Vaginal Cancer
General Information About Vaginal Cancer
Other Key Points for This Section
Vaginal cancer is a disease in which malignant (cancer) cells form in the vagina.
Age and exposure to the drug DES (diethylstilbestrol) before birth affect a woman’s risk of developing vaginal cancer.
Possible signs of vaginal cancer include pain or abnormal vaginal bleeding.
Tests that examine the vagina and other organs in the pelvis are used to detect (find) and diagnose vaginal cancer.
Certain factors affect prognosis (chance of recovery) and treatment options.
General Information About Vaginal Cancer
Note: Estimated new cases and deaths from vagina (and other female genital) cancer in the United States in 2006:[1]
New cases: 2,420. Deaths: 820.
Carcinomas of the vagina are uncommon tumors comprising 1% to 2% of gynecologic malignancies. They can be effectively treated, and when found in early stages, are often curable. The histologic distinction between squamous cell carcinoma and adenocarcinoma is important because the two types represent distinct diseases, each with a different pathogenesis and natural history. Squamous cell Vaginal Cancer (approximately 85% of cases) initially spreads superficially within the vaginal wall and later invades the paravaginal tissues and the parametria. Distant metastases occur most commonly in the lungs and liver.[2] Adenocarcinoma (approximately 15% of cases) has a peak incidence between 17 and 21 years of age and differs from squamous cell carcinoma by an increase in pulmonary metastases and supraclavicular and pelvic node involvement.[3] Rarely, melanoma and sarcoma are described as primary Vaginal Cancer. Adenosquamous carcinoma is a rare and aggressive mixed epithelial tumor comprising approximately 1% to 2% of cases.
Prognosis depends primarily on the stage of disease, but survival is reduced in patients who are greater than 60 years of age, are symptomatic at the time of diagnosis, have lesions of the middle and lower third of the vagina, or have poorly differentiated tumors.[4,5] In addition, the length of vaginal wall involvement has been found to be significantly correlated to survival and stage of disease in squamous cell carcinoma patients.[6]
Therapeutic alternatives depend on stage; surgery or radiation therapy is highly effective in early stages, while radiation therapy is the primary treatment of more advanced stages.[7,8] Chemotherapy has not been shown to be curative for advanced Vaginal Cancer, and there are no standard drug regimens.
Clear cell adenocarcinomas are rare and occur most often in patients less than 30 years of age who have a history of in utero exposure to diethylstilbestrol (DES). The incidence of this disease, which is highest for those exposed during the first trimester, peaked in the mid-1970s, reflecting the use of DES in the 1950s.[3] Young women with a history of in utero DES exposure should prospectively be followed carefully in order to diagnose this disease at an early stage. In women who have been carefully followed and well-managed, the disease is highly curable.
Vaginal adenosis is most commonly found in young women who had in utero exposure to DES and may coexist with a clear cell adenocarcinoma, although it rarely progresses to adenocarcinoma. Adenosis is replaced by squamous metaplasia, which occurs naturally, and requires follow-up but not removal. The natural history, prognosis, and treatment of other primary Vaginal Cancer (sarcoma, melanoma, lymphoma, and carcinoid tumors) may be different, and specific references should be sought.[
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Vaginal Cancer is a disease in which malignant (cancer) cells form in the vagina.
The vagina is the canal leading from the cervix (the opening of uterus) to the outside of the body. At birth, a baby passes out of the body through the vagina (also called the birth canal).
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. Squamous cell Vaginal 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. It 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. It is found most often in women aged 30 or younger.
Age and exposure to the drug DES (diethylstilbestrol) before birth affect a woman’s risk of developing Vaginal Cancer.
Risk factors for Vaginal Cancer include the following:
- Being aged 30 or younger or aged 60 or older.
- Being exposed to DES while in the mother's womb. In the 1950s, the drug DES was given to some pregnant women to prevent miscarriage (premature birth of a fetus that cannot survive). Women who were exposed to DES before birth have an increased risk of developing Vaginal Cancer. Some of these women develop a rare form of cancer called clear cell adenocarcinoma.
- Having human papilloma virus (HPV) infection.
- Using a vaginal pessary to keep the uterus from sliding into the vagina.
Possible signs of Vaginal Cancer include pain or abnormal vaginal bleeding.
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:
- Bleeding or discharge not related to menstrual periods.
- Pain during sexual intercourse.
- Pain in the pelvic area.
- A lump in the vagina.
Tests that examine the vagina and other organs in the pelvis are used to detect (find) and diagnose Vaginal Cancer.
The following tests and procedures may be used:
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. The doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. A speculum is also inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test or Pap smear of the cervix is usually done. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
- Pap smear: A procedure to collect cells from the surface of the cervix and vagina. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the cervix and vagina. The cells are viewed under a microscope to find out if they are abnormal. This procedure is also called a Pap test.
- Biopsy: The removal of cells or tissues from the vagina and cervix so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a Pap smear shows abnormal cells in the vagina, a biopsy may be done during a colposcopy.
- Colposcopy: A procedure to look inside the vagina and cervix for abnormal areas. A colposcope (a thin, lighted tube) is inserted through the vagina into the cervix. Tissue samples may be taken for biopsy.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) depends on the following:
- The stage of the cancer (whether it is in the vagina only or has spread to other areas).
- The size of the tumor.
- The grade of tumor cells (how different they are from normal cells).
- Where the cancer is within the vagina.
- Whether there are symptoms.
- The patient's age and general health.
- Whether the cancer has just been diagnosed or has recurred (come back).
- The stage, size, and location of the cancer.
- Whether the tumor cells are squamous cell or adenocarcinoma.
- Whether the patient has a uterus or has had a hysterectomy.
- Whether the patient has had past radiation treatment to the pelvis.