Vaginal cancer is a rare type of cancer. It occurs in the vagina which is the muscular tube that connects the uterus with the outer genitals. Vaginal cancer most commonly occurs in the cells that line the surface of the vagina, which is sometimes called the birth canal.
While several cancers can spread to the vagina from other places in the body, cancer that begins in the vagina (primary vaginal cancer) is rare. Vaginal cancer comprises only 2 to 3 percent of gynecologic cancers.
Women with early-stage vaginal cancer have the best chance for a cure. Vaginal cancer that spreads beyond the vagina is much more difficult to treat.
The most common symptom of vaginal cancer is painless bleeding from the vagina.
Types of vaginal cancer
There are two main types of vaginal cancer:
- Primary vaginal cancer, where the cancer begins inside the vagina.
- Secondary vaginal cancer, where the cancer begins in another part of the body (usually the reproductive system), Such as the cervix or ovaries, and then spreads to the vagina.
Types of primary vaginal cancer
There are three main types of primary vaginal cancer:
- Squamous cell carcinoma is the most common type of vaginal cancer. It accounts for 85 percent of all cases. It usually develops in women over 50.
- Clear cell adenocarcinoma accounts for 9 percent of all cases of vaginal cancer. This type of cancer usually affects teenagers and younger adults.
- Melanoma is rare and accounts for up to 2 percent of all cases of primary vaginal cancer. As with squamous cell carcinoma, melanoma usually develops in women over 50.
Vaginal cancer is rare. The exact causes of vaginal cancer are unknown, but possible risk factors include:
- Being infected with the human papilloma virus (HPV)
The outlook for squamous cell carcinoma and clear cell adenocarcinoma is generally good if the cancer is detected when it is still contained within the vagina. The outlook for the melanoma type of vaginal cancer is poor because it is very aggressive and spreads quickly. Vaginal cancer can be treated with a combination of radiotherapy, surgery and chemotherapy.
What are the signs and symptoms of vaginal cancer?
A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.
The most common symptom of vaginal cancer is painless vaginal bleeding. Early vaginal cancer may not have any signs and symptoms.
In pre-menopausal women who still have regular periods, the bleeding may occur in between normal periods. Period is much heavier than usual.
Some women with vaginal cancer also experience vaginal bleeding after sexual intercourse.
Less common symptoms of vaginal cancer include:
- Pain when urinating (dysuria)
- A sudden, urgent need to urinate
- Blood in the urine
- Pelvic pain
Seek medical advice if:
- There is vaginal bleeding after menopause
- Usual pattern of menstruation has changed, such as having irregular or heavier periods than usual
- There are problems with urination, such as pain when urinating
- There is a lump or mass in the vagina
- Pelvic pain
- Watery vaginal discharge that may be bloody and foul smelling
While it is highly unlikely that these symptoms are due to vaginal cancer, they still need to be investigated.
What causes vaginal cancer?
In general, cancer begins when healthy cells acquire a genetic mutation that turns normal cells into abnormal cells. Cancer cells grow and multiply out of control, and they do not die. The accumulating abnormal cells form a mass or tumor. Cancer cells invade nearby tissues and can break off from an initial tumor to spread elsewhere in the body (metastasize). Left untreated, cancer can quickly grow and spread to other parts of the body, usually through the lymphatic system.
As is the case with many types of cancer, it is not clear what causes the genetic mutation that leads to vaginal cancer.
The exact cause of vaginal cancer has not yet been identified. However, evidence suggests that a number of risk factors can increase the likelihood of developing vaginal cancer:
- Human papilloma virus (HPV)
It is a family of viruses that affect the skin and the moist membranes that line the body, such as those in the cervix, anus, mouth and throat.
HPV is known to cause changes in the cells of the cervix, which can lead to cervical cancer. It is thought that the virus could have a similar effect on the cells of the vagina. HPV is spread during sexual intercourse, including anal and oral sex. A vaccine (Gardasil) that prevents some types of HPV is now available.
- Diethylstilbestrol (DES)
The medicine diethylstilbestrol (DES) is another known risk factor for vaginal cancer. DES was widely prescribed for pregnant women from 1938 to 1971. At the time, it was mistakenly thought that DES could help reduce the risk of miscarriage. In 1971, researchers discovered a link between DES and cancer and the use of DES in pregnant women was banned.
