Vaginal Cancer

Vaginal cancer is a rare type of cancer that begins in the vagina, the muscular tube connecting the uterus to the outside of the body. It often has no early symptoms, but can cause unusual vaginal bleeding or discharge. Early detection and treatment are important for a better outlook.

What is Vaginal Cancer?

Vaginal cancer is a rare disease where cancerous (malignant) cells form in the tissues of the vagina. It is one of the less common gynecologic cancers. Most cases are primary vaginal cancer, meaning the cancer starts in the vagina itself, but it can also be secondary, spreading from other parts of the body.

The vagina is a muscular tube that connects the uterus to the outside of the body. It plays a role in menstruation, sexual intercourse, and childbirth. Vaginal cancer occurs when cells in the lining of the vagina grow out of control, forming a tumor. The most common type of vaginal cancer is squamous cell carcinoma, which accounts for about 70% of cases. This type begins in the thin, flat cells that line the surface of the vagina. Another type, adenocarcinoma, starts in the glandular cells and makes up about 15% to 20% of cases. Rarer types include melanoma and sarcoma. Vaginal cancer is considered rare, affecting less than 1% of people with gynecologic cancers. It is more common for cancer to spread to the vagina from other areas, such as the cervix or uterus, than for it to start there.

Symptoms

Vaginal cancer often does not cause any noticeable symptoms in its early stages. When symptoms do appear, they can include unusual vaginal bleeding, such as bleeding after sex, between periods, or after menopause. Other signs might be a watery vaginal discharge or pelvic pain.

Because early vaginal cancer often has no symptoms, it may be found during a routine pelvic exam or Pap test. If symptoms do develop, they can vary from person to person. The most common symptom is unusual vaginal bleeding. This might include bleeding after sexual intercourse, bleeding between menstrual periods, or any vaginal bleeding after menopause has occurred. You might also notice a watery vaginal discharge that is not typical for you. Other possible symptoms can include pain during sexual intercourse, painful urination, constipation, or a lump or mass that you can feel in your vagina. Some people may experience pelvic pain or discomfort. If you notice any of these symptoms, it is important to see a doctor.

Causes & risk factors

The exact cause of vaginal cancer is not fully understood, but it is believed to start when healthy cells in the vagina develop changes (mutations) in their DNA. Several factors can increase your risk of developing vaginal cancer, including certain infections and a history of other gynecologic conditions.

While the precise reasons why vaginal cancer develops are not clear, it is known that the cancer begins when cells' DNA changes, causing them to grow and divide uncontrollably. These abnormal cells can then form a tumor. Several factors can increase your risk of developing vaginal cancer. One significant risk factor is infection with human papillomavirus (HPV), a common sexually transmitted infection. A history of cervical cancer or precancerous vaginal lesions, known as vaginal intraepithelial neoplasia (VAIN), also increases risk. VAIN means there are abnormal cells on the surface of the vagina that are not yet cancerous but could become so over time. Other risk factors include increasing age, with most cases occurring in women over 60. Exposure to the drug diethylstilbestrol (DES) before birth, if your mother took it during pregnancy, is linked to a rare type of vaginal cancer called clear cell adenocarcinoma. Smoking and having a weakened immune system, such as from HIV infection, can also raise your risk.

How it's diagnosed

Diagnosing vaginal cancer typically begins with a pelvic exam and a Pap test, which can detect abnormal cells. If abnormalities are found, further tests like a colposcopy and a biopsy are performed. Imaging tests are then used to determine if the cancer has spread and to help stage the disease.

If you have symptoms or if your doctor suspects vaginal cancer, they will usually start with a physical exam, including a pelvic exam. During this exam, the doctor can check for any lumps or abnormal areas in your vagina. A Pap test (Papanicolaou test) may also be performed, which collects cells from the vagina and cervix to check for abnormalities. If abnormal cells are found, the next step is often a colposcopy. This procedure involves using a lighted magnifying instrument called a colposcope to closely examine the vagina and cervix. During a colposcopy, your doctor may take a small tissue sample (biopsy) from any suspicious areas. This tissue sample is then sent to a lab to be examined under a microscope to confirm if cancer cells are present. Once cancer is confirmed, imaging tests are used to determine the stage of the cancer, meaning how far it has spread. These tests may include computed tomography (CT) scans, magnetic resonance imaging (MRI), positron emission tomography (PET) scans, or a chest X-ray. These images help doctors plan the most effective treatment.

Treatment options

Treatment for vaginal cancer depends on the type and stage of the cancer, as well as your overall health. Common treatment options include surgery to remove the cancerous tissue, radiation therapy to destroy cancer cells, and chemotherapy, which uses drugs to kill cancer cells throughout the body.

