Vaginal Cancer

The vagina

The vagina is a muscular tube that extends from the opening of the womb (cervix) to the folds of skin (vulva) between a woman’s legs.

It allows blood from periods (menstruation) to pass out of the body, and is the passageway through which babies are born.

 

The vagina and surrounding organs

Vaginal cancer

Cancers affecting the vagina are rare.

Vaginal cancer can start in the vagina itself (primary vaginal cancer) or spread into the vagina from another part of the body (secondary vaginal cancer).

Primary vaginal cancer

There are two main types of primary vaginal cancer, and they are named after the cells from which they develop:

Squamous cell

The most common type of vaginal cancer is called squamous cell. This is usually found in the upper part of the vagina, and most commonly affects women aged 50–70.

Adenocarcinoma

This type of vaginal cancer usually affects women under 20, but may occasionally occur in older women.

Other very rare types of vaginal cancer include melanoma, small cell carcinoma, sarcoma, and lymphoma.

Secondary vaginal cancer

Secondary cancers in the vagina are more common than primary vaginal cancer, and usually come from the neck of the womb (cervix), the lining of the womb (endometrium) or from nearby organs such as the bladder or bowel.

This information is about primary vaginal cancer. Our cancer support specialists can give you further information about secondary cancers in the vagina.

Causes and risk factors of vaginal cancer

As with many cancers, the exact cause of most vaginal cancers is unknown, but research into this is ongoing. Cancer of the vagina is not infectious and so can’t be passed on to other people.

Women who have had genital warts caused by the human papilloma virus (HPV) may have a slightly higher risk of developing vaginal cancer.

Women who have had radiotherapy to the pelvic area may also have a very slightly increased risk.

A hormone drug called diethylstilbestrol (DES) has been identified as a cause of a particular type of adenocarcinoma of the vagina. Between 1940 and 1970, DES was prescribed to some pregnant women to try to prevent miscarriages. The female children of women who took DES during pregnancy have an increased risk of developing a type of adenocarcinoma of the vagina called clear cell adenocarcinoma (CCA), although it is very rare. Daughters of women who took DES should have annual check-ups to detect early signs of CCA.

Although DES and some other female hormones (oestrogens) can be safely used to treat other medical conditions, DES is no longer used during pregnancy.

Signs and symptoms of vaginal cancer

The most common symptoms of vaginal cancer are a blood-stained vaginal discharge, bleeding after sexual intercourse and pain. Problems with passing urine (such as blood in the urine, the need to pass urine frequently and the need to pass urine at night) can be a symptom of vaginal cancer. Women may also have some pain in the back passage (rectum).

How vaginal cancer is diagnosed

Usually you will begin by seeing your PCP, who will refer you to a specialist doctor for tests, and for expert advice and treatment. The following tests are commonly used to diagnose vaginal cancers.

Internal vaginal examination

At the hospital, the specialist doctor will do a full pelvic examination. They will examine the inside of your vagina to check for any lumps or swellings. The doctor will also feel your groin and pelvic area to check for any swollen lymph nodes and may also check your back passage (rectum).

Cervical screening

You may have a liquid-based cytology test or smear test to see if there are any abnormalities in the cells of the cervix.

The person taking the liquid-based cytology or smear test should explain the procedure and you should feel able to ask questions at any time. Once you are lying comfortably on the couch, the doctor or nurse will gently insert an instrument called a speculum into the vagina, to keep it open while the smear is taken.

A special brush or small disposable spatula is then used to take a sample of cells from the cervix. The cells are then either put into a small container of preservative or placed on a glass slide, and sent to the laboratory for examination under a microscope.

Colposcopy

This is an examination of the vagina using a colposcope, which is a small, low-powered microscope.

The colposcope acts like a magnifying glass so the doctor or specialist nurse can see the whole vagina in more detail.

The doctor will use a speculum in the same way as in the screening test, to hold the vagina open. A liquid is then applied to the vagina that makes any abnormal areas show up more clearly. A colposcopy is usually carried out in the hospital outpatient department and takes about 10-15 minutes. It isn’t usually painful but may be slightly uncomfortable.

Biopsy

A small sample of tissue will be taken from any abnormal areas. This sample will be examined under a microscope.

VAIN

The above tests may show early cell changes in the vagina known as vaginal intra-epithelial neoplasia (VAIN). This is sometimes referred to as carcinoma-in-situ. VAIN is not cancer, and therefore the treatment for this condition is not the same as for cancer.

Further tests

Cancer can spread in the body, either in the bloodstream or through the lymphatic system. The lymphatic system is part of the body’s defense against infection and disease. The system is made up of a network of lymph nodes (also called lymph glands) that are linked by fine ducts containing lymph fluid.

If the above tests show that you have a vaginal cancer, further tests may be necessary to find out whether or not any cancer cells have spread.

The results of these tests will help the specialist to decide on the best type of treatment for you. You may have any of the following.

Chest x-ray and blood tests

These are necessary to assess your general health and to check whether the cancer has spread to the lungs.

CT (computerized tomography) scan

A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body. The scan is painless and takes 10-30 minutes. CT scans use a small amount of radiation, which will be very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.

You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. For a few minutes, this may make you feel hot all over. If you are allergic to iodine or have asthma you could have a more serious reaction to the injection, so it is important to let your doctor know this beforehand.

MRI (magnetic resonance imaging) scan

This test is similar to a CT scan but uses magnetism instead of x-rays to build up a detailed picture of areas of your body. Before the scan you may be asked to complete and sign a checklist. This is to make sure that it’s safe for you to have an MRI scan.

Before having the scan, you’ll be asked to remove any metal belongings, including jewelry. Some people are given an injection of dye into a vein in the arm. This is called a contrast medium and can help the images from the scan to show up more clearly.

During the test you’ll be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It’s painless but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. It’s also noisy, but you’ll be given earplugs or headphones. You’ll be able to hear, and speak to, the person operating the scanner.

Staging and grading of vaginal cancer

Staging

The stage of a cancer is a term used to describe its size and whether or not it has spread. Knowing the particular type and stage of a cancer helps the doctors decide on the most appropriate treatment for you.

Vaginal cancers are usually staged using a combination of the FIGO and AJCC (TNM) classifications.  A number between 0 and 4 is given to the tumor, depending on its growth in the vagina and surrounding tissues, and whether it has spread to lymph nodes or other organs.

Stage 1 describes a cancer at an early stage, when it is usually small and hasn’t spread. Stage 4 describes cancer at a more advanced stage, when it has usually spread to other parts of the body. Stages 2 and 3 are between these stages.

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