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Vaginal cancer

Definition


Disease: Vaginal cancer Vaginal cancer
Category: Gynecological diseases
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Disease Definition:

Connecting a woman’s uterus with her outer genitals, the vagina is a muscular tube. Vaginal cancer is a rare form of cancer that usually occurs in the cells that line the surface of the vagina, which is called the birth canal sometimes. Primary vaginal cancer is a rare cancer that starts in the vagina, while various cancers spreading to the vagina from other places in the body are more common. Only 2 to 3 % of gynecologic cancers are vaginal cancers. Vaginal cancer that spreads beyond the vagina is difficult to treat, while women suffering from early-stage vaginal cancer have the best chance for a cure.
 

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Vaginal cancer in early stages might not have any signs and symptoms,  but as it grows, it may cause signs and symptoms like the following:

  • Watery vaginal discharge that might be bloody and foul smelling
  • Lump or mass in the vagina
  • Unusual vaginal bleeding, like after menopause or after intercourse
  • Constipation
  • Pelvic pain
  • Painful urination

 

Since vaginal cancer doesn’t always have signs and symptoms, the patient might take the doctor’s recommendations about when to have routing pelvic exams. A woman should see her doctor in the case of having any signs and symptoms associated with vaginal cancer like abnormal vaginal bleeding.
 

Causes:

Cancer cells grow and multiply out of control without dying. Generally, when healthy cells acquire a genetic mutation that turns normal cells into abnormal ones, cancer begins. Healthy cells develop and multiply at a set rate, finally dying at a set time. Cancer cells invade close tissues and could come off from an initial tumor to spread elsewhere in the body (metastasize). A mass (tumor) forms as a result of the accumulation of abnormal cells. About 85 to 90% of vaginal cancers start in the squamous cells. These thin, flat cells line the surface of the vagina. Other less common kinds of vaginal cancer include the following:

 

Vaginal sarcoma:

This type develops in the connective tissue cells or smooth muscle cells in the walls of the vagina.

 

Vaginal adenocarcinoma: 

In the glandular cells on the surface of the vagina is where this type starts. 

 

Vaginal melanoma:

This type develops in the pigment-producing cells (melanocytes) of the vagina.

 

What causes the genetic mutation leading to vaginal cancer isn’t clear, as is the case with various types of cancer. Some of the factors that may increase a woman’s risk of developing vaginal cancer are: 

 

Atypical cells in the vagina (VAIN): 

In women with vaginal intraepithelial neoplasia (VAIN), cells in the vagina seem to be different from normal cells, but not different enough to be considered cancer. Though doctors aren’t sure why, but a small number of women with VAIN eventually develop vaginal cancer while others don’t. Having VAIN increases the risk of developing vaginal cancer.

 

Age: 

Women older than 60 are usually diagnosed with vaginal cancer. 

 

Previous gynecologic cancer: 

Increased risk of vaginal cancer is found in women who’ve been treated for a different gynecologic cancer, specifically cervical cancer.

 

Exposure to miscarriage prevention drug: 

DES was used to prevent miscarriage in early pregnancy from the late 1940s until 1971. There is an increased risk of a certain kind of vaginal cancer named clear cell adenocarcinoma in women whose mothers took a medication called diethylstilbestrol (DES) while pregnant.

 

Human papillomavirus (HPV): 

The majority of cervical cancers and precancerous changes in the cervix are caused by HPV. HPV is a virus that is transmitted by sexual means that could increase the risk of vaginal cancer and other cancers. A vaccine preventing some types of HPV is available. Other risk factors that are related to an increased risk of vaginal cancer are:

  • Early age at first intercourse
  • HIV infection
  • Multiple sexual partners
  • Smoking

 

However, women with no known risk factors also develop vaginal cancer.
 

Complications

Complications:

Vaginal cancer might spread (metastasize) to further areas of the body, such as the liver, pelvic bones and lungs.
 