The risk of vaginal cancer associated with using DES is small. It is estimated that only one in every 1,000 women whose mothers used DES during pregnancy go on to develop vaginal cancer.
Other possible risk factors:
- A history of reproductive cancers, such as cervical or ovarian cancer.
- Alcohol consumption.
- 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. In women with VAIN, cells in the vagina appear different from normal cells, but not different enough to be considered cancer. A small number of women with VAIN will eventually develop vaginal cancer.
- Previous gynecologic cancer. Women who have been treated for a different gynecologic cancer, especially cervical cancer, may have an increased risk of vaginal cancer.
Other risk factors that have been linked to an increased risk of vaginal cancer include:
- Multiple sexual partners
- Early age at first intercourse
- HIV infection
How is vaginal cancer diagnosed?
Before diagnosing vaginal cancer, symptoms and the pattern of vaginal bleeding will be studied. Blood tests may be recommended to rule out other causes of vaginal bleeding, such as infection or an overactive thyroid gland (hyperthyroidism).
While there is no general screening test for vaginal cancer, it’s sometimes found during a routine pelvic exam before signs and symptoms become evident. Also a Pap test screens for cervical cancer, but sometimes vaginal cancer cells can be detected on a Pap test. Pap tests and pelvic exams are generally recommended every two to three years.
Referral to a gynecologist
If no obvious cause of the symptoms can be found, a gynecologist will recommend further testing. A gynecologist is a specialist in treating conditions of the female reproductive system.
Further tests will probably include:
- An internal vaginal examination to look for any unusual lumps or swellings
- A colposcopy, using a special instrument (colposcope) that acts like a magnifying glass
If testing reveals that there may be abnormal tissue inside the vagina, a small sample of the tissue will be removed and checked under a microscope for cancerous cells. This is known as a biopsy.
- Computerized tomography (CT) scans
- Magnetic resonance imaging (MRI) scans
Once vaginal cancer has been diagnosed, the extent of the cancer will be determined. This process is called staging. The stage of the cancer helps decide what treatments are appropriate. The following test can be used in order to determine the stage of the cancer:
- Biopsy. Tissue samples from the cervix or vulva may show whether cancer has spread to those areas.
- Imaging tests. To determine whether cancer has spread. Imaging tests may include X-rays, computerized tomography (CT) scans or magnetic resonance imaging (MRI).
- Small cameras to see inside the body. Procedures that use tiny cameras to see inside the body may help determine if cancer has spread to certain areas.
- Positron emission tomography (PET) scan. This test uses sugar (glucose) combined with a radioactive atom to detect areas where cancer has spread. Cancer cells use more glucose because they are more active than normal cells, and the PET scan highlights areas to detect cancer.
The stages of vaginal cancer are:
- Stage 0. Cancer has not spread past the first layer of the vaginal wall. Five-year survival rates at this stage are as high as 96 percent.
- Stage 1. Cancer is limited to the vaginal wall.
- Stage 2. Cancer has spread to tissue next to the vagina.
- Stage 3. Cancer has spread to nearby lymph nodes, or to the pelvic wall or both.
- Stage 4A. Cancer has spread beyond the pelvis and into the linings of the bladder and bowel.
- Stage 4B. Cancer has spread into the bladder and bowel.
- Stage 4C. Cancer had spread to other organs, such as the lungs.
In stage 0 vaginal cancer, it may be possible to remove the abnormal cells using laser surgery or a special type of ointment. In stage 1 vaginal cancer, it may be possible to achieve a cure using radiotherapy alone and/or by removing a small section of the vagina. In stages 2, 3 and 4a vaginal cancer, a combination of radiotherapy, chemotherapy and surgery may be required to get rid of the cancer. In stages 4b and 4c vaginal cancer, a cure is not usually possible. However, radiotherapy and chemotherapy can relieve the symptoms and slow down the spread of cancer.
What is the treatment for vaginal cancer?
Treatment options for vaginal cancer depend on several factors, including the type of vaginal cancer and its stage. Because vaginal cancer is rare, no standard treatment guidelines have been developed. Treatment for vaginal cancer typically includes surgery and radiation.
Surgery to remove the cancer from the body is primarily used for early-stage vaginal cancer that is limited to the vagina or, in selected cases, nearby tissue. Because many important organs are located in the pelvis, surgery to remove larger tumors would require removal of these organs. For this reason, the cancer may be controlled through other treatment methods first.
