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What is Vaginal Cancer?

Vaginal cancer is not common. When found in early stages, it can often be cured. There are two main types of vaginal cancer:

Squamous Cell Carcinoma: Cancer that forms in squamous cells, the thin, flat cells lining the vagina. This cancer spreads slowly and usually stays near the vagina, but may spread to the lungs and liver. This is the most common type of vaginal cancer and is found most often in women aged 60 or older.

Adenocarcinoma: Cancer that begins in glandular (secretory) cells. Glandular cells in the lining of the vagina make and release fluids such as mucus. Adenocarcinoma is more likely than squamous cell cancer to spread to the lungs and lymph nodes and is found most often in women aged 30 or younger.

Research is increasing regarding what we know about vaginal cancer. Scientists are learning more about its causes. Following are common risk factors for the disease:

Age and exposure to the drug DES (Diethylstilbestrol) before birth affect a woman’s risk of developing vaginal cancer.

Additional risk factors for vaginal cancer include the following:

  • Age - Being aged 60 or older
  • Human Papillomavirus - Being infected with HPV 
  • Cervical Issues - Having a history of abnormal cells in the cervix or cervical cancer. 

Signs and Symptoms

Vaginal cancer often does not cause early symptoms and may be found during a routine Pap Test. When symptoms occur they may be caused by vaginal cancer or by other conditions. A doctor should be consulted if any of the following problems occur:

  • Pain or abnormal vaginal bleeding
  • Bleeding or discharge not related to menstrual periods 
  • Pain during sexual intercourse 
  • Pain in the pelvic area 
  • A lump in the vagina 

Diagnosis

If a patient has symptoms that could be vaginal cancer, the doctor will test for fever and high blood pressure and check general signs of health. The patient will likely have one or more of the following tests:

Biopsy

A biopsy may be done to find out if cancer has spread to the cervix. A sample of tissue is cut from the cervix and viewed under a microscope. A biopsy that removes only a small amount of tissue is usually done in the doctor’s office. A woman may need to go to a hospital for a cone biopsy (removal of a larger, cone-shaped piece of tissue from the cervix and cervical canal). A biopsy of the vulva may also be done to see if cancer has spread there.

Chest X-Ray

An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

Cystoscopy

A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope is inserted through the urethra into the bladder. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are then checked under a microscope for signs of cancer.

Ureteroscopy

A procedure to look inside the ureters to check for abnormal areas. A ureteroscope is inserted through the bladder and into the ureters. A ureteroscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease. A ureteroscopy and cystoscopy may be done during the same procedure.

Proctoscopy

A procedure to look inside the rectum to check for abnormal areas. A proctoscope is inserted through the rectum. A proctoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease. CT Scan (CAT Scan) - A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

MRI

A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Lymphangiogram

A procedure used to x-ray the lymph system. A dye is injected into the lymph vessels in the feet. The dye travels upward through the lymph nodes and lymph vessels and x-rays are taken to see if there are any blockages. This test helps find out whether cancer has spread to the lymph nodes.

Learn more about Diagnosis

Treatment

In the majority of cases, squamous cell carcinoma (SCC) is easily cured using local surgery and/or medications applied to the skin (called topical therapies).

Treatment will depend on the size, location and how deep the tumor is in the skin, as well as if it has spread elsewhere.

Treatments usually include:

Surgery

There are several different types of surgical procedures that can be used:

  • Excision – the entire growth is removed along with a surrounding border of normal skin
  • Curettage and electrodessication – the tumor is scraped down to its base followed by pulses of electrical energy
  • Mohs surgery – the goal is to remove skin cancer one layer at a time to spare healthy tissue. After each layer is removed, it is sent to an off-site laboratory to be examined, so the surgeon knows whether more layers need to be removed in real-time.
  • Laser surgery – lasers can be used to kill SCCs that are very early and sit on the surface of the skin. It is often used on the lip, face or scalp.
  • Cryosurgery – may be considered for patients with small, well-defined primary tumors; this involves freezing the cancer cells.

SCC can invade nearby tissue. If this happens, several surgeries may be needed to try to remove all of the cancer cells. These procedures can be disfiguring and very upsetting. If nearby lymph nodes are involved, a lymph node dissection may also be required.

Medications for the Skin

If SCC is “superficial” (in other words, not very deep in the skin), creams containing chemotherapy medications (imiquimod, 5-Fluorouracil) can be applied to the skin.

Photodynamic Therapy

This treatment uses a medication, called a photosensitizer, and a particular type of light to kill cancer cells.

Radiation Therapy

Radiation therapy uses high-energy x-rays to target and kill cancer cells. The use of radiation is controversial to treat SCC, but may be considered for patients who have:

  • Undergone lymph node dissection
  • Remaining SCC cells after surgery (positive margins)
  • Evidence that cancer cells are spreading to the space surrounding a nerve (called perineural invasion) on a pathology report)

For SCC that has spread (metastasized), systemic therapy can be considered which includes chemotherapy, targeted therapy, and clinical trials. For organ transplant patients who have many SCCs, transplant physicians can consider adjusting the immunosuppressive treatment if appropriate.