Vaginal Cancer

Definition

Vaginal cancer is an uncommon disease in which cancer cells grow from the cells of the vaginal lining. The vagina is a tube that connects the vulva (external female genitals) to the cervix (lower end of the uterus). The vagina is also called the “birth canal.”

Cancer occurs when cells in the body (in this case, vaginal cells) divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue, called a growth or tumor, forms. The term cancer refers to malignant tumors, which can invade nearby tissue and spread to other parts of the body. A benign tumor does not invade or spread.

There are several types of vaginal cancer:

• Squamous cell carcinoma—occurs in the lining of the vagina
• Adenocarcinoma—occurs in the area of the vagina lined with cells similar to those in the glands of the cervix and uterus
  • A special type of this cancer, called clear cell adenocarcinoma, occurs in women who were exposed to a drug called diethylstilbestrol (DES) while in their mother’s womb. This drug was introduced in the late 1930s and no longer used after 1971, so the incidence of this particular type of adenocarcinoma is expected to decline.
• Melanoma—usually affects lower or outer portion of the vagina
• Sarcoma—forms deep in the walls of the vagina, not on the surface

Female Reproductive Organs

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Causes

The exact cause of vaginal cancer is unknown. However, several risk factors are known.

Risk Factors

These risk factors increase your chance of developing vaginal cancer. Tell your doctor if you have any of these risk factors:

• Age: 60 and older
• History of cervical cancer
• History of precancerous conditions in the cervix or vagina
• Having a mother who took diethylstilbestrol (DES) while pregnant
• Human papillomavirus infection (HPV) —a sexually transmitted disease (STD)
• Vaginal adenosis—when cells lining the vagina look like those found in the cervix and uterus
• Smoking

Symptoms

If you have any of these symptoms, do not assume it is due to vaginal cancer. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:

• Bleeding or discharge not related to menstrual periods
• Pain or difficulty when urinating
• Pain during intercourse
• Pain in the pelvic area
• New or worsening constipation
• A mass in the vagina that can be felt

Diagnosis

Your doctor will ask about your symptoms and medical history and perform a physical exam, including a pelvic exam. You may be referred to a doctor who specializes in women’s health (a gynecologist).

Tests may include:

• Pap test —tissue from the inside of the cervix and upper vagina is scraped and tested
• Colposcopy —a lighted, magnifying instrument is used to examine the vagina and cervix in great detail
• Biopsy —removal of a sample of vaginal tissue for testing

If cancer is found, additional tests are usually done to determine whether or not it has spread to other parts of the pelvis or elsewhere in the body. These tests may include:

• CT scan —a type of x-ray that uses a computer to make pictures of structures inside the body
• MRI scan —a test that uses magnetic waves to make pictures of structures inside the body

Treatment

Once vaginal cancer is found, staging tests are done to find out if the cancer has spread and, if so, to what parts of the body. Treatments for vaginal cancer depend on the stage of the cancer.

Talk with your doctor about the best treatment plan for you. Treatment options include:

Prevention

While a Pap smear is an effective screening tool for cervical cancer, it cannot be relied upon to detect vaginal cancer. However, regular gynecologic exams may reduce the risk of death from vaginal cancer by providing your doctor with the opportunity to detect it earlier. If you were exposed to DES in the womb, tell your doctor so that he can be more aware of your risk for vaginal cancer and take steps to closely monitor you.

There is a vaccine available, called Gardasil, that protects against four types of the human papillomaviruses (HPV). Since HPV is associated with certain types of cancer, the vaccine helps to prevent cancers of the cervix, vulva, and vagina.