The vagina is the birth canal that leads from a woman’s external genitals (the vulva) to the bottom of the uterus (the cervix). The flat, thin skin cells that comprise the surface of the vaginal walls are squamous cells. Squamous cells are one of three types of epithelial cells – the cells that make up the tissue that line the body’s cavities, blood vessels, and organs.
Beneath the epithelial layer, the vaginal walls are composed of muscles, connective tissues, lymph vessels, and nerves. The vagina also contains a series of glands, which secrete fluids, keeping it moist and elastic.
Vaginal cancer is a rare type of cancer. It is more common in women 60 and older and the prognosis for recovery is usually good when the cancer is detected early. Some cancers, however, can start elsewhere and spread to the vagina, such as cervical or vulvar cancers. Vaginal cancer happens when malignant (cancerous) cells form in the vagina.
Normally healthy cells grow and multiply at a set rate, eventually dying at a set time. Cancer cells grow and multiply out of control, and they don’t die. The accumulating abnormal cells form a mass (tumor). Sometimes cancer that begins in other parts of the body spreads (metastasizes) to the vagina. When this happens, the cancer is named for the part of the body where it started.
Symptoms of Vaginal Cancer
Vaginal cancer has many of the same symptoms as other reproductive diseases and infections.
Early stage cancer and precancerous lesions often don’t cause symptoms but are found during a routine exam. Later stage vaginal cancers are more likely to be associated with some symptoms. One of the most common symptoms is abnormal vaginal bleeding after sexual intercourse. It is often one of the first symptoms to be noticed. Vaginal bleeding in women after menopause is abnormal and should always be evaluated.
You should always make an appointment with your gynecologist if you’re experiencing any abnormal symptoms, including:
- Pelvic pain
- Painful sexual intercourse
- Abnormal vaginal bleeding (not related to menstruation)
- Abnormal Vaginal discharge
- Vaginal mass
- Difficulty or pain when urinating
- Pain in the back of the legs or leg swelling
Types of Vaginal Cancer
Squamous cell carcinoma
Squamous cell carcinoma (also squamous cell cancer) is by far the most common vaginal cancer type, comprising about 70% of cases. Carcinomas of the squamous cells affect the epithelial (surface layer) of the vagina. They most often occur in the upper third of the vagina (the part nearest to the cervix), but they can occur in the lower portion as well.
Squamous cell carcinomas have been known to develop slowly over many years. They typically start as pre-cancerous changes called vaginal intraepithelial neoplasia (VAIN). Mild cases of VAIN, called VAIN 1, sometimes develop and then disappear before the problem becomes cancerous. However, it can progress to more severe stages, such as VAIN 2 and VAIN 3, before becoming cancer.
The second most common type of vaginal cancer is clear cell adenocarcinoma, which makes up about 15% of cases. Adenocarcinomas originate in the glandular cells in the vaginal lining. Glandular cells are responsible for secreting fluids, which make it more likely for adenocarcinomas to spread to the lungs and lymph nodes.
A sarcoma is a type of cancer that originates in the bone, muscular, or connective tissue cells. Unlike squamous cell carcinomas, which develop on the epithelial surface, vaginal sarcomas develop deep in the walls of the vagina.
Melanomas are most commonly found on sun-exposed areas of the body. They don’t commonly affect the vagina, but it can happen. Melanomas are carcinomas of the pigment-producing cells in the skin. Most cases of vaginal melanomas occur on the outside or lower portion of the vagina.
Causes of Vaginal Cancer
Researchers do not yet know the exact causes of vaginal cancer. They have, however, identified several cancer risk factors for developing vaginal cancer. These risk factors include:
- Age – those aged over 60 are at most risk.
- HPV infection – contracting the human papillomavirus increases risk.
- Hysterectomy – women who have had a hysterectomy are statistically more likely to get vaginal cancer.
- A history of cervical cancer – cervical cancer diagnosis is a risk factor for vaginal cancer.
- Previous radiation treatment – this can sometimes cause an increased likelihood of vaginal cancer.
- Use of a vaginal pessary – use of these, such as during pelvic organ prolapse, is associated with an increase in risk.
- Vaginal intraepithelial neoplasia (VAIN) – these cells are different from normal cells, but not different enough to be classed as cancer cells. Sometimes, these are considered precancerous cells that can develop into cancer.
Many types of cancer caused by HPV, including vaginal and cervical cancer, are associated with precancerous lesions. These develop before cancer and can be picked up on a Pap smear test.
Exposure to the synthetic hormone Diethylstilbestrol (DES) while in the womb can increase risk. This drug was given to pregnant women from the 1940s until 1971. As a result, the cases attributed to DES are on the decline as children born from those pregnancies are now in their late 40s or older.
Diagnosis of Vaginal Cancer
Your appointment with a health care doctor will include a review of your medical history and physical, pelvic exam (an exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum) and pap test. They will ask about any symptoms or concerns you might be having. The examination will include:
- Pelvic exam – the doctor will look and feel for abnormalities.
- Pap smear – a test for cervical cancer.
- Colposcopy (examination of the cervix) – may be carried out if the Pap test was abnormal, or if the doctor saw anything unusual or suspicious during the pelvic exam.
To make a definitive diagnosis to confirm that you are at risk of vaginal cancer a biopsy is required. During a biopsy, small tissue samples are taken and examined by a pathologist. Biopsies are commonly carried out during a colposcopy. A local anesthetic is used to ease discomfort and pain.
If vaginal cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may be called symptom management, palliative care, or supportive care.
Finding out that you have cancer is often very distressing. Coping with a new diagnosis can be difficult, but getting support early on may help an individual to cope during cancer care treatment and beyond.
Vaginal Cancer Treatment and Care
Vaginal cancer treatment options can involve one of several different treatments.
- Radiation therapy
While these are standard methods of treatment in many types of cancer, before any treatment regimen, a patient should understand what to expect, possible side effects, and the risks and benefits of treatment.
The more educated an individual is about cancer treatment, the better they can communicate with the gynecologic oncology care team and participate in their treatment decisions and overall care.
Surgery is sometimes used to remove cancer, but most patients are treated with radiation. Your doctor may use a laser to cut out affected tissue or growths. In some cases, removal of all or part of the vagina. Or a hysterectomy will be performed. If the tumor is cervical cancer that has spread to the vagina, or if it is at an advanced stage, radiation and chemotherapy are often given.