Overview of vaginal cancer
Though several cancers can spread to the vagina from elsewhere in your body, it is uncommon to find a cancer that begins there. The vagina, or birth canal, is a hollow muscular tube connecting your uterus to the exterior of your body, and vaginal cancer usually develops in the cells that form its surface area.
If diagnosed at an early stage, there is a much better chance of a cure. However, vaginal cancer that has spread beyond the vagina then becomes much harder to treat.
Symptoms of vaginal cancer
Early vaginal cancer may occur without symptoms, but its progression may result in some of the following symptoms:
- abnormal vaginal bleeding (e.g. after sex, or after the menopause)
- a watery vaginal discharge
- a lump or mass in your vagina
- frequent and/or painful urination
- pain in your pelvis
Causes of vaginal cancer
What causes vaginal cancer is rather unclear. Cancers generally start when healthy cells mutate (change) into abnormal cells. Unlike healthy cells, which have a set growth cycle, malignant cancerous cells can grow vigorously (without dying off as normal cells do).
Eventually, cancer cells accumulate to form tumours, and sometimes break away to spread to other places in the body.
Vaginal cancer is classified according to the cell type from which the cancer originated, and is therefore described as follows:
- squamous cell carcinoma is the most common type of cancer, which develops in the thin, flat cells (squamous cells) lining the surface of the vagina
- adenocarcinoma starts in the glandular cells in the lining of the vagina
- melanoma starts in the melanocyte (pigment-producing) cells inside the vagina
- sarcoma develops in the muscle cells or connective tissue of the vagina walls
Diagnosis of vaginal cancer
Vaginal cancer that is presenting no symptoms can be discovered as a result of routine pelvic examinations.
Such regular screening checks your vagina and cervix for abnormalities, and together with a Pap or smear test, usually forms the first part of an examination to diagnose vaginal cancer. Further tests and procedures that may be necessary include:
- colposcopy, which uses a magnifying instrument to check your vagina for abnormalities
- a biopsy to take sample tissues for further laboratory testing
Once vaginal cancer has been diagnosed, the next phase is to determine its status and extent (known as ‘staging’) to inform decisions about treatment. This may involve:
- a range of imaging techniques, such as X-rays, CT (computerised tomography) scans, MRI (magnetic resonance imaging) or PET (positron emission tomography) scans, to check whether the cancer has spread
- small cameras to view your body internally, perhaps in connection with cystoscopy (to check your bladder), or proctoscopy (to check your rectum)
These test results will be used to classify your vaginal cancer according to one of the following stages:
- 1. Cancer is restricted to the vaginal wall
- 2. Cancer has spread into tissue surrounding the vagina
- 3. Cancer has spread to other pelvic areas
- 4a. Cancer has spread to neighbouring regions (e.g. the bladder or rectum)
- 4b. Cancer has spread beyond your vagina to other regions, such as the liver
Treatment of vaginal cancer
The treatment chosen for vaginal cancer will depend on a range of factors, and the typical options will normally include surgery and radiation.
Surgical interventions employed in the treatment of vaginal cancer may include:
- an excision (removal) of small tumours or lesions from the vaginal area, along with some of the adjoining healthy tissue
- a vaginectomy to remove some (or all) of the vagina in order to destroy the cancer cells
- a hysterectomy (removal of uterus and ovaries) and removal of the lymph nodes close by may be recommended, in conjunction with a vaginectomy
- a pelvic exenteration (removal of many pelvic organs) may be considered if vaginal cancer returns, or if the cancer has spread across the pelvic region
Radiation therapy treatment uses powerful energy beams to eradicate cancerous cells and has two modes of delivery:
- external radiation is the most common form, in which a machine generates and delivers radiation to the site of the cancer in the abdominal or pelvic regions
- internal radiation or brachytherapy, using internally positioned radioactive devices to deliver radiation inside your body and thus accurately target cancer cells
Chemotherapy uses chemicals to combat cancer, and may sometimes be used to support radiation treatment.
Chances of recovery from vaginal cancer
The chances of recovery will depend on these factors:
- the stage the cancer has reached
- the type and size of the tumour
- the location of the vaginal cancer
- the age and general health of the patient and the symptoms experienced
- whether the cancer is newly diagnosed or has returned
Prevention of vaginal cancer
Vaginal cancer is not easily preventable, though the following measures may reduce your risk:
- regular pelvic examinations and Pap/smear tests help to discover cancer early – when it is most treatable
- HPV (human papilloma virus) vaccines prevent infection by certain types of human papillomavirus and thus reduce your cancer risk – ask your doctor for details
- stop smoking – smoking raises your risk of vaginal cancer