Vaginal Cancer

Signs and Symptoms

Vaginal cancer is a rare disease and makes up less than 3 percent of all gynecological cancers. There are four different types of vaginal cancer, including:

• Squamous Cell Cancer: The most common type and usually occurs in the upper part of the vagina. It typically affects women between the ages of 50 and 70.
• Adenocarcinoma: The second most common type and usually affects women between the ages of 12 and 30, although it occassionally occurs in women of all age groups.
• Malignant Melanomas Sarcomas: Extremely rare forms of the disease.

It is important to know that even if you have had a hysterectomy, you can still develop vaginal cancer.

Risk Factors

As with many cancers, the exact cause of vaginal cancer is not known for sure. However, some factors may increase a woman's risk for the disease, including:

• Smoking
• Age, women over the age of 50 are most commonly affected by squamous cell vaginal cancer
• History of cervical cancer
• Having had a hysterectomy
• History of genital warts caused by the human papilloma virus (HPV)
• Having had radiation therapy to the pelvic area

In addition, research has shown that young women whose mothers took a drug known as diethylstilbestrol (DES) are at a higher risk for developing the disease. The drug DES was given to pregnant women between 1945 and 1970 to prevent them from having miscarriages.

In some cases, vaginal cancer may not cause any symptoms and is detected by an abnormal Pap smear. However, some common symptoms of the condition include:

• Bleeding or discharge not related to menstrual periods
• Difficult or painful urination
• Pain during intercourse or in the pelvic area

Diagnosis

If you are experiencing any symptoms of vaginal cancer or other problems related to your vagina, you should visit a doctor immediately for a definite diagnosis. Your doctor will begin by asking about any symptoms you may be experiencing, as well as reviewing your medical history and conducting a thorough physical exam. To determine the cause of your symptoms, the following tests may be performed:

• Pelvic Exam-- This test involves feeling the uterus, vagina, ovaries, fallopian tubes, bladder and rectum to find any abnormality in their shape or size.
• Pap Smear-- As part of the pelvic exam, your doctor may conduct a Pap smear. He or she will use a piece of gently scrape the outside of the cervix and vagina with a small spatula and brush in order to pick up cells, which then can be analyzed for any abnormalities. Some pressure may be felt, but usually with no pain.
• Coloscopy-- If any abnormal cells are found during your Pap smear, your doctor may recommend a coloscopy. During this exam, your doctor will use a colposcope, which is a small microscope to see your vagina in more detail. This is an outpatient procedure that takes about 10-15 minutes and is usually not painful, though may be a little uncomfortable.
• Biopsy-- If any abnormal cells are found during your Pap smear, your doctor will then need to conduct a biopsy. During this procedure, a small sample of tissue is removed from the vagina and then examined under a microscope for any cancer cells.
• Computed tomography (CT) Scan-- This imaging test takes a series of detailed pictures of areas inside the body. The pictures are created by a computer, which is linked to an X-ray machine. A special dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.
• Magnetic Resonance Imagining (MRI)-- This is a painless non-invasive procedure that uses powerful magnets and radio waves to construct pictures of the body. Any imaging plane, or "slice" can be projected, stored in a computer, or printed on film. MRI can easily be performed through clothing and bones.

Treatment

Treatment for vaginal cancer typically involves surgery, radiation therapy and possibly chemotherapy. With surgery, some patients may need skin grafts and plastic surgery to make an artificial vagina. Some patients may need more than one type of treatment in combination.

At UCSF Medical Center, a team of cancer specialists and plastic surgeons work together to design the most effective treatment plan for your condition.

Surgery

Surgery is the most common treatment for all stages of vaginal cancer. A doctor may remove the cancer using one of the following:

Laser Surgery: A narrow beam of light is used to kill cancer cells. It may be used for the very earliest stages of when the cancer has been confined to the place of its origin which is also known as in situ cancer.

Wide Local Excision: A type of surgery that removes the cancer and some of the tissue around it. A patient may need to have skin taken from another part of the body, or grafted, to repair the vagina after the cancer has been removed.

Vaginectomy: In some cases, an operation in which the vagina is removed may be recommended. When the cancer has spread outside the vagina, vaginectomy may be combined with surgery to take out the uterus, ovaries and fallopian tubes. This is called a radical hysterectomy. During these operations, lymph nodes in the pelvis also may be removed.

Exenteration: If the cancer has spread outside the vagina and the other female organs, the doctor may take out the lower colon, rectum or bladder -- depending on where the cancer has spread -- along with the cervix, uterus and vagina.

Radiation Therapy

Radiation therapy uses X-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body, called external beam radiation therapy. Another form or radiation therapy, called internal radiation, works by placing materials that produce radiation, called radioisotopes, through thin plastic tubes into the area where the cancer cells are found. Radiation may be used alone, in combination with chemotherapy, or after surgery.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells outside the vagina. Chemotherapy may be used in combination with radiation treatment, or alone.