Your treatment plan will be tailored to your specific situation by your healthcare team. The goal of treatment is to remove or destroy the cancer cells while preserving as much normal vaginal function as possible. Surgery is often an option for early-stage vaginal cancer. This can range from local excision, which removes only the cancerous area and a small margin of healthy tissue, to a vaginectomy, which removes part or all of the vagina. In some cases, a radical hysterectomy, which removes the uterus, cervix, and surrounding tissues, may be necessary if the cancer has spread nearby. Radiation therapy is a common treatment, often used alone or with surgery. It uses high-energy beams to kill cancer cells. This can be external beam radiation, delivered from a machine outside the body, or brachytherapy (internal radiation), where radioactive material is placed directly into or near the tumor. Chemotherapy, which uses powerful drugs to kill cancer cells, may be used for more advanced stages or in combination with radiation therapy.

Recovery & outlook

The outlook for vaginal cancer depends significantly on the stage at which it is diagnosed and the type of cancer. Early detection greatly improves the chances of successful treatment and recovery. After treatment, regular follow-up appointments are crucial to monitor for any recurrence and manage potential side effects.

Because vaginal cancer is rare, the outlook can vary widely. Generally, cancers caught at an early stage, before they have spread, have a better prognosis. Your healthcare team can provide more specific information based on your individual diagnosis. Recovery after treatment can involve managing side effects from surgery, radiation, or chemotherapy. These side effects can include pain, fatigue, changes in bowel or bladder function, and sexual health concerns. Your doctor can help you manage these issues and connect you with supportive care resources. After completing treatment, regular follow-up care is essential. This typically includes physical exams, Pap tests, and sometimes imaging scans to check for any signs of the cancer returning. Maintaining a healthy lifestyle and open communication with your medical team are important parts of long-term recovery and well-being.

When to see a doctor

You should see a doctor if you experience any unusual or persistent vaginal symptoms, especially new vaginal bleeding after menopause, bleeding between periods, or bleeding after sex. Other concerning signs include a new lump or mass in your vagina, persistent watery discharge, or unexplained pelvic pain.

It is important to pay attention to your body and report any new or unusual symptoms to your doctor promptly. While many vaginal symptoms can be caused by less serious conditions, it is always best to have them checked to rule out cancer or other significant health issues. Specifically, seek medical attention if you notice: * Any vaginal bleeding after you have gone through menopause. * Bleeding between your regular menstrual periods. * Vaginal bleeding that occurs after sexual intercourse. * A new lump or mass that you can feel in your vagina. * Persistent, watery vaginal discharge that is unusual for you. * Ongoing pelvic pain or discomfort that does not go away. Early diagnosis of vaginal cancer can lead to more effective treatment and a better chance of recovery. Do not delay in seeking medical advice if you have these symptoms.

Frequently asked questions

How rare is vaginal cancer?

Vaginal cancer is very rare. It accounts for less than 1% of all gynecologic cancers. It is much more common for cancer to spread to the vagina from another part of the body than for it to start there.

Can the HPV vaccine prevent vaginal cancer?

Yes, the human papillomavirus (HPV) vaccine can help reduce your risk of developing vaginal cancer. HPV infection is a major risk factor for this cancer, so vaccination can offer significant protection against certain types of HPV linked to cancer.

What is vaginal intraepithelial neoplasia (VAIN)?

Vaginal intraepithelial neoplasia (VAIN) is a precancerous condition where abnormal cells are found on the surface lining of the vagina. These cells are not yet cancerous, but they have the potential to become cancer over time if not treated.

Is vaginal cancer curable?

Yes, vaginal cancer can be curable, especially when it is diagnosed at an early stage before it has spread. The success of treatment depends on factors like the cancer's stage, type, and your overall health. Early detection is key for a better prognosis.

What is the difference between primary and secondary vaginal cancer?

Primary vaginal cancer means the cancer started directly in the tissues of the vagina. Secondary vaginal cancer means the cancer began in another part of the body, such as the cervix or uterus, and then spread (metastasized) to the vagina.

Does a Pap test detect vaginal cancer?

A Pap test primarily screens for abnormal cells in the cervix, but it can sometimes detect abnormal cells from the vagina. If abnormal vaginal cells are found, further tests like a colposcopy and biopsy are needed to confirm a diagnosis of vaginal cancer.

Sources

• MedlinePlus — Vaginal Cancer
• Mayo Clinic — Vaginal Cancer
• Cochrane Library — Vaginal Cancer