Vaginal Cancer: Types, Causes, Risk Factors, Signs, Symptoms, Investigations, Stages, Treatment
Cancer which originates in the vagina (birth canal) is known as vaginal cancer and this is a rare type of cancer. Vaginal cancer usually occurs in the cells which cover the vaginal surface. Primary vaginal cancer, i.e. cancer which begins in the vagina, is quite rare; although, there are other types of cancer which can spread to the vagina from other areas of the body.
Prognosis is good if the cancer is detected in its early stages. If the cancer spreads beyond the vagina, then the treatment becomes difficult. Treatment options include surgery, radiation therapy and chemotherapy.
Types of Vaginal Cancer
Depending of the cell type where the cancer has begun, vaginal cancer is divided into the following types:
- Vaginal Squamous Cell Carcinoma: This type of vaginal cancer is the most common type and it starts in the squamous cells, which are the thin, flat cells lining the vaginal surface.
- Vaginal Melanoma: This type of vaginal cancer develops in the melanocytes of the vagina. Melanocytes are the cells which produce the pigment melanin.
- Vaginal Adenocarcinoma: This type of vaginal cancer starts in the glandular cells which are present on the vaginal surface.
- Vaginal Sarcoma: This type of vaginal cancer develops in the cells of the connective tissue or the muscles located in the vaginal walls.
Causes of Vaginal Cancer
The cause of vaginal cancer is not clear. Doctors believe that any cancer develops when there are genetic mutations in the cells resulting in uncontrollable and rapid division of the cells. These abnormal cells continue to live on instead of dying at a particular time like normal cells do. The cancer cells infiltrate the adjacent tissues and can metastasize to anywhere in the body.
Risk Factors for Vaginal Cancer
- Women suffering with vaginal intraepithelial neoplasia (VAIN) are at an increased risk of developing vaginal cancer.
- The risk of having vaginal cancer increases with age.
- Daughters of those mothers who have taken diethylstilbestrol (DES), a drug which was given to prevent miscarriages, during their pregnancy in the 1950s are at an increased risk for developing clear cell adenocarcinoma, which is a type of vaginal cancer.
- Women who start having intercourse at a very early age are at an increased risk for developing vaginal cancer.
- Women having multiple sex partners are at an increased risk of having vaginal cancer.
- HIV infection increases the risk of having vaginal cancer.
- Smoking increases the risk of developing vaginal cancer.
Signs and Symptoms of Vaginal Cancer
Patient may not experience any signs and symptoms if the cancer is in its early stages. Signs and symptoms of vaginal cancer at later stages include:
- Abnormal vaginal bleeding, such as after menopause or after sexual intercourse.
- Watery discharge from the vagina.
- Presence of a mass or a lump in the vagina.
- Painful urination.
- Pain in the pelvis.
Investigations for Vaginal Cancer
- Pelvic exam.
- Pap test may help in detecting the cancer cells.
- Colposcopy is a test where the vagina is examined with the help of a colposcope, which is a special lighted magnifying instrument. Colposcopy helps in magnifying the vaginal surface and makes detection of any abnormal cells easier.
- Biopsy is a procedure where a tissue sample is removed and sent for testing for cancer cells. Biopsy can also be done during a colposcopy exam.
Investigations to Help Determine Staging of Vaginal Cancer
- Computerized Tomography (CT) Scans.
- Magnetic Resonance Imaging (MRI).
- Positron Emission Tomography (PET) Scan.
Stages of Vaginal Cancer
- Stage I: In this stage, the cancer is limited to the walls of the vagina.
- Stage II: In this stage, the cancer has spread to the tissues adjacent to the vagina.
- Stage III: In this stage, the cancer has spread to the pelvis.
- Stage IVA: In this stage, the cancer has metastasized to the nearby areas (rectum or bladder).
- Stage IVB: In this stage, the cancer has spread to distant regions from the vagina, e.g. liver.
Treatment for Vaginal Cancer
Treatment for vaginal cancer depends on the type of vaginal cancer, its stage and the preferences of the patient.
Surgery for Vaginal Cancer
- Surgery for removing small tumors/ lesions if the cancer is limited to the vaginal surface. The tumors are excised along with a small amount of healthy tissue surrounding the tumor to make sure that all the cancer cells have been removed.
- Vaginectomy is a surgical procedure where the vagina is removed. It could be partial vaginectomy, where a part of the vagina is removed; or a radical vaginectomy where the entire vagina is removed. Hysterectomy (removal of uterus) and lymphadenectomy (removal of lymph nodes) are done depending on the cancer stage at the same time as vaginectomy.
- Pelvic exenteration or pelvic evisceration is the surgical removal of most of the pelvic organs. This massive surgery is done if the cancer has spread throughout the entire pelvic region or if there is a recurrence of vaginal cancer. The organs removed during a pelvic exenteration may include: Ovaries, uterus, vagina, bladder, rectum and the lower part of the colon.
Radiation Therapy for Vaginal Cancer
Radiation therapy is a treatment modality where high-powered energy beams, like x-rays, are used to destroy cancer cells. Radiation therapy is of 2 types:
- External Beam Radiation: In this type, depending on the extent of the cancer, high-powered energy beams are directed only at the pelvis or towards the abdomen.
- Internal Radiation or Brachytherapy: In this type, radioactive devices, such as wires, seeds, cylinders etc. are placed within the vagina or in the tissue surrounding the vagina. After a brief period of time, these devices are removed. Women having vaginal cancer in its initial stages may only receive internal radiation. Otherwise, they may receive internal radiation after having undergone external radiation.
Chemotherapy for Vaginal Cancer
Chemotherapy uses drugs or chemicals to destroy cancer cells. However, it is not clear if chemotherapy helps women with vaginal cancer. Due to this reason, chemotherapy often isn't used individually for treating vaginal cancer. Chemotherapy can be used during or in combination with radiation therapy to boost the efficacy of radiation therapy.
Prevention of Vaginal Cancer
- Undergoing routine Pap tests and regular pelvic exams helps in early detection of vaginal cancer.
- Getting HPV vaccine to prevent HPV infection also helps in reducing the risk of vaginal cancer along with additional HPV-related cancers.
- Smoking increases the risk of vaginal cancer. So, quitting of smoking increases the chances of preventing vaginal cancer.