Types of surgery:
- Removal of small tumors or lesions. Cancer limited to the surface of the vagina may be cut away using a scalpel or a laser. A small amount of healthy tissue may be removed to ensure that all of the cancer cells have been removed.
- Removal of the vagina (vaginectomy). Removing part of the vagina (partial vaginectomy) or the entire vagina (radical vaginectomy) may be necessary to remove all of the cancer. A partial vaginectomy can be used to treat stage 1 vaginal cancer, where radiotherapy has failed to remove the cancer or where a woman prefers to have surgery rather than radiotherapy because she still wants to have children. The rest of the vagina is stretched up and stitched into place, normal sexual intercourse is possible after recovery from the operation. A radical vaginectomy is used to treat cases of advanced stage 1 and stage 2 vaginal cancers. The surgeon will remove most or the entire vagina. Depending on the extent of the cancer, surgery to remove the uterus and ovaries (hysterectomy) and nearby lymph nodes (lymphadenectomy) may be recommended at the same time as the vaginectomy.
- Removal of the majority of the pelvic organs (Total pelvic Exenteration or TPE). This extensive surgery may be an option if cancer has spread throughout the pelvic area or if the vaginal cancer has recurred. Many of the organs in the pelvic area are removed, including the bladder, ovaries, uterus, vagina, rectum and the lower portion of the colon. Openings are created in the abdomen to allow urine (urostomy) and waste (colostomy) to exit the body and collect in ostomy bags. It may be possible to reconstruct the rectum and attach it to the remaining section of colon once this has healed. In this case, a temporary colostomy is needed.TPE is major surgery, and requires several months to fully recover from the operation.
When the vagina is completely removed, a patient may choose to undergo surgery to construct a new vagina.
Radiation therapy is a common treatment for vaginal cancers. Radiation therapy uses high-powered energy beams to kill cancer cells. Radiation can be delivered two ways:
- External radiation. External beam radiation is directed at the entire abdomen or just the pelvis, depending on the extent of the cancer. Most women with vaginal cancer receive external beam radiation.
- Internal radiation. During internal radiation (brachytherapy), devices containing radiation (radioactive seeds, wires, cylinders or other materials) are placed in the vagina or the surrounding tissue. After a set number of days, the devices are removed. Women with very early-stage vaginal cancer may receive internal radiation only. Other women may receive internal radiation after undergoing external radiation.
Radiation therapy kills rapidly-growing cancer cells, but it may also damage nearby healthy cells, causing side effects. Side effects of radiation depend on the radiation’s intensity and where it is aimed. Complications may include bladder irritation, inflammation of the lining of the rectum, narrowing of the vagina, thinning of the lining of the vagina, premature menopause and infertility.
If surgery and radiation cannot control the cancer, other treatments may be offered including:
- Chemotherapy. Chemotherapy uses chemicals to kill cancer cells. It is not clear whether chemotherapy is really useful in women with vaginal cancer. Chemotherapy is usually given by injection (called intravenous chemotherapy).Chemotherapy is sometimes used during radiation therapy to enhance the effectiveness of radiation. Like radiotherapy, the powerful cancer-killing medicines used in chemotherapy can also damage healthy tissue and cause a range of side effects. Side effects of chemotherapy include nausea, vomiting, hair loss, and fatigue. Chemotherapy can also weaken the immune system. However, the side effects should stop once treatment has finished.
- Clinical trials. Clinical trials are experiments to test new treatment methods. Most clinical trials involve comparing a new treatment with an existing treatment to determine whether the new treatment is more or less effective. They give a chance to try the latest treatment advances, but a cure is not guaranteed.
What are the complications of vaginal cancer?
Emotional effects of treatment
Treatment for vaginal cancer can have a significant emotional impact, particularly in women who have not yet reached the menopause and need to have radiotherapy or a hysterectomy.
Both these treatments trigger an early menopause, which means that many women have to come to terms with the fact that they will never be able to have children. This can be particularly traumatic for women who have clear cell adenocarcinoma because they are usually teenagers when the cancer develops.
The removal of some or the entire vagina can be traumatic for pre- and post-menopausal women alike. Many women feel less ‘womanly’ than before. In some women, this may trigger the start of depression.
