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The vaginal or birth canal is the opening via which a woman’s menstrual blood exits her body and infants are born. It is linked to the cervix, the opening of the uterus or womb, and the vulva, which are skin folds around the vaginal opening.
The vagina is usually in a collapsed state, with its walls touching. The creases in the walls allow the vaginal opening and expansion during sexual intercourse and vaginal birthing. Mucus produced by glands in the cervix keeps the vaginal lining wet.
The vaginal walls are made up of a thin layer of cells called the epithelium, which contains squamous epithelial cells. The vaginal wall is composed of connective tissue, involuntary muscle tissue, lymph veins, and nerves beneath the epithelium.
PRECANCEROUS LESIONS IN THE VAGINA
Vaginal intraepithelial neoplasia (VaIN), also known as vaginal dysplasia, is a disorder in which aberrant vaginal cells can develop into cancer in certain people. Cervical dysplasia, also known as cervical intraepithelial neoplasia (CIN), is a precancerous lesion of the cervix that frequently contains these abnormal cells. Typically, these lesions are linked to the human papillomavirus, generally known as HPV.
Surgical removal, laser surgery, and drugs, including topical estrogen, are used to treat these potentially precancerous lesions. The use of a focused beam of light to burn the precancerous lesion off the vaginal wall is known as laser surgery.
VAGINAL CANCER
Vaginal cancer is a rare type of cancer that affects the female reproductive system. Vaginal cancer develops when healthy cells in the vagina mutate and expand uncontrollably, causing a lump known as a tumor. A tumor might be malignant or noncancerous. A malignant tumor is one that can grow and spread to other regions of the body. A benign tumor is one that grows but does not spread.
Approximately 85 percent of vaginal cancers have spread from other regions of the body, with the cervix or uterus accounting for roughly half of these cases.
There are five main forms of cancer that start in the vagina.
Squamous cell carcinoma: Squamous cell carcinoma can occur in the cells lining the vagina, most commonly near the cervix. Squamous cell carcinoma accounts for around 85 percent of vaginal malignancies. It develops gradually as a result of the precancerous condition known as vaginal intraepithelial neoplasia, or VaIN.
Melanoma: Melanoma can start in the vagina, which is uncommon. Melanomas are typically seen on skin in areas of the body that are frequently exposed to sunlight, but they can occasionally grow in areas where there is no sun exposure. Melanoma frequently manifests itself as a dark-colored lesion with uneven edges.
Sarcomas: There are various varieties of these uncommon tumors that can develop in the vagina.
Adenocarcinoma: The vaginal gland tissue is where adenocarcinoma originates. It accounts for roughly 5% to 10% of vaginal cancers.
Clear cell adenocarcinoma: This cancer affects women whose mothers used the medication diethylstilbestrol (DES) during pregnancy between the late 1940s and 1971. It is expected that one woman in every 1,000 who is exposed to DES will acquire vaginal cancer.
SYMPTOMS OF VAGINAL CANCER
The following symptoms or indicators may be experienced by women with vaginal cancer. Women with vaginal cancer may not have any of these alterations at all. Alternatively, the origin of a symptom could be a medical disease other than cancer.
Symptoms of precancerous diseases such as VaIN and early-stage vaginal carcinoma are uncommon. Later stages of cancer might create symptoms. Regular gynecologic checkups or Pap tests can detect many cases of VaIN and early vaginal cancer.
Abnormal vaginal bleeding is the most prevalent sign of vaginal cancer. Vaginal bleeding during or after menopause might indicate a problem, so talk to your doctor about it. Other vaginal cancer symptoms include:
- Vaginal discharge that is abnormal.
- Urinating is difficult or painful.
- During sexual intercourse, there is pain.
- Pelvic pain (the lower part of the abdomen between the hip bones).
- Back or leg pain.
- Leg swelling.
- Abnormal bowel function
Please consult your doctor if you are concerned about any changes you are experiencing. In addition to other questions, your doctor will inquire as to how long and how frequently you have been experiencing the symptom(s). This is done to assist in determining the cause of the condition, which is referred to as a diagnostic.
If cancer is discovered, symptom relief is an important element of cancer care and treatment. This is known as palliative care or supportive care. It is frequently initiated shortly after diagnosis and continues throughout treatment. Make an appointment with your health care provider to discuss your symptoms, especially any new or changing symptoms.
