Vaginal Cancer
En Español (Spanish Version)

Definition
Vaginal cancer is an uncommon disease in which cancer cells grow in the vaginal lining. The vagina is a tube that connects the vulva (external female genitals) to the cervix (lower end of the uterus).

There are several types of vaginal cancer:

  • Squamous cell carcinoma—Occurs in the lining of the vagina.
  • Adenocarcinoma—Occurs in the area of the vagina lined with cells similar to those in the glands of the cervix and uterus.
    • Clear cell adenocarcinoma—Occurs in women whose mother used a drug called diethylstilbestrol (DES) during pregnancy. This drug was introduced in the late 1930s and no longer used after 1971, so the incidence of this particular type of adenocarcinoma is expected to decline.
  • Melanoma—Usually affects lower or outer portion of the vagina.
  • Sarcoma—Forms deep in the walls of the vagina, not on the surface.
Female Reproductive Organs

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Causes
Cancer occurs when cells in the body divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant growths. These growths can invade nearby tissues. Cancer that has invaded nearby tissues can then spread to other parts of the body.

It is not clear exactly what causes these problems in the cells, but is probably a combination of genetics and environment.

Risk Factors
Vaginal cancer is more common in women after age 60 years of age. Other factors that may increase your chance of vaginal cancer include:

  • History of cervical cancer
  • History of precancerous conditions in the cervix or vagina
  • Having a mother who took diethylstilbestrol (DES) while pregnant
  • Human papillomavirus infection (HPV)—a sexually transmitted disease (STD)
  • Vaginal adenosis—when cells lining the vagina look like those found in the cervix and uterus
  • Smoking
Symptoms
Vaginal cancer may cause:

  • Bleeding or discharge not related to menstrual periods
  • Pain or difficulty when urinating
  • Pain during intercourse
  • Pain in the pelvic area
  • New or worsening constipation
  • A mass in the vagina that can be felt
Diagnosis
Your doctor will ask about your symptoms and medical history. A physical and pelvic exam will be done.

Your bodily fluids and tissue may be tested. This can be done with:

  • Pap test—tissue from the inside of the cervix and upper vagina is scraped and tested
  • Colposcopy—a lighted, magnifying instrument is used to examine the vagina and cervix
  • Biopsy—removal of a sample of vaginal tissue for testing
Imaging tests may include:

The physical exam combined with all of your test results, will help to determine the stage of cancer you have. Staging is used to guide your treatment plan. Like other cancers, vaginal cancer is staged from I-IV. Stage I is a very localized cancer, while stage IV indicates a spread to other parts of the body.

Treatment
Treatments for vaginal cancer depend on the stage of the cancer. Talk with your doctor about the best treatment plan for you. Treatment options include:

Radiation Therapy
Radiation therapy is the use of high-dose radiation to kill cancer cells and shrink tumors. Radiation is usually directed at the tumor from a source outside the body. In some cases, radioactive material may be temporarily placed near the tumor to expose the cancerous cells to a constant level of radiation. This is called an implant and may require a short hospital stay. Other radiation treatments can be done on an outpatient basis.

Surgery
This involves the surgical removal of a cancerous tumor and nearby tissues, and possibly lymph nodes. Depending on how far the cancer has spread outside the vagina, the doctor may remove the vagina, cervix, uterus, and sometimes the bladder, rectum, and parts of the colon.

Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. This treatment may be given as a topical cream, pill, or intravenous injection. Except for topical creams, in which the drug is applied directly on the walls of the vagina, chemotherapy drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells.

Prevention
While a Pap smear is an effective screening tool for cervical cancer, it cannot be relied upon to detect vaginal cancer. To help reduce your chance of vaginal cancer:

  • Have regular pelvic exams to monitor any changes that may signal cancer.
  • Talk to your doctor if you were exposed to DES while your mother was pregnant with you. Your doctor can monitor your risk of vaginal cancer.
  • HPV vaccine—Gardasil, that protects against four types of HPV. HPV is associated with certain types of cancer. The vaccine helps to prevent cancers of the cervix, vulva, and vagina.



RESOURCES:
American Cancer Society

National Cancer Institute

CANADIAN RESOURCES:
Canadian Cancer Society

Women's Health Matters

References:
Andrassy, RJ, Wiener, ES, et al. Progress in the surgical management of vaginal rhabdomyosarcoma: A 25-year review from the Intergroup Rhabdomyosarcoma Study Group. J Pediatr Surg. 1999; 34:731-734.

DeMatos, P, Tyler, D, et al. Mucosal melanoma of the female genitalia: A clinicopathologic study of forty-three cases at Duke University Medical Center. Surgery. 1998; 124:38-48.

Frank SJ, Jhingran A, et al. Definitive radiation therapy for squamous cell carcinoma of the vagina. Int J Radiat Oncol Biol Phys. 2005;62:138-147.

Pandey , Mathew A, et al. Primary malignant melanoma of the mucous membranes. Eur J Surg Oncol. 1998;24(4):303-307.

Squamous cell carcinoma of vagina. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 26, 2014. Accessed November 26, 2014.

Vaginal cancer. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003146-pdf.pdf. Accessed November 26, 2014.

Vaginal cancer. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/types/vaginal. Accessed November 26, 2014.

Last Reviewed December 2013



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