Vaginal Cancer - Symptoms, Causes, Diagnosis, and Treatment

What Is Vaginal Cancer?

Rare cancer that originates in the vagina, the tube made of muscles that connect the uterus with the outer genitals, is called vaginal cancer. Healthy cells in the vaginal wall change and start multiplying out of control, forming a tumor, which can be cancerous or benign. Cancerous tumors grow and spread to other parts of the body, while benign tumors can grow but will not spread. It is rare to see cancer that begins from the vaginal cells (primary vaginal cancer), and almost 85 percent of cancer found in the vagina actually spreads from other body parts, and 50 percent of such cancer spreads from the cervix or uterus. An early diagnosis of vaginal cancer is essential to cure it because if it extends beyond the vagina, it becomes more challenging to treat.

What Are the Common Types of Vaginal Cancer?

The following are the five main types of cancer that begin in the vagina:

1. Vaginal Squamous Cell Carcinoma - This is the most commonly seen vaginal cancer, and almost 80 % of all vaginal cancer cases are squamous cell carcinoma. It can develop in the cells that line the vagina and most often present closer to the cervix. This cancer develops slowly from vaginal intraepithelial neoplasia (VaIN), which is a precancerous condition.

2. Vaginal Adenocarcinoma - This cancer originates in the glandular cells in the lining of the vagina or the gland tissue that secrete mucus and other fluids. This type is more likely to spread to other areas like the lymph nodes and lungs. Around 5 to 10 % of vaginal cancers are adenocarcinomas.

3. Vaginal Clear Cell Adenocarcinoma - It is a rare subtype of adenocarcinoma. It is usually seen in women whose mothers took Diethylstilbestrol (DES), a hormone, during the early months of pregnancy. This medicine was frequently prescribed between the 1940s and 1970s to prevent miscarriage and other problems. In every 1000 women exposed to DES, at least one woman will develop vaginal cancer.

4. Vaginal Melanoma - This cancer is commonly seen in the parts of the body exposed to the sun. But rarely (9 %), melanoma, a cancer that originates from the cells that give the skin color, can also grow in the vagina. It generally occurs in the outer portion of the vagina.

5. Vaginal Sarcomas - Various types of sarcomas, cancers that originate from the connective tissue, can be found in the vagina. This cancer makes up around 4% of cases. The most commonly found vaginal cancer in children is rhabdomyosarcoma, and leiomyosarcoma occurs commonly in women over the age of 50.

What Are the Signs and Symptoms of Vaginal Cancer?

Vaginal cancer usually does not produce any noticeable symptoms, so by the time it gets diagnosed, the cancer will have spread. In the later stages, vaginal cancer can result in:

• Abnormal vaginal bleeding that is not related to menstruation, such as bleeding after sex and intermenstrual spotting.

• Pain during sex.

• Abnormal discharge from the vagina.

• Constipation.

• Pelvic pain.

• A palpable mass in the vagina.

• Pain during urination.

What Causes Vaginal Cancer?

The causes of vaginal cancer include:

1. Human Papillomavirus (HPV) - This virus is transmitted sexually and is the most common cause of vaginal cancer. Some strains of HPV are linked more strongly with certain types of vaginal cancer.

2. Herpes Simplex Virus (HSV) - Women infected with this virus are also at increased risk of developing vaginal cancer.

3. History of Cervical Cancer - As cervical cancer is also usually due to infection with HPV, women with a history of cervical cancer are at increased risk for vaginal cancer.

4. Exposure to Diethylstilbestrol (DES) - As mentioned above, women exposed to this hormone in-vitro are at risk. As this medicine is no longer prescribed to prevent miscarriage in early pregnancy, vaginal cancer due to DES is very rare.

Who Is at Risk of Developing Vaginal Cancer?

Factors that increase a woman’s chance of developing vaginal cancer are:

• This cancer is more common in women who are 60 years or older. Almost 50 % of cases occur in women older than 70 years, and just 15 % of the affected women are younger than 40 years.

• Women who smoke are at risk.

• Previous treatment with radiation in the vaginal area increases the risk.

• HIV (human immunodeficiency virus) infected women.