Treatments:

Since vaginal cancer is rare, no standard treatment guidelines have been developed. Vaginal cancer treatment options depend on various factors, such as the type of vaginal cancer that the woman has and its stage. The patient might consult the doctor to see which treatments are best for her depending on the goals of treatment and the side effects she is willing to endure. Radiation and surgery are usually included in the treatment of vaginal cancer.

 

SURGERY: 

The doctor might try controlling the cancer through other treatment techniques before trying the option of surgery, because surgery is primarily used for early-stage vaginal cancer that’s limited to the vagina or, in selected cases, nearby tissue, because various important organs are located in the pelvis; these organs will have to be removed in case the doctor tries surgically removing a large tumor. Women with vaginal cancer may undergo one of these surgeries: 

 

Removal of small tumors or lesions: 

Using a scalpel or a laser, the cancer may be cut away if it is limited to the surface of the vagina. Additionally, to ensure that all of the cancer cells have been removed, a small amount of healthy tissue may also be removed.

 

Vaginectomy: 

The entire vagina is removed in this surgery. To remove all of the cancer, removing portion of the vagina (partial vaginectomy) or the entire vagina (radical vaginectomy) might be essential. The surgeon might recommend surgery to remove the uterus and ovaries (hysterectomy) and nearby lymph nodes (lymphadenectomy) at the same time as the vaginectomy depending on the extent of the patient’s cancer.

 

Removal of the majority of the pelvic organs (pelvic exenteration):

In this procedure, the majority of the pelvic organs are removed. When cancer has spread throughout the pelvic area or in case the vaginal cancer has recurred, this extensive surgery might be an option. Several of the organs in the pelvic area including the ovaries, bladder, vagina, uterus, rectum and the lower part of the colon are removed during pelvic exenteration. In order to allow urine (urostomy) and waste (colostomy) exit the body and collect in ostomy bags, openings are created in the abdomen. A new vagina can be constructed with surgery in case the patient’s vagina is completely removed. Pieces of skin, flaps of muscle from other areas of the body or parts of intestine are used to form a new vagina. A reconstructed vagina lets the woman have vaginal intercourse after doing some adjustments. Yet, a reconstructed vagina isn’t the same as the patient’s own vagina. For example, natural lubricant is lacking in a reconstructed vagina and due to changes in surrounding nerves, a different sensation is created when touched.

 

RADIATION THERAPY: 

One of the common treatments for vaginal cancers is radiation therapy. To kill cancer cells, high-powered energy beams are used in radiation therapy. The two ways through which radiation can be delivered are:

 

Internal radiation:

Devices that contain radiation, including radioactive seeds, cylinders, wires or other materials; are placed in the vagina or the surrounding tissue during internal radiation (brachytherapy). Those devices are removed after a set number of days. While women might receive internal radiation after undergoing external radiation, others suffering from very early-stage vaginal cancer might receive internal radiation only.

 

External radiation:

Depending on the extent of the cancer, external beam radiation could be directed at the entire abdomen or just the pelvis. Most women suffering from vaginal cancer receive external beam radiation. During external beam radiation, the patient is positioned on a table and a large radiation machine is directed around her targeting the treatment area. Quickly growing cancer cells are killed by radiation therapy, which may also damage nearby healthy cells and end up causing side effects. The intensity of the radiation and where it is aimed are the factors that determine side effects. Narrowing of the vagina, irritation of the bladder, thinning of the lining of the vagina, inflammation of the lining of the rectum, infertility and premature menopause are some of the complications of radiation therapy.

 

OTHER OPTIONS: 

The woman might be suggested other treatments such as chemotherapy in case surgery and radiation couldn’t control the cancer. Chemicals are used in chemotherapy to kill cancer cells. But it isn’t certain whether chemotherapy is beneficial for women with vaginal cancer or not. Small studies of different chemotherapy combinations have had mixed results. To increase the effectiveness of radiation, chemotherapy could be used during radiation therapy.
 

Prognosis:

Not available

Expert's opinion

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