques, the doctor can examine the surrounding organs. This allows the doctor to determine whether the tumor has already spread to other parts of the body and whether metastasis has occurred. Helpful imaging tests include:

• Ultrasound of the pelvic organs, the vagina, and the liver,
• Computed tomography (CT) or magnetic resonance imaging (MRI) of the pelvic organs,
• Whole-body CT to assess the lymph nodes, lungs, and liver.

In most cases, a rectal examination (rectoscopy) and an examination of the urinary tract (urethrocystoscopy) are also performed.

Treatment depends on the stage of the tumor and is usually carried out by a specialist in gynecologic oncology. In the early stages, the medical team typically chooses different treatment options than in more advanced stages.

The tumor can be surgically removed, but radiation therapy alone may also be used. In some cases, it makes sense to surgically remove the vaginal cancer and follow up with radiation therapy. Chemotherapy plays a relatively minor role in the treatment of vaginal cancer.

The extent of the surgery depends on the size of the tumor. If a small tumor is detected early, it can be completely removed while preserving the vagina.

In cases of very extensive vaginal cancer, the vagina may need to be completely removed.

In rare cases, part of the intestine or the bladder may need to be removed. Regional lymph nodes may also be affected and must then be surgically removed as well.

The goal of radiation therapy is to kill cancerous cells using radioactive radiation. There are two different methods doctors use to direct the radiation to the affected area.

• Percutaneous radiation therapy through the skin: In this method, special accelerators are used to direct the radiation from outside the body onto the affected area.
• Afterloading as part of brachytherapy: Here, the radiation source is placed directly inside the body at the site of the tumor. This ensures that the radiation damages almost exclusively the cancerous cells, while healthy tissue is largely spared.

Vaginal cancer can lead to complications as the disease progresses. One such complication is that the cancer spreads to neighboring organs. The following organs are particularly at risk:

• the external genitalia (vulva),
• the cervix,
• the rectum,
• the bladder.

In some cases, vaginal cancer also spreads through the lymphatic system, leading to the formation of secondary tumors (metastases). Most often, the pelvic lymph nodes are affected by metastases. They are rarely found in organs such as the lungs, liver, or bones.

If the cancer grows in the pelvis, it can compress other organs. If vaginal cancer presses on the ureters, urine cannot drain properly. It can then back up into the kidneys and damage them.

The prognosis for vaginal cancer depends on the stage of the disease. If vaginal cancer is detected early, the prognosis is very good. A complete cure is definitely possible in such cases.

However, since vaginal cancer does not show any obvious symptoms in its early stages, the disease is often not detected until relatively late. This is one of the reasons why regular cancer screenings by a gynecologist are extremely important.

If vaginal cancer is suspected, an immediate visit to a specialist is essential.

If a malignant tumor in the vagina has been successfully treated, regular follow-up care is required. For the first three years following treatment, follow-up appointments take place every three months. After that, they occur every six months for the next two years, and after five years, an annual follow-up is sufficient.

During these visits, the gynecologist asks the patient in detail about any symptoms she may be experiencing. Any abnormalities not related to vaginal cancer should also be discussed. During the examination, the doctor will palpate the vagina and examine it using ultrasound and a colposcope. The doctor will take a cell sample from the vagina, which will then be analyzed in a laboratory. This allows for the precise detection of any cells that may have become malignant again.

If any suspicious symptoms occur between follow-up appointments, please do not wait until your next appointment. See your treating gynecologist immediately.

Vaginal cancer is a rare gynecological cancer, and the risk factors for vaginal cancer, as well as its causes and risk factors, can vary from person to person. Vaginal cancer is usually diagnosed through a gynecological examination, especially if vaginal cancer is suspected. An increased risk of vaginal cancer can result from infection with human papillomavirus (HPV), as HPV infection is considered the primary cause.

Typical symptoms include bleeding after sexual intercourse, although harmless causes must also be ruled out. If vaginal cancer is left untreated, the tumor can spread to surrounding tissue, and the extent of the spread increases as the cancer progresses. The development of vaginal cancer depends on how it arises and its underlying causes; prolonged exposure to risk factors can increase the likelihood of developing the disease.

Vaginal cancer is classified into different types, including primary vaginal cancer, which is often not detected until an advanced stage. Treatment depends on the stage of the disease, and surgical removal of the tumor is frequently necessary. In advanced cases, malignant tumors can affect adjacent organs, which is why an endoscopic examination of the urinary tract may also be performed. Overall, it is clear that the prognosis for vaginal cancer depends heavily on early detection, which is why prevention and regular checkups play a central role.