STAGES OF VAGINAL CANCER
Staging describes where the cancer is present, whether or not it has spread, and whether or not it is impacting other sections of the body.
Doctors utilize diagnostic tests to determine the stage of the cancer, therefore staging may not be complete until all of the tests are completed. Knowing the stage assists the doctor in determining the best course of treatment and can help estimate a patient’s prognosis, or possibility of recovery. Distinct forms of cancer have different stage descriptions. The staging system devised by FIGO, the International Federation of Obstetrics and Gynecology (Federation Internationale de Gynecologie et d’Obstetrique), is the most often used for vaginal cancer.
FIGO stages for vaginal cancer
Doctors determine the cancer stage by examining the tumor and determining if it has spread to lymph nodes or other parts of the body.
Stage I: Only the vaginal tumor is present. It has not spread to other parts of the body or through the vaginal wall.
Stage II: The tumor has progressed through the vaginal wall but not the pelvic walls.
Stage III: One or both of the following conditions apply:
- The cancer has progressed to the pelvic lymph nodes.
- The cancer has progressed to the wall of the pelvic cavity.
Stage IVA: Cancer has spread from the pelvis to the bladder, rectum, or beyond. It’s possible that lymph nodes are implicated, but it’s also possible that they aren’t.
Stage IVB: The cancer has spread to a new location in the body.
Recurrent vaginal cancer
Cancer that recurs after therapy is referred to as recurrent cancer. If the cancer returns, more tests will be performed to determine the degree of the recurrence. These tests and scans are frequently identical to those performed at the time of the first diagnosis.
DIAGNOSIS OF VAGINAL CANCER
Many tests are used by doctors to detect or diagnose cancer. They do tests to determine whether cancer has spread to a different section of the body from where it began. This is referred as as metastasis. Imaging tests, for example, can reveal whether or not the cancer has spread. Images of the inside of the body are produced via imaging tests. Doctors may conduct tests to determine which therapies are most likely to be effective.
A biopsy is the only guaranteed way for a doctor to know if a part of the body contains cancer in most types of cancer. A biopsy is a procedure in which a doctor removes a small sample of tissue to be tested in a laboratory. If a biopsy is not possible, the doctor may recommend further tests to aid in the diagnosis.
Not every person will be subjected to all of the tests described below. When choosing a diagnostic test, your doctor may take into account the following factors:
- The cancer type suspected
- Your symptoms and signs
- Your age and general well-being
- The outcomes of previous medical tests
The following tests, in addition to a physical examination, may be used to identify vaginal cancer:
Pap test: A Pap test involves the doctor gently scraping the exterior of the cervix and vagina and collecting a sample of cells for testing. During the test, a woman may feel some pressure while the doctor collects a sample of her cells, but she should not experience any pain. In women over the age of 30, HPV testing is routinely included in the Pap test.
Colposcopy: A colposcopy may be performed by the doctor to evaluate the vagina and cervix for any abnormalities, especially if the Pap or HPV tests show abnormal results. A colposcope is a specific equipment that magnifies the surface of the cervix and vagina. It is comparable to a microscope. The colposcope provides the clinician with an illuminated, magnified view of the vaginal and cervix tissues. The colposcope is not placed within the woman’s body. The exam is not painful, may be performed in the doctor’s office, and has no negative side effects. This examination is safe for pregnant women.
Pelvic examination: To look for any unexpected changes, the doctor examines the vagina, the rest of the reproductive system, the bladder, and the rectum.
Biopsy: A biopsy is the removal of a small sample of tissue for microscopic examination. Other tests can indicate the presence of cancer, but only a biopsy can provide a definitive diagnosis. The material is examined by a pathologist (s). A pathologist is a medical professional who specializes in interpreting laboratory tests and assessing cells, tissues, and organs to identify disease. The sort of biopsy required will be determined by the location of the tissue to be biopsied.
If a woman’s biopsy reveals that she has vaginal cancer, her doctor will recommend her to a gynecologic oncologist, a doctor who specializes in treating vaginal cancer. The doctor may recommend imaging studies to see whether the cancer has progressed beyond the vagina.
Ultrasound: An ultrasound creates a picture of the interior organs by using sound waves.
