Vaginal cancer: Types, Causes, Diagnosis Treatment

Vaginal cancer is a very rare type of cancer that occurs in the vaginal tissue. Estimates show that about 1 in 1,100 women is affected. Vaginal cancer most often occurs in cells on the surface of the vagina, sometimes called the birth canal. The vagina is a tubular organ that connects the cervix to the vulva (external genitalia). The vagina is covered by a layer of flat cells called squamous cells. This layer of cells is also called the epithelium because it is made up of epithelial cells. The baby passes through the vagina at birth, so sometimes, the vagina is also known as the birth canal.

Early detection of vaginal cancer has the best chance of cure. Vaginal cancer that spreads beyond the vagina is much more difficult to treat. This type of cancer is more common in women over 60 years. Women with human papillomavirus (HPV) are at higher risk for cancer.

Symptoms

Early stages of vaginal cancer and precancerous lesions tend not to cause symptoms in the early stages. Often, they are diagnosed accidentally at the time of examination. Vaginal cancers are more likely to cause significant symptoms in later stages. One of the most common symptoms of vaginal cancer is abnormal vaginal bleeding after intercourse. This is regularly one of the first signs that people notice. Other symptoms of include:

•  Abnormal vaginal discharge
•  A mass in the vagina
•  Difficulty or pain when urinating
•  Constipation
•  Pain during sex
•  Pelvic pain
•  Pain in the back of the legs
•  Leg swelling

Types

There are several types of vaginal cancer. Two types are more common, and some are rarer.

Squamous cell carcinoma

Vaginal squamous cell carcinoma develops in the squamous cells lining the vaginitis is the most common type, which includes about 9 out of 10 diagnoses. This type of squamous cell carcinoma most often occurs in women 60 years of age or older.

Adenocarcinoma

Adenocarcinoma begins in glandular cells in the vaginal mucosa that produce certain fluids. The spread of adenocarcinoma is higher than squamous cell carcinoma

Rarer types

Rare cancers include:

•  Melanoma: This type of cancer originates from cells that produce skin pigment, generally outside the vagina.
•  Sarcoma: This cancer develops in bone, muscle, or connective tissue cells. Less than 3% of vaginal cancers are sarcomas. The most common vaginal sarcoma is rhabdomyosarcoma, which affects most children.
•  Cancers that spread from other organs: Cancers of the cervix, uterus, bladder, or rectum may spread to the vagina.

Causes

The exact cause of vaginal cancer is not known. Cancer begins when healthy cells undergo a genetic mutation that turns normal cells into abnormal cells. Healthy cells grow and multiply at a certain rate and eventually die at a certain time. Cancer cells grow and multiply uncontrollably and do not die. Abnormally accumulated cells form a mass or tumor. Cancer cells invade nearby tissues and can be isolated from the primary tumor and spread to other parts of the body.

Risk factors

Factors that may increase the risk include:

•  Increasing age: The risk of vaginal cancer increases with age.
•  Abnormal cells in the vagina are called vaginal intraepithelial neoplasia: Diagnosis of vaginal intraepithelial neoplasia increases the risk of vaginal cancer. In this case, the cells in the vagina look different from normal cells, but they are not very different (they are not called cancer in all cases). A small number of people eventually develop vaginal cancer. Some cases turn into cancer, and others remain benign. Vaginal intraepithelial neoplasia is often caused by the sexually transmitted papillomavirus (HPV), which can cause cancers of the cervix, vagina, and vulva, and more.
•  Exposure to miscarriage prevention drug: If a mother took a drug called diethylstilbestrol (DES) during pregnancy in the 1950s, she may more likely to develop a certain type of vaginal cancer called clear cell adenocarcinoma.

Other risk factors that are associated with an increased risk of vaginal cancer include:

•  Multiple sexual partners
•  Early age at first intercourse
•  Smoking
•  HIV infection

Stages

After the doctor diagnoses vaginal cancer, they perform imaging tests and other tests to see if the cancer has spread to other body parts. This helps them determine the stage of cancer and how to treat it. The steps are:

•  Stage I: The cancer is only in the vaginal wall.
•  Stage II: It has spread to the tissue around the vagina.
•  Stage III: Cancer is in the wall of the pelvis.
•  Stage IVa: Cancer has reached the lining of the bladder, the lining of r rectum, or another area of the pelvis.
•  Stage IVb: It has spread to farther parts of the body like lungs or bones.

