Vaginal cancer is the unrestrained enlargement of abnormal cells inside the vagina, which is also known as the birth canal.
Cancer beginning in the vagina is known as primary vaginal cancer. This disease occurs very seldom and represents only about 2 per cent of cancers affecting the female reproductive system. It is more frequent that cancer cells discovered inside the vagina originated from cancer that began in another area, such as the cervix. There are two major kinds of primary vaginal cancer:
* Squamous cell carcinoma — In this type of vaginal cancer, cancerous cells grow from the surface layer of the vagina’s lining. This disease normally develops unhurriedly. It usually occurs in the upper part of the vagina close to the cervix. According to the National Cancer Institute, this kind of cancer normally appears in women between 50 and 70 years of age. The American Cancer Society informs that squamous cell carcinomas represent 85 per cent to 90 per cent of vaginal cancers.
* Adenocarcinomas — Cancerous cells appear in the glands in the vaginal wall. In accordance with the data of American Cancer Society, this kind of cancer is more frequently diagnosed in younger women. A subtype, known as clear cell adenocarcinoma, is the most widespread. Daughters of mothers who took the medication called diethylstilbestrol (DES) during pregnancy are at greater risk of developing this rare type of cancer. DES was introduced in the 1940s to help prevent miscarriages, however it was prohibited from use in the United States in the beginning of the 70s. According to the estimates of the American Cancer Society, roughly 5 per cent to 10 per cent of vaginal cancers are adenocarcinomas.
Other, less frequent kinds of vaginal cancer include: malignant melanomas and sarcomas. Melanomas usually affect the lower or outer part of the vagina. Sarcomas appear deep in the vaginal wall.
Symptoms of Vaginal Cancer
The most common symptoms of vaginal cancer include:
* Abnormal vaginal bleeding, frequently after sexual contact that is not associated with your menstruation
* Strange vaginal discharge
* A mass that can be felt
* Pain in the course of sexual contact
* Pain in the region of pelvis
* Painful urination and constipation
Remember that these symptoms more frequently appear in several less perilous conditions, including infections of the reproductive organs. These symptoms should always be assessed by a physician.
Diagnosis
Your healthcare provider will ask about your medical history, symptoms observed and any risk factors you might have for vaginal cancer. The physician will do an internal pelvic examination and Pap smear. In the course of a Pap smear, a small plastic stick and soft brush are used in order to collect cells from the vagina and cervix. These cells are checked for any abnormalities. If the examination or Pap smear demonstrates any abnormalities, additional examinations may include:
* Colposcopy — An instrument with a magnifying lens is used to inspect the walls of the vagina and cervix.
* Biopsy — A small tissue sample is taken and analyzed in a laboratory for the presence of cancerous cells.
If cancer is recognized, more examinations are performed in order to determine how far the cancer has spread. These may include:
* Imaging tests, such as intravenous pyelogram in order to observe of the kidneys and bladder, barium enema to X-ray the colon, computed tomography (CT) scan, and bone or chest X-rays
* Endoscopic tests, like cystoscopy to check the inside of the bladder or proctosigmoidoscopy to view the rectum and part of the colon
Here are the stages of vaginal cancer:
* Stage 0 — This is an initial stage. Cancer occurs only on the surface layer of the vagina.
* Stage I — Cancer is limited to the vagina however it penetrates beyond the surface layer.
* Stage II — Cancer extends to the connective tissue just beyond the vagina, but not to the pelvic wall or any other organ.
* Stage III — Cancer extends to the bones of the pelvis and/or other organs and lymph nodes in the pelvis on the same side as the tumor.
* Stage IVA — Cancer extends to the rectum and bladder. The lymph nodes possibly will be involved on both sides of the body.
* Stage IVB — Cancer extends to other parts of the body, including the lungs.
* Recurrent — Cancer returns after the treatment. It may reappear in the vagina or other parts of the body.
Expected Duration
If it is not treated, vaginal cancer keeps on growing and spreading.
Prevention
To reduce your risk of experiencing vaginal cancer, think about the following guidelines.