Talking to other women who have had similar treatment can give emotional support and reassurance. Enquire about a suitable local support group.
How can vaginal cancer be prevented?
There is no sure way to prevent vaginal cancer. However, having routine pelvic exams and Pap tests increases the chance that vaginal cancer is discovered early. When discovered in its earliest stages, vaginal cancer is more likely to be cured. Doctors recommend women get pelvic exams and Pap tests soon after they have begun having sexual intercourse or by age 21.
There is a strong link between certain types of human papilloma virus (HPV) and the development of abnormalities that may develop into vaginal cancer.
Vaccines such as Gardasil and Cervarix are now available. They provide protection against the two strains of HPV that are thought to be responsible for most cases of vaginal cancer. HPV vaccination also protects against cervical cancer, which is far more common than vaginal cancer.
Girls should be offered the HPV vaccine as part of their routine childhood immunization program. The vaccine should be given to girls who are 12 to 13 years old, with three doses given over six months. The HPV vaccine does not provide protection against all strains of HPV. As HPV is spread through unprotected sex, using a condom is the best way to avoid it.
Early first intercourse is associated with vaginal cancer. Delaying first sexual experience may also help prevent vaginal cancer. In addition, avoiding having sex with multiple partners may also reduce risk of vaginal cancer. Quitting smoking or never starting to smoke also may decrease the risk of vaginal cancer.
During cancer treatment:
It is essential to take care of overall health while undergoing cancer treatments and beyond. Eating well, managing stress and getting adequate exercise can all help promote good health.
Good nutrition is especially important for people undergoing cancer treatment. This can be difficult for a time if treatment includes chemotherapy or radiation therapy because of nausea or loss of appetite, and foods may taste bland or unpleasant. As a result, planning meals can become unpleasant.
Nevertheless, eating well during cancer treatment can help maintain stamina and the ability to cope with the side effects of treatments. Good nutrition may also help prevent infections.
Some strategies for eating well:
- Eat protein-rich foods. Foods high in protein can help build and repair body tissues. These include eggs, yogurt, cottage cheese, peanut butter, lean meat, poultry, fish, beans and lentils.
- Keep an open mind about foods. Something that is unappealing today might taste better next week.
- When feeling well, make the most of it. Eat as many healthy foods as you can. Prepare meals that can easily be frozen and reheated. Also look for low-fat frozen dinners and other prepared foods.
- Pack calories into the foods you eat. For instance, spread butter, jam or honey on bread. Sprinkle foods with chopped nuts.
- Eat smaller amounts of food more frequently. If a large meal is too difficult, try eating small amounts of food more often. Keep fruits and vegetables handy for snacking.
Try to stay physically active, even when not feeling well. A regular, short walk or climbing the stairs can keep muscles from deteriorating due to lack of use. Exercise can also help prevent fatigue, reduce anxiety and help prevent depression.
In addition, activities that require repetitive movement, such as swimming, can produce a mental state similar to that achieved with meditation. The same is true of yoga and other stretching exercises.
Each woman with cancer deals with her diagnosis in her own way. Some might want to surround themselves with friends and family, or others might ask for some time alone to sort through their thoughts. Some useful tips:
- Learning everything about the cancer. Write down all the questions you have and ask them at the next appointment with your doctor. Get a friend or family member to come to appointments with you to take notes. Get further sources of information. The better knowledge you have about your condition, the better prepared you will be to make decisions about your treatment.
- Maintain intimacy with your partner. Vaginal cancer treatments are likely to cause side effects that make sexual intimacy more difficult. If treatment makes sex painful or temporarily impossible, try to find new ways of maintaining intimacy. Spending quality time together and having meaningful conversations are ways to build your emotional intimacy. If sexual side effects of your cancer treatment are hurting your relationship with your partner, talk to your doctor. He or she may offer ways to cope with sexual side effects and may refer you to a specialist.
- Support network. Having friends and family around you and supporting you can be valuable. It is often helpful to have someone to talk to about your emotions. Other sources of support include social workers and psychologists. Talk with your pastor, rabbi or other spiritual leader. Other people with cancer can offer a unique perspective, and may better understand what you’re going through, so consider joining a support group.
- Take time for yourself when you need it. Let people know when you want to be alone. Quiet time to think or write in a journal can help you sort out your emotions.