Endoscopy: An endoscopy allows the doctor to view within the body using an endoscope, which is a narrow, illuminated, flexible tube. As the tube is introduced through the mouth, anus, vagina, urethra, or a minor surgical hole, the patient may be sedated. Sedation is the administration of drugs in order to become more relaxed, tranquil, or sleepy.
Computed tomography (CT) scan: A CT scan uses x-rays captured from various angles to create images of the inside of the body. A computer combines these images to create a detailed, three-dimensional image that identifies any anomalies or malignancies. A CT scan can be performed to determine the size of the tumor. To improve image detail, a specific dye known as a contrast medium is sometimes administered before to the scan. This dye can be injected into a patient’s vein or given orally as a tablet or drink.
Magnetic resonance imaging (MRI): Magnetic fields, not x-rays, are used in an MRI to provide detailed images of the body. Before the scan, a specific dye called a contrast medium is administered to create a crisper image. This dye can either be injected into a patient’s vein or swallowed as a tablet or drink.
Positron emission tomography (PET) or PET-CT scan: PET scans are frequently paired with CT scans (see above), resulting in a PET-CT scan. Your doctor may, however, refer to this technique simply as a PET scan. A PET scan is a technique for generating images of organs and tissues within the body. The patient is given a little amount of a radioactive sugar material to inject into his or her body. The cells that use the most energy absorb this sugar molecule. Cancer absorbs more of the radioactive substance since it uses energy actively. The substance is then detected by a scanner, which produces images of the inside of the body.
TREATMENT OF VAGINAL CANCER
Different types of specialists frequently collaborate in cancer care to develop a patient’s overall treatment plan, which may include a variety of treatments. A multidisciplinary team is what this is referred to as. Physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, nutritionists, and other health care professionals are all part of cancer treatment teams.
The following are descriptions of the most prevalent types of vaginal cancer therapies. The most common treatment for vaginal cancer is surgery, followed by radiation therapy and/or chemotherapy. Treatment for symptoms and side effects may be part of your treatment plan, which is an important element of cancer therapy.
The type and stage of cancer, potential side effects, as well as the patient’s preferences and overall health, all influence treatment options and recommendations. Take the time to learn about all of your treatment options, and don’t be afraid to ask questions if you have any concerns. Discuss the aims of each treatment with your doctor, as well as what to expect during treatment. “Shared decision making” is the term for these types of discussions. When you and your doctors work together to identify treatments that match your care objectives, this is known as shared decision making. Because there are several treatment choices for vaginal cancer, shared decision making is especially crucial.
Concerns about sexual health and the prospect of having children
Women who have been diagnosed with vaginal cancer may be concerned about how their treatment may effect their sexual health and fertility. Before beginning therapy, these issues should be discussed with your health care provider. A reproductive endocrinologist may be referenced to premenopausal women who are still capable of becoming pregnant and want to preserve their fertility (REI). It’s a good idea to find out what fertility preservation alternatives are covered by your health insurance. There may be philanthropic funds available to assist with the costs of this treatment.
Surgery
During a surgery, the tumor and some surrounding healthy tissue are removed. The sort of surgery required is determined by the cancer’s stage and other factors. A gynecologic oncologist is a specialist who specializes in using surgery to treat vaginal cancer.
For a very tiny vaginal cancer, surgery may be the only option.
The following are surgical possibilities for vaginal cancer:
Vaginectomy: This procedure involves the excision of a portion or all of the vaginal wall, as well as the pelvic lymph nodes. Because tissues adjacent to the vagina must also be surgically removed, the procedure is known as a radical or modified radical vaginectomy in some women. Using tissue grafts from other sections of the woman’s body, a gynecologic or reconstructive surgeon can repair or replace the vagina. After this sort of surgery, sexual intercourse may be possible, but lubrication may be required.
Hysterectomy: In many situations, the uterus and other internal reproductive organs must be removed during surgery to aid in the total excision of vaginal cancer. The ovaries, fallopian tubes, and lymph nodes may also be removed in addition to the uterus. The procedure is known as a radical or modified hysterectomy in some women, and it may be combined with a radical or modified vaginectomy.
Managing the effects of vaginal cancer surgery
Following vaginal surgery, many women experience a range of emotions, including loss, sadness, and anxiety. Some women may believe they have lost their feminine identity. Others wonder if they will be able to continue having sexual relations following surgery.