• Previous hysterectomy for uterine cancer.

How Is Vaginal Cancer Diagnosed?

Usually, vaginal cancer is found during a routine pelvic exam. During the pelvic examination, the doctor inspects the outer genitals, after which he or she inserts two fingers into the vagina and simultaneously applies pressure on the abdomen. If needed, a speculum is also used to open the vaginal canal to inspect the vagina and cervix properly.

The doctor might also perform a Pap smear test, where cells are collected from the cervix and vagina for testing. Sometimes, a colposcopy is performed. Here, a lighted magnifying tube called a colposcope is inserted into the vagina to look for any abnormalities. If any abnormal growth is seen, the doctor might collect some tissue to test for cancer cells.

Imaging tests, like X-rays, computerized tomography (CT) scans, magnetic resonance imaging (MRI), and positron emission tomography (PET), are used to determine if cancer has spread.

How Is Vaginal Cancer Staged?

Vaginal cancer is staged based on where it has spread. The stages are:

Stage I - The cancer cells are only in the vagina.

Stage II - The cancer cells have spread but not to the walls of the pelvis.

Stage III - The cancer cells have spread to the lymph nodes or the pelvic wall.

Stage IVA - The cancer cells have spread to the rectum, bladder, or far from the pelvis.

Stage IVB - Here, cancer cells have spread to a distant body part.

How Is Vaginal Cancer Treated?

Based on the type of vaginal cancer and the stage, the oncologist will suggest treatment. The various treatment options include:

1) Surgery

Surgical removal of the tumor or lesion is done when the cancer is limited to the surface of the vagina. A small margin of healthy surrounding tissue is also removed to ensure cancer cells are not left behind. If the cancer is more aggressive, then the vagina has to be removed surgically (vaginectomy). When part of the vagina is removed, it is called partial vaginectomy, and when the entire vagina is removed, it is called radical vaginectomy. After complete removal of the vagina, surgery can be done to reconstruct a new vagina. If cancer has spread to the uterus, then a hysterectomy (removal of the uterus) along with the ovaries and nearby lymph nodes is done. And if cancer has spread to the pelvic region, organs from the pelvis, such as the bladder, rectum, and lower part of the colon, might have to be removed.

2) Radiation Therapy

The use of high-energy beams, like X-rays, are used to destroy cancer cells. High-powered X-rays or other types of radiation are used in this procedure to eradicate malignancy. The doctor may insert a radioactive substance inside the body, on or near the cancer, or they may use a device that transmits X-rays into the patient's body.

What Is the Prognosis of Vaginal Cancer?

The stage of cancer at diagnosis, the size and position of the tumor, and the patient's general health all affect the prognosis of vaginal cancer. According to the American Cancer Society, the 5-year relative survival rate for women with vaginal cancer is approximately 47%, which means that 47 % of women with this cancer are anticipated to be alive 5 years after diagnosis. However, this rate differs depending on the cancer's stage, with higher survival rates for cancers diagnosed at an earlier stage. The prognosis can also be impacted by the type of treatment chosen, such as surgery, chemotherapy, or radiation therapy. The prognosis is good for the early stages of vaginal cancer, and the 5-year survival rate is 80 to 90 %.

How Is Vaginal Cancer Prevented?

Even though vaginal cancer is uncommon, it is preventable if people take steps to lessen their exposure to certain risk factors. According to medical professionals, the HPV vaccine, quitting smoking, using protection during sexual activity, and undergoing routine gynecological exams are methods to reduce the risk of vaginal cancer. Women should be conscious of any changes in their vaginal health and notify their doctor right away if they experience any symptoms like abnormal bleeding, discharge, or pain. The risk of getting vaginal cancer can also be decreased by leading a healthy lifestyle that includes a balanced diet and regular exercise.

Conclusion:

To conclude, vaginal cancers are rare, and thus many women do not know about them. Therefore, spreading awareness about this rare form of cancer can help educate women about it so that its complications can be prevented. When vaginal cancer is found early, it is most likely that the person will get better. Treatment for vaginal cancer that has spread outside of the vagina is much more challenging.