Overview
The vagina leads from the cervix, which is the opening of the uterus, to the outside of the body. There are two main types of vaginal cancer: squamous cell carcinoma and adenocarcinoma.
Cancer in the squamous cells, the thin, flat cells lining the vagina, is the most common. It spreads slowly and usually stays near the vagina but may spread to the lungs, liver or bone.
Adenocarcinoma develops in the glandular cells, which make and release fluids and are also found in the vaginal lining. This type of vaginal cancer is more likely to spread to the lungs and lymph nodes.
Vaginal cancer is not common. Approximately 3,000 new cases are diagnosed annually in the U.S.
Symptoms
Vaginal cancer frequently does not trigger early symptoms but once they develop, may include:
Bleeding or discharge not related to menstrual periods
Pain during sexual intercourse
Pain in the pelvic area or when urinating
Lump in the vagina
Constipation
These symptoms may also be caused by other conditions so check with your physician if you are experiencing any of these symptoms.
Causes
The exact cause of most types of vaginal cancers is not known. Some types of the human papillomavirus (HPV) are known to interfere with cells' tumor suppressor genes, which keep cells from growing too quickly and becoming cancers, and seem to contribute to the development of vaginal cancer.
Women exposed before birth to diethylstilbestrol, a drug given to pregnant women in the 1950s to help prevent miscarriages, are at an increased risk of developing a rare type of adenocarcinoma.
Risk Factors
Infection with human papillomavirus (HPV)
Age – almost half of all cases of squamous cell cancer of the vagina occur in women over 70 years of age.
Exposure to diethylstilbestrol (DES), a hormonal drug given to women prior to giving birth to prevent miscarriages between 1940 and 1971.
A history of abnormal cells in the cervix or uterus, or a history of cervical or uterine cancer.
Tests and Diagnoses
Routine tests do not screen for vaginal cancer though it may be discovered during a pelvic exam or Pap smear.
Treatment
Surgery and radiation are mainly used to treat vaginal cancer. Surgery can range from removing the cancerous cells to taking out part or the entire vagina to a total hysterectomy, depending on the stage of the disease. Radiation therapy may be given either before or after surgery.
Certain types of chemotherapy are effective in treating vaginal cancer, and research is being done to see if combining it with radiation will provide better outcomes than radiation alone.
Laser surgery and topical treatments are used to treat pre-cancers of the vagina.
Precancerous Conditions
To treat precancers or dysplasia – a precancerous condition involving the growth of abnormal cells on the lining of the cervix or at the opening between the uterus and vagina – liquid nitrogen may be used to freeze abnormal cells, a procedure known as cryosurgery. Patients may experience a watery brown discharge for several weeks after the procedure. Laser surgery may also be performed to burn off the abnormal cells.
For severe dysplasia, also known as CIN 3, a conization to remove a cone-shaped piece of tissue, may be performed. This can be done several ways, with a surgical or laser knife or a thin heated wire, known as the loop electrosurgical (LEEP) procedure. A cone biopsy may be used for diagnosis or as treatment for women with early stage disease who want to preserve their fertility.
Prevention
Gardasil, a vaccine for the prevention of certain high-risk subtypes of HPV, has been shown to reduce the risk of vaginal cancer.