Before surgery, make sure you question the surgeon about the operation, potential side effects, and when you can resume sexual activity. Women should speak with their health-care providers about getting more information or support to help them cope with the procedure.
Radiation therapy
The use of high-energy x-rays or other particles to eliminate cancer cells is known as radiation therapy. A radiation oncologist is a doctor who specializes in treating cancer patients with radiation therapy. Radiation therapy can be used as a stand-alone treatment or in conjunction with surgery. External-beam radiation therapy, in which radiation is delivered from a machine outside the body, is the most prevalent method of radiation treatment. A radiation therapy regimen, often known as a schedule, is made up of a defined number of treatments administered over a set amount of time.
Internal radiation therapy is used to treat cancer. Internal radiation therapy, commonly known as brachytherapy, is when radiation is delivered through implants. Intracavitary radiation therapy and interstitial radiation therapy are two types of brachytherapy.
Brachytherapy is frequently used in conjunction with external-beam radiation therapy to treat vaginal cancers. Women with vaginal cancer who had brachytherapy lived longer, according to a new study.
Placing hollow tubes in the vaginal canal near to the tumor allows a specific dose of radiation to be put into the tubes and directly delivered to the tumor, which is one method of intracavitary radiation therapy. The radioactive material is left in place in the vaginal canal for several minutes, during which time patients must remain in bed. The majority of these operations are performed as outpatient procedures.
Interstitial radiation therapy is another option, in which radioactive material is injected directly into the tumor using specific needles. Patients are admitted to the hospital for this operation.
Radiation therapy side effects: Radiation therapy side effects vary depending on the dose, the area treated, and the type of radiation therapy. Fatigue, moderate skin responses, upset stomach, and loose bowel motions are all possible side effects. The majority of these side effects subside once treatment is completed. Other possible side effects include vaginal constriction, damage to healthy vaginal tissue, vaginal dryness, and intestinal irritation. Sexual intercourse may be impossible due to the vaginal shortening and narrowing. To avoid this, the vagina may need to be stretched many times a week with a plastic tube called a vaginal dilator. Discuss any potential side effects of your specific radiation therapy with your health care provider, as well as how they might be managed.
Chemotherapy
The use of drugs to kill cancer cells is known as systemic treatment. This sort of drug is injected into the bloodstream to reach cancer cells all over the body. A medical oncologist, a clinician who specializes in using medications to treat cancer, usually prescribes systemic therapy. An intravenous (IV) tube, which is inserted into a vein with a needle, or a pill or capsule that is eaten are two common ways to administer systemic medicines (orally).
Chemotherapy is a sort of systemic therapy used to treat vaginal cancer. Chemotherapy is the use of medications to kill cancer cells by preventing them from growing, dividing, and producing new ones.
A chemotherapy regimen, often known as a schedule, consists of a defined number of cycles administered over a set length of time. Chemotherapy can be used to kill cancer cells that remain after surgery, limit tumor development, or reduce adverse effects. A patient may receive a single medicine at a time or a mixture of drugs at the same time.
Although chemotherapy can be given orally (by mouth), most medications for vaginal cancer are administered intravenously (IV). IV chemotherapy is injected directly into a vein or through a catheter, which is a thin tube that is temporarily inserted into a big vein to facilitate injections. Early-stage vaginal cancer may be treated with intravaginal chemotherapy (drugs injected directly into the vagina).
When radiation treatment is used to treat the pelvis, a low-dose of chemotherapy is usually given to help the radiation therapy work better. Chemoradiation is the name given to this therapeutic combination.
Chemotherapy side effects vary by person and dose, but they can include fatigue, infection risk, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects normally subside once the treatment is completed. Other possible adverse effects include inability to conceive and early menopausal symptoms.
The drugs used to treat cancer are being tested all the time. The best approach to understand about the prescriptions given for you, their purpose, and any potential adverse effects or combinations with other medications is to speak with your doctor. It’s also crucial to inform your doctor if you’re taking any additional medications or supplements, whether prescription or over-the-counter. Cancer treatments can interact with herbs, vitamins, and other medications.
Treatment by vaginal cancer stage
Depending on the stage of vaginal cancer, several treatments may be prescribed. Based on the stage of your cancer and other criteria, your doctor will propose a treatment strategy for you. Earlier on this page, detailed descriptions of each type of treatment are provided. Clinical trials may be a possibility for each step of treatment.
