Vaginal Cancer

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Overview

Vaginal cancer is a rare form of gynaecological cancer that arises from the cells that line the vagina. It is more commonly seen among women who are aged 50 and above. Chronic HPV infection is found to be the risk factor for vaginal cancer.

In the case of early detection, vaginal cancers can have good clinical outcomes and promising survival rates. Vaginal cancers are often treated with a multimodal approach, which involves treatment modalities, namely surgery, chemotherapy and radiation therapy.

Types

Based on the type of cell that they originate from, vaginal cancers are categorised into the following types:

1. Squamous Cell Carcinoma: Squamous cell carcinoma is a common type of vaginal cancer, and it begins in the inner lining of the vagina. This vaginal cancer type is slow-growing; however, in the advanced stage, it can spread to critical organs such as the bone, lungs and liver.
2. Adenocarcinoma: Adenocarcinoma starts in the special type of cells called the glandular cells, which produce the mucus. This cancer type is also found to spread to nearby lymph nodes and critical organs, such as the lungs.
3. Vaginal Sarcoma: This cancer type is rare and forms in the connective tissues present in the vaginal wall.
4. Vaginal Melanoma: Vaginal melanoma arises from melanocytes, which are the pigment-producing cells present in the vaginal wall. This cancer type, just like vaginal sarcoma, is rare.

Symptoms

In most cases, vaginal cancer may not show any symptoms in the early stages. Vaginal cancers may be detected during the routine Pap test, which is recommended to check for the presence of abnormal cells in the cervical lining.

Following are the symptoms that are associated with vaginal cancer:

Unusual bleeding or discharge that is not associated with menstruation
A lump in the vagina
Watery discharge
Frequent urination
Pain while urinating
Constipation
Painful sexual intercourse
Pain in the pelvic region

Courses

Although the exact cause of vaginal cancer is not known, researchers have identified a few risk factors that increase one’s risk of developing vaginal cancers:

Age: The risk of vaginal cancer increases with age. Most women are 50 or above when they are diagnosed with vaginal cancer.
HPV Infection: Chronic HPV infection is a major risk factor for various gynaecological cancers, including vaginal cancers.
History of Cervical Cancer: Those with a personal history of cervical cancer are at a higher risk of developing vaginal cancer.
Radiation Therapy in the Past: Those who have received radiation in the vaginal or pelvic area are at a higher risk of getting vaginal cancer.
Exposure to DES (diethylstilbestrol) before Birth: Decades ago, DES, which is a synthetic oestrogen hormone, was recommended to prevent miscarriage and other pregnancy-related complications. Women who were exposed to DES before birth were found to be at a higher risk of developing vaginal cancer.
Smoking: Smoking increases the risk of vaginal cancers.

Diagnosis

Doctors may recommend various tests for the detection and diagnosis of vaginal cancers. Following are the test methods that are commonly recommended:

a. Physical Exam and Medical History Assessment: When a patient presents herself with symptoms, the first thing that a doctor does is to thoroughly go through her medical history. After understanding the symptoms experienced by the patient, the doctor physically examines the patient for signs of vaginal cancer.

b. Pelvic Exam: During a pelvic exam, the doctor examines the key organs, such as the vagina, cervix, uterus, ovaries, fallopian tubes and rectum. The doctor inserts a gloved, lubricated finger into the patient’s vagina to look for vaginal cancer signs, which could be a lump or any abnormal lesions.

c. Pap Smear: Pap smear or pap test is a procedure conducted to collect the cells that line the cervix and vagina. These cells are further analysed under a microscope for the presence of cancerous cells.

d. Colposcopy: During a colposcopy, a specialised tool called a colposcope is inserted into the vagina to check for the presence of abnormal lesions in the regions of the vagina and cervix. During this procedure, the doctor may consider collecting tissue samples for further analysis; a specialised spoon-shaped instrument called a curette is used to collect the tissue sample.

e. Biopsy: During the biopsy, the tissue sample from the vagina and cervix are collected and examined under a microscope for signs of vaginal cancer.

Treatment

There are several treatment options available for the management of vaginal cancer. The treatment plans are devised upon considering various factors, such as the stage of the disease, exact location of the tumour, the tumour grade, the patient’s age and her overall condition.

The main treatment options available for vaginal cancer include surgery, radiation therapy and chemotherapy.

a. Surgery: Surgery is the main line of treatment for vaginal cancer. There are different surgical procedures recommended for vaginal cancer management depending on the stage of the disease.

