Vaginal cancer, though a rare form of cancer, is an essential topic for women to understand to ensure early detection, timely treatment, and better outcomes. In this comprehensive guide, we’ll cover everything you need to know about vaginal cancer, from its symptoms and causes to its stages, survival rates, and treatment options.

What Is Vaginal Cancer?

Vaginal cancer occurs when abnormal cells in the vaginal tissue grow uncontrollably, forming a malignant tumour. The vagina, part of the female reproductive system, serves as a canal connecting the cervix to the outside of the body. This cancer is rare, accounting for about 1-2% of all gynaecological cancers.

Types of Vaginal Cancer

The primary types of vaginal cancer include:

• Squamous Cell Carcinoma: This is the most common type, starting in the flat cells lining the vagina.
• Adenocarcinoma: This originates in the glandular cells of the vaginal lining.
• Melanoma: A rare type that begins in the pigment-producing cells.
• Sarcoma: Starts in the connective tissues or muscles of the vagina.

Understanding the Stages of Vaginal Cancer

Cancer staging is crucial for determining the severity of the disease and the best treatment approach. Vaginal cancer has four stages:

• Stage 1: Cancer is confined to the vaginal wall.
• Stage 2: Cancer has spread to nearby tissues but remains within the pelvis.
• Stage 3: Cancer spreads to lymph nodes or beyond the pelvis.
• Stage 4: Advanced stage where cancer spreads to distant organs like the lungs or liver.

Stage 4 vaginal cancer is the most critical stage and often requires aggressive treatment.

Symptoms of Vaginal Cancer

Vaginal cancer often presents with subtle symptoms in its early stages, making regular check-ups crucial for early detection. Common symptoms include:

• Unusual vaginal bleeding, especially after intercourse or menopause.
• Watery vaginal discharge that may have a foul odour.
• Persistent pelvic pain or discomfort during intercourse.
• A palpable mass or lump in the vagina.
• Frequent urinary issues, such as difficulty urinating or pain.
• Unexplained weight loss and fatigue.

Causes of Vaginal Cancer

Vaginal cancer is caused by uncontrollable growth of cells in the vaginal lining due to genetic mutations. Identifying and understanding risk factors and underlying conditions can help prevent the development of the disease.

• Persistent infection with high-risk HPV strains is the most significant risk factor for vaginal cancer.
• Most cases occur in women over 60, with the risk increasing with age.
• Women whose mothers took DES during pregnancy (1940s–1970s) have a higher risk of developing clear cell adenocarcinoma.
• Smoking damages immune function and increases the risk of HPV-related cancers.
• Shared risk factors like HPV infection elevate the likelihood of vaginal cancer in women with a history of cervical cancer.
• Conditions like HIV/AIDS or immunosuppressive medications weaken the immune system, increasing cancer risk.
• A precancerous condition where abnormal cells form in the vaginal lining can progress to cancer if untreated.
• Long-term inflammation or infection can contribute to changes in vaginal cells.
• Increases the likelihood of exposure to HPV and other sexually transmitted infections.
• Long-term use of oestrogen-only hormone replacement therapy without progesterone may be linked to increased risk.

Diagnosis of Vaginal Cancer

Diagnosing vaginal cancer includes evaluating medical history, physical exams, imaging tests, and lab procedures. Early detection is important for better treatment results. Key steps in diagnosis involve these methods.

Pelvic Exam

During a pelvic exam, the doctor will inspect the vagina and cervix for visible abnormalities such as lumps, lesions, or irregularities. The doctor may also palpate (feel) the pelvic area to check for any masses or abnormal growths in the vagina, cervix, or surrounding tissues.

Pap Smear and HPV Testing

A Pap smear involves collecting cells from the cervix and vagina to look for abnormal or precancerous cells. While this test is primarily used for cervical cancer, it can sometimes detect abnormal changes in vaginal cells. If a Pap smear reveals abnormal cells, an HPV test may be done to check for high-risk strains of the virus that could lead to cancer.

Colposcopy

If abnormal cells are detected on the Pap smear or during the pelvic exam, a colposcopy may be performed. A colposcope (a special microscope) is used to examine the vagina and cervix more closely. If suspicious areas are found during the colposcopy, a small tissue sample (biopsy) may be taken for further analysis to determine if cancer cells are present.

Biopsy

A biopsy is the most accurate way to diagnose vaginal cancer. There are different types of biopsies, including endocervical curettage and punch biopsy, where a small sample of tissue is taken for examination. The tissue sample is sent to a lab for a pathological examination to confirm the presence of cancer cells and identify the type of cancer.

Imaging Tests

Once vaginal cancer is suspected, imaging tests help determine the extent of the cancer and whether it has spread to nearby tissues or organs. Common imaging tests include:

• Ultrasound
• CT scan (Computed Tomography)
• MRI (Magnetic Resonance Imaging)
• PET Scan (Positron Emission Tomography)

Cystoscopy and Proctoscopy

If the cancer may have spread to the bladder, a cystoscopy is performed to examine the bladder and urethra using a thin tube with a camera. If there’s a possibility that cancer has spread to the rectum, a proctoscopy can be used to examine the lower part of the large intestine.

How Serious is Vaginal Cancer?

