What are Precancerous Conditions?
Cancer starts when cells begin to grow out of control. Cells in nearly any part of the body can become cancer and can spread to other parts of the body.
Cancer is usually named based on the part of the body where it’s first detected. Vaginal cancer is a very rare type of cancer that forms in a woman’s vagina. The vagina leads from a woman’s cervix to the outside of her body. Vaginal cancer is only one of several types of cancer that can develop on a woman’s reproductive organs. The others include cervical, endometrial, ovarian, and vulvar cancer.
Vaginal cancer can be treated and is often cured. It is easiest to treat if it is located only on the vagina and has not spread to any other areas of the body. Like vulvar cancer, vaginal cancer is rare – so rare that together, both vulvar and vaginal cancers account for less than seven percent of all the cancers of the women’s reproductive organs that are diagnosed every year.
Most vaginal cancers form in another part of the body and later spread to the vagina. These cancers are called secondary vaginal cancer. In these cases, cancer has usually spread from another cancer of the female reproductive system, such as endometrial or cervical cancer. In some very rare cases, cancer can form in the vagina without having spread from another location. If this is the case, the cancer is referred to as primary vaginal cancer.
Vaginal Cancer starts in the vagina. There are many different types of vaginal cancer, but the most common is called squamous cell carcinoma, and it starts in the lining of the vagina.
Precancerous Vaginal Conditions like vaginal intraepithelial neoplasia (or VIN) is a condition in which the skin cells of the vulva develop precancerous cells. The vulva is the external area of a woman’s genitals, including the clitoris, the labia majora, and the labia minora. It forms the opening to the vagina and urethra.
Precancerous Conditions like VIN are not cancer, and not all cases become problematic. In fact, many cases resolve without any treatment. However, if the condition is ignored, it can become cancerous after several years.
Vaginal Intraepithelial Neoplasia Symptoms
Not all women with Precancerous Vaginal Conditions like VIN experience symptoms. However, some common signs include:
- Itching, burning, or tingling in the genitals
- Burning during urination
- Vulvar pain
- Painful intercourse
- Warty or raised texture on the vulvar skin
- Red, white, or discoloration of the vulvar skin
Risk Factors for VIN
- Precancerous Vaginal Conditions like VIN can occur in women of all ages, but it typically only affects women over age 20. VIN is much more commonly found in women over age 35.
- Weakened immune system. Immunodeficiency can be caused by disease, certain medications, or hereditary factors.
- Smoking cigarettes. Smoking has also been shown to weaken the immune system.
- Some bone marrow and blood disorders
The different types of VIN
There are two main types of VIN.
Usual-type VIN
This is the most common type of VIN. It typically is found in women ages 35-60 and is strongly linked with HPV (human papillomavirus). HPV is an extremely common sexually transmitted virus that is spread through skin-to-skin contact with a person who is infected. Many people are unaware of their HPV infection status because it’s possible to carry the virus for many years without any outward symptoms.
Differentiated VIN
This type is uncommon, but most cases occur in women ages 60-85. Differentiated VIN is not associated with HPV, but it often occurs alongside other vulvar abnormalities, such as lichen planus or lichen sclerosis.
Diagnosing VIN
If you’re experiencing any changes or symptoms in your vulva, please make an appointment with your gynecologist. Your gynecologist will conduct a pelvic exam, pap test and may examine your vulvar skin under a colposcope, which is a special magnification lens.
Your OB-GYN may also take a biopsy of your vulvar cells. This process may be uncomfortable. However, a local anesthetic is usually injected into the area before the procedure. Your doctor will then send the specimen to pathology to test the cells for any abnormalities.
VIN can also be classified as low grade or high grade. Low-grade means the cells look almost like normal cells. Lower-grade cells tend to be slow-growing and are less likely to change into cancer cells. High-grade means the cells look less normal or more abnormal. High-grade VIN involves either the outer third of the mucosa or the entire thickness of the epithelium.
Treating VIN
Your doctor will recommend a treatment plan based on the severity of your condition. The severity depends on the result of the biopsy, risk for cancer, and the size of the area that is affected by the cell changes.
If the cell changes are mild, your doctor may want to monitor it with exams. In many cases, the abnormalities will resolve without medical intervention. Your doctor will want to schedule regular exams to track the condition’s progress.
Women at higher risk for cancer (for example, women with a weakened immune system or smokers) will probably require treatment to prevent cancerous changes. If you do smoke, you may be able to boost your immune system to fight the abnormal cell changes by quitting.
The treatment for these potentially precancerous lesions includes surgical removal, laser surgery, and medications, including estrogen hormone therapy. Laser surgery is the use of a focused beam of light that burns cancer off the vaginal wall.
VIN can be effectively treated with:
Surgical removal
Surgery is the most frequently recommended treatment for women with VIN. The affected area will be removed via a procedure known as surgical excision of precancerous lesions. The most severe cases may require a complete vulvectomy, but this is rare. In some cases, the vulvar skin can be replaced with a skin graft taken from a different part of your body.
Ablation
Ablation involves the destruction of the affected area using a high-energy laser beam or a pulse of electricity passed through a special instrument known as diathermy. Ablation is usually only performed if the affected skin would be difficult to surgically remove, such as the skin surrounding the clitoris.
Both surgical excision and ablation will have a permanent effect on your vulvar skin. Depending on the area to be treated, this may impact your sex life. Bring your concerns to your gynecologist to make sure you fully understand the risks and possible outcomes of treatment.
Follow up
You should schedule follow-up appointments with your OB-GYN to check in on your recovery. Some cases of VIN are more susceptible to relapse than others. Your OB-GYN will evaluate your risk and help you understand how you can reduce your risk and monitor your condition. If several areas of your vagina are affected, or if your doctor feels there is a high risk the disease may return, they may treat all of your vagina with CO2 laser treatment. If you notice any changes or if your symptoms return, please call your doctor.
If you believe you are experiencing symptoms of, or suffering from Precancerous Vaginal Conditions, or have questions about it, please see your doctor.
We also invite you to establish care with Dr. Aliabadi. Please click here to make an appointment or call us at (844) 863- 6700.
Supported by her warm professional team, Dr. Aliabadi treats women through all phases of life and cherishes the special one-on-one relationship between patient and doctor.