Surgery is the most common treatment of vaginal cancer. The following surgical procedures may be used:

Wide Excision or Local Excision: This surgical procedure removes the tumour along with a small portion of the healthy tissue called margin.
Vaginectomy: This surgical procedure is recommended to either remove a part of the vagina (partial vaginectomy) or the entire vagina (radical vaginectomy) depending on the extent of the disease.
Hysterectomy: During this procedure, along with the vagina, the uterus and cervix are also removed. Hysterectomy can either be performed through one large incision in the abdomen (total abdominal hysterectomy) or through tiny incisions (laparoscopic hysterectomy).
Lymphadenectomy: Lymphadenectomy is a surgical procedure performed to remove the lymph nodes close to the vagina. These lymph nodes are further examined for signs of cancer. Lymph nodes in the pelvic region are removed if the cancer is found in the upper vagina; whereas lymph nodes in the groin are operated on if the cancer is present in the lower region.
Pelvic Exenteration: This surgical procedure removes all the critical organs present in the pelvic region including the colon, rectum and bladder along with the cervix, ovaries and vagina. The lymph nodes that are close to these organs are also removed. To expel urine and stool, an artificial opening called a stoma is created. Through these openings, the faecal matter and urine are collected in a collection bag, which needs to be emptied frequently.
Laser Surgery: A few cases of vaginal cancers can be treated with laser surgery. During the procedure, the tumour is destroyed using a laser beam (which is a narrow beam of intense-energy, single wavelength light) that is directed towards the tumour. This is a non-invasive procedure and comes with fewer treatment-related complications.

b. Radiation therapy: Radiation therapy involves the use of high-energy X-rays or other forms of radiation to destroy cancer cells or stop them from dividing and metastasising. Radiation therapy can either be administered externally (external beam radiation therapy) or internally (internal beam radiation therapy or brachytherapy).

During external beam radiation therapy, the radiation beams are directed towards the tumour from an external radiation source. Brachytherapy, on the other hand, involves placing a radiation source (radioactive substance) inside or close to the tumour. The radiation emitted by this source kills the tumour cells. The radioactive substance may be administered via needles, seeds or catheters. The radiation dose is decided by the doctor depending on the stage of vaginal cancer.

c. Chemotherapy: During chemotherapy, potent anti-cancer drugs are administered to destroy the tumour cells and limit cancer growth. Chemotherapy may be administered orally, intravenously or intramuscularly. Chemotherapy may be administered right before the surgery (neoadjuvant therapy) in order to shrink the tumour or after the surgery (adjuvant therapy) to destroy the residual cancer cells. Chemotherapy may also be administered in combination with radiation therapy to enhance the efficacy of the overall treatment.

Frequently Asked Questions

1. Is vaginal cancer curable?

If detected in the early stages, vaginal cancers can be treated successfully. There are multiple treatment options available today, and the doctors can devise treatment plans that not only improve survival but also have a positive impact on the quality of life.

2. Can HPV infection cause vaginal cancer?

Not all individuals with HPV infections get vaginal cancer. However, chronic HPV infection is one of the risk factors for vaginal cancer. Therefore, it is important to not ignore HPV infection and get it treated at the earliest. Apart from vaginal cancers, HPV infections also tend to increase the risk of other gynaecological cancers.

3. Can I have children after my vaginal cancer treatment?

This entirely depends on the stage of the disease, the exact location of the tumour and the overall condition of the patient. Before the treatment, you can talk to your treating doctor who will be explaining the possible fertility preservation options or other methods to have a child to you.

4. Do vaginal cancers come back?

In rare cases, vaginal cancers can come back after years. However, if they are detected in the early stages, they can be treated successfully.

Following a strict follow-up regimen is important after your vaginal cancer treatment as it helps in reducing the risk of a recurrence.

5. Can vaginal cancers be prevented?

Although there are no preventive measures that can completely prevent vaginal cancers, there are a few measures that you can take to reduce your risk of developing this disease:

Taking your HPV vaccination is important as it reduces your HPV infection risk, which is one of the biggest risk factors for vaginal cancers.
If you are diagnosed with HPV infection, ensure to receive on-time treatment as chronic HPV infection may cause various gynaecological cancers, including vaginal cancers.
Quit smoking, as chemicals present in tobacco are found to increase vaginal cancer risk.