![Vaginal Cancer](https://images.medicinenet.com/images/article/main_image/vaginal-infections-1.jpg?output-quality=75)
Vaginal cancer first manifests itself in the vagina, which joins the external genitalia to the uterus. Most of these cancers develop in the squamous epithelium lining of the vagina and typically affect women aged between 50 and 70 years.
Primary vaginal cancer is one of the rarer types of gynecologic cancer. As a significant number of vaginal malignancies are linked to human papillomavirus types 16 and 18, the vaccinations advised for the prevention of cervical cancer can also prevent vaginal cancer.
4 Types of Vaginal Cancer
- Vaginal squamous cell carcinoma: Thin, flat cells that line the surface of the vagina
- Vaginal adenocarcinoma: Develops in the glandular cells that line the vaginal surface
- Vaginal melanoma: Develops on the pigment-producing cells of the vagina
- Vaginal sarcoma: Forms in the smooth muscle or connective tissue cells that line the vagina
What Are the Symptoms of Vaginal Cancer?
Vaginal cancer does not always show symptoms. A woman might not even be aware that she has it until the doctor detects abnormal cells during a routine checkup, so routine checkups are important. The doctor can still identify vaginal cancer even if the patient’s body isn't giving any warning signs.
Symptoms of vaginal cancer include:
- Constipation
- Pelvic pain
- Unusual vaginal bleeding, for example, after intercourse or after menopause
- Painful urination
- Frequent urination
- Watery vaginal discharge
- A lump or mass in the vagina
What Are the Stages of Vaginal Cancer?
Vaginal intraepithelial neoplasia (VaIN) is characterized by the presence of abnormal cells in the tissue that lines the vagina. These abnormal cells don't harbor cancer.
Types of VaIN can be distinguished based on how far the abnormal cells have infiltrated the tissue lining the vagina:
- VaIN 1: The outermost one-third of the tissue lining the vagina contains abnormal cells.
- VaIN 2: The outermost two-thirds of the tissue surrounding the vagina include abnormal cells.
- VaIN 3: More than two-thirds of the tissue lining the vagina contain abnormal cells.
Carcinoma in situ is the medical term for VaIN 3 lesions that are present across the entire thickness of the tissue lining the vagina. VaIN has the potential to develop into cancer and invade the vaginal wall.
Vaginal cancer is classified into four stages:
- Stage I: Cancer is limited to the vaginal wall.
- Stage II: Cancer has penetrated the vaginal wall and reached the surrounding tissue. The pelvic wall has not been affected by cancer.
- Stage III: Cancer has reached the pelvic wall.
- Stage IV: Divided into stages IVA and IVB.
- Stage IVA: Cancer may have spread to one or more of the following locations:
- Bladder lining
- The lining of the rectum
- Beyond the region of the pelvis where the bladder, uterus, ovaries, and cervix are located
- Stage IVB: Cancer has progressed to organs other than the vagina, such as the lung or bone
- Stage IVA: Cancer may have spread to one or more of the following locations:
Which Tests Are Used to Diagnose Vaginal Cancer?
The following tests and procedures may be used:
- Physical exam: Examination of the body to check for signs of disease, such as lumps or anything else that appears unusual.
- Health history: A history of the patient's health habits, previous illnesses, and treatments will be taken.
- Pelvic exam: During a pelvic exam, the doctor inserts two gloved fingers inside the patient’s vagina to feel the shape, size, and position of the ovaries and uterus. Moreover, they check the vagina, fallopian tubes, cervix, and rectum.
- Pap test: Involves collecting cells from the cervix and vaginal surface. To gently scrape cells from the vagina and cervix, the doctor uses a brush, piece of cotton, or small wooden stick. A microscope is used to examine the cells to determine if they are abnormal. This test is also known as a Pap smear.
- Human papillomavirus (HPV) test: A laboratory test that looks for certain types of HPV infection in the DNA or RNA.
- Colposcopy: A colposcope (tube-shaped magnifying instrument) is used to visually examine the cervix, vagina, and vulva.
- Biopsy: The removal of tissue or sample of cells from the vagina and cervix so that a pathologist can examine it in a laboratory for signs of cancer.
How to Treat Vaginal Cancer
The following types of treatment are used to treat vaginal cancer:
Surgery
Both vaginal intraepithelial neoplasia (VaIN) and vaginal cancer are treated. VaIN may be treated with any of the following surgical procedures:
- Laser surgery: A surgical operation in which a laser beam (a focused, powerful beam of light) is used as a knife to slice into a tissue or remove a surface lesion of a tumor.
- Wide local excision: A surgical procedure that removes the malignancy and some surrounding healthy tissue.
- Vaginectomy: Surgery to remove all or a portion of the vagina. The vagina may need reconstruction or repair using skin grafts from other body areas (vaginoplasty).
The following surgical procedures are used to treat vaginal cancer:
- Wide local excision: A surgical operation that removes the malignancy and some surrounding healthy tissue.
- Vaginectomy: Surgery to remove all or a portion of the vagina. The vagina may need to be rebuilt using skin grafts from other body areas.
- Total hysterectomy: A procedure to remove the uterus and cervix. A vaginal hysterectomy is a medical term for a surgery in which the uterus and cervix are removed through the vagina. If a major abdominal incision is made to remove both the uterus and cervix, the treatment is known as a total abdominal hysterectomy. If the uterus and cervix are removed through a small abdominal incision by using a laparoscope, the treatment is referred to as a total laparoscopic hysterectomy.
- Lymph node dissection or lymphadenectomy: A surgical procedure in which lymph nodes are excised and a tissue sample is examined under a microscope for indications of malignancy. The pelvic lymph nodes may need to be removed if the malignancy is in the upper vagina. Lymph nodes in the groin may be removed if the malignancy is in the lower vagina.
- Pelvic exenteration: During a pelvic exenteration, the lower intestine, rectum, bladder, cervix, vagina, and ovaries are surgically removed. The surrounding lymph nodes are also removed. Artificial openings (stomas) are created to facilitate the flow of urine and feces from the body into a collection bag.
Radiation therapy
High-energy radiation, such as X-rays or other forms of radiation, is used in radiation therapy to either kill or stop the growth of cancer cells.
Radiation therapy is available in two different forms:
- External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.
- Internal radiation therapy uses radioactive materials that are inserted into or close to the tumor using needles, seeds, wires, catheters, or other devices. Certain delivery techniques of radiation therapy can reduce the likelihood of radiation harming neighboring healthy tissue.
Chemotherapy
A type of cancer treatment that uses medications to inhibit the growth of cancer cells by either killing the cells or preventing them from proliferating. Chemotherapy is administered differently depending on cancer's stage and location in the body.
- Systemic chemotherapy: When taken orally or injected into a vein or muscle, chemotherapy drugs can enter the bloodstream and reach cancer cells everywhere in the body.
- Regional therapy: Chemotherapy primarily affects cancer cells in the areas where it is given, such as the cerebrospinal fluid (intrathecal chemotherapy), an organ, or a body cavity.
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https://my.clevelandclinic.org/health/diseases/15579-vaginal-cancer#symptoms-and-causes
https://www.cancerresearchuk.org/about-cancer/vaginal-cancer/types-grades
https://www.macmillan.org.uk/cancer-information-and-support/vaginal-cancer
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