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Vaginal Cancer

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(Cancer of the Vagina)

Definition

Vaginal cancer is an uncommon disease in which cancer cells grow from the cells of the vaginal lining. The vagina is a tube that connects the vulva (external female genitals) to the cervix (lower end of the uterus). The vagina is also called the “birth canal.”
Cancer occurs when cells in the body (in this case, vaginal cells) divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue, called a growth or tumor, forms. The term cancer refers to malignant tumors, which can invade nearby tissue and spread to other parts of the body. A benign tumor does not invade or spread.
There are several types of vaginal cancer:
  • Squamous cell carcinoma—occurs in the lining of the vagina
  • Adenocarcinoma—occurs in the area of the vagina lined with cells similar to those in the glands of the cervix and uterus
    • A special type of this cancer, called clear cell adenocarcinoma, occurs in women who were exposed to a drug called diethylstilbestrol (DES) while in their mother’s womb. This drug was introduced in the late 1930s and no longer used after 1971, so the incidence of this particular type of adenocarcinoma is expected to decline.
  • Melanoma—usually affects lower or outer portion of the vagina
  • Sarcoma—forms deep in the walls of the vagina, not on the surface
Female Reproductive Organs
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Causes

The exact cause of vaginal cancer is unknown. However, several risk factors are known.

Risk Factors

These risk factors increase your chance of developing vaginal cancer. Tell your doctor if you have any of these risk factors:
  • Age: 60 and older
  • History of cervical cancer
  • History of precancerous conditions in the cervix or vagina
  • Having a mother who took diethylstilbestrol (DES) while pregnant
  • Human papillomavirus infection (HPV) —a sexually transmitted disease (STD)
  • Vaginal adenosis—when cells lining the vagina look like those found in the cervix and uterus
  • Smoking

Symptoms

If you have any of these symptoms, do not assume it is due to vaginal cancer. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:
  • Bleeding or discharge not related to menstrual periods
  • Pain or difficulty when urinating
  • Pain during intercourse
  • Pain in the pelvic area
  • New or worsening constipation
  • A mass in the vagina that can be felt

Diagnosis

Your doctor will ask about your symptoms and medical history and perform a physical exam, including a pelvic exam. You may be referred to a doctor who specializes in women’s health (a gynecologist).
Tests may include:
  • Pap test —tissue from the inside of the cervix and upper vagina is scraped and tested
  • Colposcopy —a lighted, magnifying instrument is used to examine the vagina and cervix in great detail
  • Biopsy —removal of a sample of vaginal tissue for testing
If cancer is found, additional tests are usually done to determine whether or not it has spread to other parts of the pelvis or elsewhere in the body. These tests may include:
  • CT scan —a type of x-ray that uses a computer to make pictures of structures inside the body
  • MRI scan —a test that uses magnetic waves to make pictures of structures inside the body

Treatment

Once vaginal cancer is found, staging tests are done to find out if the cancer has spread and, if so, to what parts of the body. Treatments for vaginal cancer depend on the stage of the cancer.
Talk with your doctor about the best treatment plan for you. Treatment options include:

Radiation Therapy

Radiation therapy is the use of high-dose radiation to kill cancer cells and shrink tumors. Radiation is usually directed at the tumor from a source outside the body. In some cases, radioactive material may be temporarily placed near the tumor to expose the cancerous cells to a constant level of radiation. This is called an implant and generally requires a short hospital stay. Other radiation treatments are outpatient.

Surgery

This involves the surgical removal of a cancerous tumor and nearby tissues, and possibly lymph nodes. Depending on how far the cancer has spread outside the vagina, the doctor may remove the vagina, cervix, uterus, and sometimes the bladder, rectum, and parts of the colon.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. This treatment may be given as a topical cream, pill, or intravenous injection. Except for topical creams, in which the drug is applied directly on the walls of the vagina, chemotherapy drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells.

Prevention

While a Pap smear is an effective screening tool for cervical cancer, it cannot be relied upon to detect vaginal cancer. However, regular gynecologic exams may reduce the risk of death from vaginal cancer by providing your doctor with the opportunity to detect it earlier. If you were exposed to DES in the womb, tell your doctor so that he can be more aware of your risk for vaginal cancer and take steps to closely monitor you.
There is a vaccine available, called Gardasil, that protects against four types of the human papillomaviruses (HPV). Since HPV is associated with certain types of cancer, the vaccine helps to prevent cancers of the cervix, vulva, and vagina.

RESOURCES

American Cancer Society http://www.cancer.org/

Gynecologic Cancer Foundation http://www.thegcf.org/

CANADIAN RESOURCES

Canadian Cancer Society http://www.cancer.ca/

Canadian Women's Health Network http://www.cwhn.ca/

References

Andrassy, RJ, Wiener, ES, Raney, RB, et al. Progress in the surgical management of vaginal rhabdomyosarcoma: a 25-year review from the Intergroup Rhabdomyosarcoma Study Group. J Pediatr Surg . 1999; 34:731.

DeMatos, P, Tyler, D, Seigler, HF. Mucosal melanoma of the female genitalia: a clinicopathologic study of forty-three cases at Duke University Medical Center. Surgery . 1998; 124:38.

Frank SJ, Jhingran A, Levenback C, et al. Definitive radiation therapy for squamous cell carcinoma of the vagina. Int J Radiat Oncol Biol Phys . 2005;62:138-147.

Human papillomavirus vaccine. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated December 4, 2009. Accessed December 15, 2009.

Pandey M; Mathew A; Abraham EK; Ahamed IM; Nair KM. Primary malignant melanoma of the mucous membranes. Eur J Surg Oncol . 1998 Aug;24(4):303-7.

Vaginal cancer. American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/CRI%5F2%5F3x.asp?dt=55 . Accessed July 12, 2005.

Vaginal cancer. Gynecological Oncology Health Guide website. Available at: http://www/umm.edu/gyn/vaginal.htm . Accessed July 12, 2005.

Vaginal cancer (PDQ) treatment. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/vagina/patient . Accessed July 12, 2005.

What is vaginal cancer? American Cancer Society website. Available at: http://www.cancer.org/cancer/vaginalcancer/detailedguide/vaginal-cancer-what-is-vaginal-cancer . Updated August 2010. Accessed October 13, 2010.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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