About Vaginal Cancer
While researchers do not yet know the exact causes of vaginal cancer, they have identified several risk factors that can increase a person's likelihood of developing this condition.
Non-modifiable risk factors for vaginal cancer cannot be changed or controlled. These include:
- Age: Females over 60 years of age have the highest risk of vaginal cancer. Doctors most commonly diagnose vaginal cancer in people aged 70 and over.
- Human papillomavirus (HPV) infection: Contracting HPV increases the risk. Certain types of HPV can increase the risk of vaginal cancer. If you are infected with certain types of HPV for a long time, it may increase your chance of developing vaginal or vulvar cancer.
- A history of cervical cancer: A previous or current cervical cancer diagnosis is a risk factor for vaginal cancer. People with cervical precancer or cervical cancer have an increased risk of vaginal cancer. Having had cervical precancer or cervical cancer may increase your chance of getting vaginal or vulvar cancer.
- Previous radiation treatment: Previous radiation treatment can sometimes cause an increased likelihood of vaginal cancer. If you were treated with radiotherapy for womb cancer, it may increase your chance of developing vaginal or vulvar cancer.
- Exposure to diethylstilbestrol (DES): DES is a drug that was given to pregnant women between 1938 and 1971 to prevent miscarriage. If you were exposed to DES before birth, it may increase your chance of developing vaginal or vulvar cancer.
Modifiable risk factors for vaginal cancer can be influenced or changed. These include:
- Smoking: Smoking increases the risk of developing vaginal cancer. Smoking more than doubles the risk according to the American Cancer Society (ACS). Among women who have an HPV infection, smoking may prevent the body's immune system from getting rid of the HPV infection.
- Use of a vaginal pessary: The use of vaginal pessaries, such as during pelvic organ prolapse, is associated with an increased risk of vaginal cancer.
- Weakened immune system: Having a condition that weakens your immune system, such as HIV/AIDS, can make it harder for your body to fight off health problems and increase your risk of developing vaginal or vulvar cancer.
- Chronic vulvar itching or burning: Having chronic vulvar itching or burning may also be a modifiable risk factor for vaginal or vulvar cancer.
Vaginal cancer can have different symptoms depending on the stage and severity of the disease. Here are the most common early symptoms of vaginal cancer:
- Abnormal vaginal bleeding: This includes bleeding after menopause, bleeding during or after sex, and bleeding in between menstruation. The bleeding may be heavier or last longer than usual.
- Vaginal discharge: It may be watery, have a strong smell, or be bloodstained.
- Painful or frequent urination: You may experience discomfort or pain when urinating, and you may need to urinate more often than usual.
- Pelvic pain: This can occur at any time but is especially common during sex.
- A lump or mass in the vagina: You may feel a growth or bump in your vaginal area.
As vaginal cancer progresses to later stages or becomes more severe, additional symptoms may occur. These can include:
- Constant itchiness in the vagina
- Constipation
- Blood in stool or urine
- Back pain
- Swollen legs
- Fistulas (abnormal openings) in later stage cancer
It's important to note that many of these symptoms can also be caused by conditions other than cancer. If you experience any of these symptoms, it's important to see a doctor or other healthcare professional for an evaluation to rule out any underlying issues. Early detection and treatment of vaginal cancer can improve outcomes and increase chances of successful treatment.
To diagnose vaginal cancer, doctors commonly perform the following examinations, tests, and procedures:
- History and physical examination: The doctor will ask about your medical history and perform a physical exam to check for any signs or symptoms of vaginal cancer.
- Pelvic examination: This involves the doctor examining the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum to look for any abnormalities or signs of disease.
- Cervical cytology (Pap smear): A Pap smear is a procedure where cells from the surface of the cervix and vagina are collected using a brush or small wooden stick. These cells are then examined under a microscope to check for any abnormalities.
- HPV testing: Human papillomavirus (HPV) testing may be done to determine if you have an HPV infection, which is a risk factor for vaginal cancer.
- Colposcopy: If there are any abnormal areas found during the pelvic examination or Pap smear, a colposcopy may be performed. This procedure uses a special magnifying instrument called a colposcope to examine the vagina and cervix more closely.
- Biopsy: If there are suspicious areas found during the colposcopy or if there is a need to rule out other types of cancer (such as cervical or vulvar cancer), a biopsy may be done. During a biopsy, a small sample of tissue is taken from the abnormal area and examined under a microscope to determine if it is cancerous.