* Avoid the infection with human papilloma virus (HPV)— HPV is a widespread sexually transmitted disease causing genital warts. Some kinds of HPV are connected with cervical and vaginal cancer. If the vagina or cervix becomes infected with HPV, cells may develop abnormally, increasing the likelihood of experiencing squamous cell cancer. The risk of HPV infection goes up if you start having sexual contacts at an early age or if you have unprotected sex at any age, have a lot of sexual partners, or have sex with a person who has had many partners. To avoid HPV infection, always use condoms and restrict the number of people you have intercourse with. Condoms do not always prevent HPV infection however, they can reduce the risk of HIV and other sexually transmitted diseases.
* Get regular Pap tests. — A lot of vaginal squamous cell cancers develop from alterations in the surface of the vagina that may be detected by a Pap test and treated before full cancer develops. Generally, physicians recommend that a woman begin to have regular Pap tests by the time she becomes sexually active or by the age of twenty one at the latest. After three negative Pap tests (at least one year apart), your health care professional may perform the test every two to three years, depending on your age and your likelihood of developing cervical cancer. All women over the age of 40 should keep on having an annual pelvic examination.
* Do not smoke/stop smoking — Women suffering from vaginal cancer are at greater risk of developing lung cancer. Due to the fact that lung cancer is primarily linked to tobacco use, the results of the studies indicate a possible connection between smoking and vaginal cancer.
Treatment Available
The method of treatment is dependent on the kind of cancer and its stage at the time of diagnosis. The treatment plan also takes under consideration a woman’s age, general health, fertility and personal considerations.
The two main methods of treatment for vaginal cancer are: radiation therapy and surgery. Chemotherapy has not appeared to be very effective for this kind of cancer. It is only being used with or without radiation for very advanced cancers, and then normally as part of a clinical trial.
Different kinds of radiation therapy may be applied, such as external-beam radiation, internal radiation or a combination. External-beam radiation involves vigilantly targeting a beam of radiation at the cancer from a machine outside of the body. In internal radiation therapy, known as brachytherapy, radioactive materials are put inside the vagina. Whilst external-beam radiation may harm nearby healthy tissues, brachytherapy can bring about more serious local side effects and scarring of the vaginal tissue.
There are also two other kids of internal radiation therapy. Low-dose brachytherapy involves placing radioactive material inside a cylindrical container, which is put into the vagina for one to two days. Interstitial therapy involves putting radioactive materials directly into the cancer through needles.
Surgery is the method of choice only for a small group of vaginal cancers due to the fact that vaginal cancer usually involves more extensive, radical surgery than other cancers and may not be any more successful than radiation therapy. One exception includes treating stage I adenocarcinomas, which can be treated with a combination of restricted surgery of the tumor and surrounding tissue, elimination of lymph nodes and radiation in order to help preserve fertility. Preserving fertility is relevant due to the fact that these cancers are more widespread in younger women. Another exception is treatment of stage II squamous cancers for women who cannot undergo radiation therapy, in the majority of cases due to the fact that they already have received radiation therapy for another cancer in the past. The extent of surgery is dependent on the cancer’s stage and size. Kinds of surgery include:
* Laser surgery — Using a narrow beam of light in order to kill cancer (useful in stage 0 cancers)
* Loop electroexcision — Using low-voltage, high-frequency radio waves in a thin loop of wire as a cutting device to eliminate superficial (stage 0) cancers
* Radical vaginectomy — Removing the vagina and adjacent tissues
* Vaginectomy along with radical hysterectomy — Removing the vagina, the uterus and adjacent tissues
* Lymphadenectomy — Eliminating the lymph nodes in the groin or inside the pelvis
* Pelvic exenteration — Radical hysterectomy, vaginectomy and removal of the bladder, rectum and part of the colon.
If only a part or entire vagina must be removed, the vagina may be reconstructed with tissue from another part of the body.
When To Contact a Specialist
Notify your healthcare provider if you observe any symptoms connected with vaginal cancer. Remember that these symptoms may be related to less hazardous conditions as well. You should always contact your physician immediately if you have fevers connected with abdominal or pelvic pain. You might have a serious infection that requires treatment as soon as possible.
Prognosis
The outlook is dependent on the size and stage of the cancer when it is diagnosed. Early detection and treatment considerably improves the prognosis.
According to the reports of the American Cancer Society, the 5-year survival rates for vaginal cancer are:
* Squamous cell and adenocarcinomas
o Stage 0 — 96 per cent
o Stage I — 73 per cent
o Stage II — 58 per cent
o Stage III/IV — 36 per cent
* Melanoma (all stages) — 14 per cent