Prevention

The best way to protect yourself is to avoid getting HPV. The FDA has approved the Gardasil 9 vaccine to prevent HPV-related diseases, including seven common types of HPV that cause cancer. This vaccine is for people between the ages of 9 and 45. Some lifestyle changes can also help reduce your risk of cancer:

•  Quit smoking, or don’t start
•  Undergo regular Pap tests to find and treat vaginal intraepithelial neoplasia
•  Use condoms or other barrier methods during sexual activity
•  Don’t have sex with more than one partner
•  Don’t have sex with someone who has more than one partner

Diagnosis

In the initial consultation with the doctor, the person’s medical history is first asked, and a physical examination is performed. Questions about:

•  Any medication they are currently taking
•  History of family medicine, especially cancer
•  Any recent sexual activity that may be related to HPV, such as sex without a condom

The physical examination includes:

•  Pelvic exam: The doctor examines the vagina and examines for the possibility of abnormalities.
•  Pap smear: It is a test for cervical cancer that can cause similar symptoms.
•  Colposcopy: If the first examination shows unusual or suspicious results, the doctor may perform a colposcopy. They use a colposcope, which is a magnifying device to which light is attached.
•  Biopsy: For a definitive diagnosis, the doctor must do a biopsy. During the biopsy, small tissue samples are collected before being sent to the lab. The biopsy is usually performed during colposcopy and under local anesthesia.

If the doctor confirms the diagnosis of cancer, he or she will order several more tests to determine the cancer stage and develop a treatment plan. These tests include:

•  Imaging scans, such as an X-ray, an MRI, and CT scans
•  Examinations in a different area, such as a proctoscopy for the rectum and anus, ureteroscopy for the tubes leading from the kidneys and cystoscopy for the bladder

Treatment

Treatment options for vaginal cancer depend on several factors, including its type and stage. Patients and physicians work together to choose the best treatment based on treatment goals and side effects. Treatment for vaginal cancer usually includes surgery and radiation.

Surgery

Types of surgery include:

•  Removal of small tumors or lesions: Cancer limited to the surface of the vagina may be treated by removing the cancer cells, along with a small margin of healthy surrounding tissue, to ensure that all the cancer cells have been removed.
•  Removal of the vagina (vaginectomy): Removal of part of the vagina (partial vaginectomy) or the entire vagina (radical vaginectomy) may be necessary to eliminate all cancer. Depending on the type of cancer, the surgeon may remove the uterus and ovaries (hysterectomy) and adjacent lymph nodes (lymphadenectomy) at the same time as the vaginectomy.
•  Removal of the majority of the pelvic organs (pelvic exenteration): If cancer has spread across the pelvic area or has recurred, extensive surgery may be needed. During a pelvic exam, the surgeon may remove many organs in the pelvic area, including the bladder, ovaries, uterus, vagina, rectum, and lower colon. There are openings in the abdomen that allow urine (urostomy) and waste products (colostomy) to leave the body and accumulate in the ostomy sacs.

Radiation therapy

Radiation therapy uses strong energy rays, such as X-rays to kill cancer cells. It is done in two ways:

• External radiation: Depending on the extent of the cancer, the radiation is directed to the entire abdomen or just the pelvis. During external beam irradiation, the patient is placed on a table, and a large radiation device maneuvers around the patient to target the treatment area. Most women with vaginal cancer receive external beam radiation.
•  Internal radiation: During internal radiation (brachytherapy), radioactive devices are placed in the vagina or surrounding tissue. Devices may be removed after a specified period of time. People in the early stages of vaginal cancer may only receive internal radiation. Others may receive internal radiation after exposure to external radiation.

Radiation therapy kills fast-growing cancer cells, but it can also damage nearby healthy cells and cause side effects. Side effects of radiation depend on the intensity of the radiation and its location.

Other options

If surgery and radiation cannot control cancer, other treatments may be suggested, including:

•  Chemotherapy: Chemotherapy uses chemicals to kill cancer cells. It is not yet known whether chemotherapy is useful for treating vaginal cancer. For this reason, chemotherapy is not generally used to treat alone. Chemotherapy may be used during radiation therapy to increase the effect of radiation.
•  Clinical trials: Clinical trials are trials to test new treatments. A clinical trial allows the patient to test the latest therapeutic advances, but there is no guarantee of cure.

The bottom line

Vaginal cancer is an example of cancer that occurs in the female genital area. Various factors can cause this disease in people. Therefore, this cancer can have different types. Although several types of cancer can spread from one part of the body to the vagina, cancers that form in the vagina and start there (primary vaginal cancer) are very rare.

Early detection of vaginal cancer provides the best opportunity for treatment. Vaginal cancer that spreads beyond the vagina is much more difficult to treat.

Treatment options for vaginal cancer depend on many factors, including the type and stage of cancer, because treatment is so easy if diagnosed at an early stage. If you notice any of these symptoms, see a gynecologist, Dr. Arjang Naim MD is one of the best OBGYN in this field in Los Angeles.

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