Stages I & II
- Surgical removal of the tumor, including part or all of the vagina and possibly pelvic lymph nodes, followed by radiation therapy with or without low-dose chemotherapy in chosen individuals.
- Internal radiation therapy with or without external-beam radiation therapy is a treatment option.
Stages III & IVA
- Internal radiation therapy and external-beam radiation therapy, often in combination with low-dose chemotherapy.
- In some cases, systemic chemotherapy is used.
Stage IVB
- Radiation therapy
- Systemic chemotherapy
Metastatic vaginal cancer
If cancer spreads to a different place in the body from where it started, doctors call it metastatic cancer. If this happens, it’s a good idea to consult with a doctor who has dealt with metastatic vaginal cancer before. Different doctors may have differing views on the optimal conventional treatment strategy. Clinical trials are another possibility. Learn more about getting a second opinion before beginning treatment so you’re confident in your decision.
Vaginal cancer in stage IV is the most advanced stage of the illness. The cancer has migrated beyond the vaginal area to the bladder, rectum, pelvic lymph nodes, or other organs such as the bones or lungs at this stage. The following are some of the signs and symptoms of advanced vaginal cancer:
- Vaginal bleeding that is unusual.
- Vaginal discharge that is abnormal.
- Urinating is difficult or painful.
- During sexual intercourse, there is pain.
- Pelvic pain.
- Back or leg pain.
- Nausea and vomiting.
- Abnormal bowel function.
Internal and external-beam radiation therapy, as well as surgery, may be used to treat vaginal cancer that has progressed to the bladder and rectum in women. Palliative treatment will be critical in assisting with the relief of symptoms and side effects.
A small segment of intestine will be connected to the abdominal wall if the woman’s bladder is removed (in a procedure known as a cystectomy), allowing her to periodically drain urine by inserting a slim, hollow tube into a surgically produced aperture. For continuous draining, a plastic bag worn at the front of the stomach might be employed.
A woman with vaginal cancer may require a colostomy if the rectum or a portion of the colon is removed. The colon is connected to the abdominal surface through a surgical hole, or stoma, to provide a channel for waste to exit the body. The patient wears a bag that collects the waste. To learn more about colostomies, go here.
A diagnosis of metastatic cancer is distressing and unpleasant for most people. Doctors, nurses, social workers, and other members of the health care team encourage you and your family to talk about how you’re feeling. It may be beneficial to speak with other patients, such as at a support group.
Remission and the possibility of recurrence
When cancer is undetectable in the body and there are no symptoms, it is said to be in remission. This is known as “no evidence of disease,” or NED.
A short or permanent remission is possible. Many survivors are concerned or scared that the cancer will return as a result of this uncertainty. While many remissions are durable, it’s crucial to discuss the potential of the cancer returning with your doctor. Knowing your recurrence risk and treatment options will help you feel more prepared if the cancer returns.
Recurrent cancer occurs when the cancer returns after the initial treatment. It may reoccur in the same location (called a local recurrence), in a nearby area (called a regional recurrence), or in a different location (called a regional recurrence) (distant recurrence).
When this happens, a new testing cycle will begin in order to understand as much as possible about the recurrence. Following the testing, you and your doctor will discuss treatment choices. The treatments outlined above, such as surgery, chemotherapy, and radiation therapy, are frequently included in treatment plans, but they may be performed in a different order or at a different pace. Depending on the location of the recurrence and the type of surgery previously performed, the cervix, uterus, lower intestine, rectum, and/or bladder may be removed. If a woman’s pelvic cancer recurs after radiation therapy and no metastatic disease is identified outside the pelvis, a major procedure called a “pelvic exenteration” may be considered to provide her a chance to be cancer-free. The vagina, as well as the bladder and rectum, are removed during the procedure. Treatment options include radiation therapy and/or chemotherapy. Your doctor may refer you to clinical studies that are looking for novel ways to treat recurring cancer. Palliative care will be vital for alleviating symptoms and side effects regardless of the treatment option you choose.
Recurrent cancer patients may experience emotions such as bewilderment or anxiety. You are urged to discuss your thoughts with your health care team and inquire about support options to assist you in coping.