To determine the stage of vaginal cancer, additional examinations, tests, and procedures may be performed:
- Imaging scans: X-rays, MRI (magnetic resonance imaging), and CT (computed tomography) scans may be done to get detailed images of the vagina and surrounding structures. These scans can help determine if the cancer has spread beyond the vaginal wall.
- Examinations in different areas: Proctoscopy (for the rectum and anus), cystoscopy (for the bladder), or ureteroscopy (for the tubes leading from the kidneys) may be performed to check if the cancer has spread to these areas.
It's important to note that there is no reliable evidence supporting routine cytological or imaging procedures for surveillance after initial management of vaginal cancer. The best approach is careful physical examination and assessment of new symptoms. Regular follow-up with your healthcare provider is essential for monitoring your condition and addressing any concerns you may have.
The goals of treatment for vaginal cancer are to remove or destroy the cancerous cells and prevent the cancer from spreading or recurring. The specific treatment options depend on the stage and progression of the cancer. Here are some recommended treatments and how they work to achieve these goals:
- Topical treatments: If a person has pre-cancerous cells on their vagina, doctors may recommend topical treatments. These treatments aim to destroy the pre-cancerous cells. They can be applied directly to the affected area.
- Laser surgery: Laser surgery is another option for removing pre-cancerous cells on the vagina. A doctor uses an intense laser to remove the cancerous tissue and lesions on the surface of the vagina.
- Surgical removal: Invasive or more advanced vaginal cancers may require surgical removal. Depending on the stage and location of the cancer, different surgical procedures may be performed:
- Wide local excision: The surgeon removes the cancerous tissue and some healthy tissue around it.
- Vaginectomy: The surgeon removes a section of the vagina or all of it.
- Hysterectomy: The surgeon removes the cervix and uterus.
- Lymph node dissection: The surgeon removes nearby lymph nodes and examines them under a microscope to check for cancer.
- Radiation therapy: Radiation therapy is a commonly used treatment for all stages of vaginal cancer. It involves using high-energy X-rays or other types of radiation to kill cancer cells or shrink tumors. It can be given internally (internal radiation therapy) or externally (external radiation therapy). In some cases, external radiation therapy may also be given to lymph nodes near tumors in the lower part of the vagina.
- Chemotherapy: Medications can be used to keep cancerous cells from spreading in vaginal cancer. Chemotherapy is one such medication-based treatment option. It involves using drugs that kill cancer cells throughout the body. Chemotherapy may be used in combination with other treatments like radiation therapy.
It's important to note that each treatment recommendation is individualized based on factors like the stage, size, location, and progression of vaginal cancer. Treatment plans may involve a combination of therapies, such as surgery followed by radiation therapy or chemotherapy, to achieve the best possible outcomes.
In addition to these medical treatments, health behavior changes such as maintaining a healthy lifestyle, quitting smoking, and following a balanced diet can support overall well-being during vaginal cancer treatment. Supportive care services like physical therapy, occupational therapy, counseling, and palliative care may also be included in the treatment plan to manage symptoms and improve quality of life.
Remember, it's crucial for individuals with vaginal cancer to consult with their healthcare team to determine the most appropriate treatment options based on their specific situation.
Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Other side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.
The natural progression of vaginal cancer can vary depending on the stage of the cancer and whether it has spread to other parts of the body. If left untreated, vaginal cancer can spread to nearby lymph nodes and other organs.
The good news is that if vaginal cancer is discovered early, there is a higher chance of effectively treating it. Treatment typically involves a combination of radiation therapy and surgery. In more severe cases, chemotherapy may also be used. The impact of treatment for vaginal cancer can vary depending on factors such as the stage of the cancer and individual response to treatment. The goal of treatment is to cure the cancer, slow its progression, or reduce complications. The 5-year survival rate for vaginal cancer is generally favorable, with rates ranging from 84% for stage 1 to 57% for more advanced stages.
Complications can arise after treatment for vaginal cancer, particularly after radiation therapy. These complications may include:
- Edema: This refers to fluid retention and swelling in the treated area.
- Erythema: It is characterized by redness and irritation of the skin.
- Vaginal mucositis: It refers to soreness in the vagina, with or without ulcers.
It's important to note that complications can occur during and after treatment, but they typically improve within a few months. Some common complications include bleeding, genital lymphedema and scarring.
Remember, always consult with your doctor or healthcare professional for personalized advice and guidance regarding your specific situation.