Vaginal cancer is a rare type of cancer that develops in the vagina. It often appears from the cells lining the inside of the vagina. The vagina is an area of the body in which many cancers can spread. However, primary vaginal cancer is not very prevalent. The disease is curable if diagnosed early. In the presence of metastases, it gets harder to treat.
About the vagina
The vagina, otherwise called the birth canal, is a muscular tube that connects the uterus with the external genitalia. It is an organ whose walls are usually collapsed and touching each other. They open during sexual intercourse or birth. Its lubricated walls are the result of the glands located in the area that provide the vagina with fluids. These fluids help the vagina clear itself from bacteria and dead cells, and enhance sexual activity. Its lining contains various types of cells, from which vaginal cancer may arise.
How common is vaginal cancer, and what’s its prognosis?
Vaginal cancer is rare. About 1 of every 1,100 women will present with vaginal cancer during their lifetime. Also, an estimated 6,230 women will develop vaginal cancer, and about 1,450 women will die from it in 2020 in the US. The prognosis of a disease depends on its five-year survival rate, which expresses the possibility of a patient being alive five years after their primary diagnosis. The five-year survival rate of vaginal cancer is 47%. Early-stage vaginal cancer has a five-year survival rate of 67%. If there are distant metastases, the survival rate drops to 19%.
Causes of vaginal cancer
Scientists are not sure what causes vaginal cancer. They believe that vaginal cancer develops as a result of changes or mutations in the DNA of some cells that build up the vagina. As a result, these cells start growing out of control, outweighing the healthy cells, and forming a tumor. However, doctors established some risk factors that significantly increase a person’s chance to develop vaginal cancer.
Risk factors of vaginal cancer
Risk factors increase an individual’s likelihood of developing a disease. The following are some of the most well-known risk factors for vaginal cancer:
- Being older than sixty years old
- Having atypical cells in the vagina called vaginal intraepithelial neoplasia (VAIN).
- Exposure to miscarriage prevention drugs, such as diethylstilbestrol (DES), during pregnancy
- Having multiple sexual partners
- Having a partner that has multiple sex partners
- Having unprotected sex
- Being young at first intercourse
- Being a smoker
- Having HIV infection
- Having HPV infection
Symptoms and signs of vaginal cancer
Early vaginal cancer may not cause any symptoms and signs. However, as the disease progresses, you might notice some of the following:
- Unusual vaginal bleeding
- Pain during sex
- Swelling in the lower limbs
- Vaginal discharge that is watery regarding its consistency
- A lump or mass in your vagina
- Frequent urination, accompanied by pain
- Pelvic pain
The four types of vaginal cancer
The four main types of vaginal cancer are the following:
- Squamous cell carcinoma. Squamous cell carcinoma develops from the cells that line the inner walls of the vagina. It most commonly appears in the part of the vagina close to the cervix. It is the most prevalent type of vaginal cancer, as it makes up 85% to 90% of all cases. It develops in the presence of vaginal intraepithelial neoplasia or VaIN, which is a premalignant finding.
- Adenocarcinoma. Adenocarcinoma arises from vaginal glands. It represents about 5% to 10% of all cases.
- Clear cell adenocarcinoma. This type of cancer, strongly associated with the drug diethylstilbestrol (DES), appears in females whose mothers took that drug during pregnancy. About 1 woman out of 1,000 will develop vaginal cancer under these conditions.
- Melanoma. Melanoma is a rare type of vaginal cancer that may appear as a dark-colored lesion. The lesion has irregular borders and does not need sun exposure to develop.
FIGO stages of vaginal cancer
The disease has four FIGO stages that depend on the type of the cancerous cell, and the extent of spread of the tumor.
Stage I: The tumor, found only in the vagina, has not spread through the vaginal wall or to other organs.
Stage II: The tumor has spread through the vaginal wall. However, it hasn’t spread to the walls of the pelvis.
Stage III: The tumor has spread to the lymph nodes in the pelvis or the pelvic wall.
Stage IVA: Cancer has spread to nearby organs, such as the bladder or rectum, independently of the lymph nodes.
Stage IVB: There are distant metastases to other parts of the body.
What is the diagnosis of vaginal cancer?
Initially, your doctor will take your history and perform a physical and pelvic examination, during which he or she inspects and palpates your vagina manually. A Pap test might be necessary too to check for abnormal, cancerous cells. Depending on the findings, you might need to undergo colposcopy and a biopsy to examine a sample of your tissue under the microscope. Finally, to stage your tumor and see if there are any metastasis, you might need to undergo some imaging tests. Another option is to perform a colposcopy with a camera to visualize the inside of your vagina.
What is the treatment of vaginal cancer?
The three standard treatments regarding vaginal cancer are surgery, radiation therapy, and chemotherapy. During operation, your surgeon might extract your tumor, your vagina, or the organs of your pelvis. Radiation therapy might be necessary before and after surgery, to kill any remaining cancerous cells, or to shrink the tumor before the operation. For women with late-stage vaginal cancer, there is palliative care.