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Cancer (Oncology)

Vaginal Cancer

Vaginal cancer refers to several different types of cancer, affecting different cells in the vagina. About 70 percent of vaginal cancers are squamous cell carcinomas that begin in the cells that line the vagina. These cancers will often develop slowly, taking many years to manifest. Another 15 percent of vaginal cancers are adenocarcinomas, meaning they develop in gland cells. These usually affect women over 50 years old. Less common types of vaginal cancer include melanomas (which tend to affect the lower or outer portion of the vagina), and sarcomas (which begin in the cells of bones, muscles, or connective tissue) that form deep in the wall of the vagina, not on its surface.

True vaginal cancer is rare, accounting for only about one percent of female reproductive system cancers. It is more common for cancer to start in other organs (such as the cervix, uterus, rectum, or bladder) and then spread to the vagina.

Risk Factors

Age is a primary risk factor, particularly for squamous cell vaginal cancer. Almost half of women who develop squamous cell vaginal cancer are over 70 years old. Smoking cigarettes more than doubles a woman's risk of getting vaginal cancer. However, the relationship between alcohol and vaginal cancer risk remains inconclusive. People with high-risk types of human papilloma virus (HPV) or human immunodeficiency virus (HIV) have a greater risk of developing certain cancers, including vaginal cancer. Having had cervical cancer or pre-cancer also increases a woman's risk of vaginal squamous cell cancer.

Women adenosis – a condition where the vagina is lined in part by glandular cells rather than flat squamous cells – are also at increased risk of developing vaginal clear cell carcinoma. Additionally, women whose mothers took the hormonal drug DES during pregnancy have an increased risk for vaginal cancer.

Screening and Prevention

Since the exact cause of most vaginal cancers is not known, the disease is difficult to prevent. But common sense precautions like avoiding smoking can help lower risk. Women can also reduce their exposure to HPV by limiting sexual activity and limiting the number of sex partners, using condoms, and getting vaccinated against HPV before becoming sexually active. The Pap test – used for detecting cervical cancer – can also detect some cases of vaginal intraepithelial neoplasia or VAIN, a vaginal pre-cancer. Following screening guidelines for cervical cancer may help guard against vaginal cancer as well.

Symptoms and Diagnosis

Many vaginal cancers do not cause symptoms until after they have reached an advanced stage. Women with invasive vaginal cancer often have one or more of the following symptoms: abnormal vaginal bleeding or discharge, a palpable mass, or pain during intercourse. They may also have painful urination, constipation, or continuous pelvic area pain. Those symptoms are more likely to be caused by an infection or some other condition, but should be checked out regardless.

Treatment

Surgery is generally used to treat vaginal cancer. Surgeons may remove surface tumors with lasers. More advanced cases may require procedures such as vaginectomy to remove all or part of the vagina, or hysterectomy where the uterus and cervix are removed. Radiation may be used prior to surgery to shrink a tumor or following surgery to destroy any remaining cancer cells. Chemotherapy may also be used as a treatment, alone or in combination, with other methods.

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