While vaginal cancer can be a serious condition, early diagnosis and treatment offer a significant advantage in improving survival rates. Many patients have successfully overcome vaginal cancer, especially when caught in its initial stages.

Treatment for Vaginal Cancer

Treatment for vaginal cancer varies based on the type, stage, and location of the cancer, as well as the patient’s overall health. The goal is to remove or destroy the cancer while preserving normal function.

1. Surgery

Surgical treatment is often the first choice for localised vaginal cancer. The type of surgery depends on the stage and extent of the disease:

• Laser Surgery – This procedure uses a focused laser beam to remove superficial tumours or precancerous lesions in the vagina without causing harm to surrounding tissues. It is recommended for early-stage vaginal cancer or pre-invasive lesions.
• Local Excision – This procedure involves removing a small tumour along with some healthy tissue around it using a scalpel. It is best suited for localised and small vaginal cancers.
• Vaginectomy – Partial Vaginectomy removes only the affected part of the vagina, while Total Vaginectomy removes the entire vagina if the cancer is extensive. It is ideal for larger tumours confined to the vagina.
• Pelvic Exenteration – Surgical removal of the vagina and nearby organs affected by advanced cancer, reserved for advanced-stage or recurrent cases that haven’t responded to other treatments.

2. Radiation Therapy

Radiation therapy uses high-energy rays to destroy cancer cells. It is often combined with other treatments like surgery or chemotherapy for better outcomes.

3. Chemotherapy

Chemotherapy uses drugs to kill cancer cells or stop their growth. It can be given either through the bloodstream (systemic chemotherapy) for advanced cancer or directly onto the vaginal surface (topical chemotherapy) for pre-cancerous lesions or localised cancer. Common drugs used include Cisplatin, 5-fluorouracil (5-FU), and Paclitaxel.

4. Targeted Therapy

Targeted therapy for cancer targets specific molecules or pathways to minimise damage to normal cells. There are different types of targeted therapy including anti-angiogenesis drugs, which block vessel formation supporting tumour growth, and monoclonal antibodies, which bind to specific proteins on cancer cells to inhibit growth. An example of targeted therapy is Bevacizumab (Avastin), used in some cases of advanced vaginal cancer.

5. Immunotherapy

Immunotherapy is a treatment that strengthens the body’s immune system to fight and kill cancer cells. Specifically for vaginal cancer, checkpoint inhibitors can block proteins that cancer cells use to avoid detection, helping the immune system target the cancer cells. Drugs like pembrolizumab are being studied for their potential use in treating gynaecological cancers.

6. Palliative Care

Palliative care for stage 4 vaginal cancer focuses on reducing symptoms, relieving pain, and enhancing quality of life through medications, counselling, nutritional support, and physical therapy.

Prevention of Vaginal Cancer

Preventing vaginal cancer is not always possible, but there are ways to reduce the risk. By addressing risk factors and promoting early detection, women can take proactive steps to protect their health.

• Get Vaccinated Against HPV: HPV is a common cause of vaginal cancer. The HPV vaccine protects against high-risk strains linked to various cancers. It is recommended for girls and boys aged 11-12 but can be given up to age 45 with medical guidance.
• Practice Safe Sexual Habits: To prevent HPV infection, use protection during sex, limit the number of sexual partners, and get regular health check-ups.
• Quit Smoking: Smoking weakens the immune system and increases the risk of developing vaginal cancer. Quitting smoking not only lowers cancer risk but also improves overall health.
• Regular Gynaecological Examinations: Routine pelvic exams and Pap smears are essential for catching abnormal or precancerous cells early on. Women need to follow their doctors’ recommendations for screening based on their age and medical history. Detecting these issues early allows for treatment before they develop into cancer.
• Manage DES Exposure Risks: Women whose mothers take diethylstilbesterol (DES) during pregnancy have a higher risk of clear cell adenocarcinoma. Those exposed should inform their healthcare provider and undergo regular screenings.
• Strengthen Immune Health: Having a strong immune system is important for fighting infections like HPV. To boost your immune system, eat a balanced diet with fruits, vegetables, and whole grains, exercise regularly, and manage stress effectively.

A Final Word

Vaginal cancer is a serious but rare disease. Awareness of symptoms, risk factors, and the importance of early diagnosis can save lives. Regular check-ups, healthy lifestyle choices, and vigilance in recognising early signs are your best defence against this condition. If you or someone you know is facing vaginal cancer, understanding the options and seeking comprehensive care can make a significant difference.

By spreading awareness and breaking the stigma surrounding gynaecological health, we can ensure that more women have the knowledge and resources they need to navigate this challenging journey.

Sources:

• https://www.mayoclinic.org/diseases-conditions/vaginal-cancer/symptoms-causes
• https://my.clevelandclinic.org/health/diseases/vaginal-cancer
• https://www.healthline.com/health/signs-of-vaginal-cancer
• https://www.webmd.com/cancer/what-is-vaginal-cancer
• https://weillcornell.org/services/obstetrics-and-gynecology/gynecologic-oncology/conditions-we-treat/vaginal-cancer
• https://foundationforwomenscancer.org/gynecologic-cancers/gynecologic-cancer-types/vaginal-cancer/
• https://www.verywellhealth.com/vulvar-self-exam
• https://www.cancer.gov/types/vaginal/patient/vaginal-treatment-pdq