What is Vaginal Cancer?
Vaginal cancer is the malignancy of the vaginal tissues. Vaginal cancer can be primary or secondary. Primary vaginal cancer is the type of cancer wherein the malignant cells initially grow on the vaginal cells. Secondary vaginal cancer is metastases from other forms of cancer. Secondary vaginal cancer is more common than primary.
Vaginal cancer develops more often among women aged 50 years old or older; however, it can occur at any age. In fact, documented cases of vaginal cancer include cases during infancy.
Cellular changes in primary vaginal cancer have two types including:
Squamous cell carcinoma. This is the most common cellular change in vaginal cancer, which involves the presence of malignant cells on the thin lining of the vaginal mucosa. It usually occurs in women above 50 years of age.
Adenocarcinoma. Adenocarcinoma arises from the glandular cells in the vagina, which secretes vaginal fluid. This type of cancer is common among women below 30 years of age. Furthermore, this type of vaginal cancer is the most common reason for metastases.
Other subtypes of vaginal cancer include clear cell cancer, which developed among women born between 1938 and 1973, because of the use of diethylstilbestrol (DES) by their mothers. DES was given to pregnant women to prevent premature labor and miscarriage. The exposure to DES increases the risk for squamous cell carcinoma of the vagina and breast cancer in their offspring.
Vaginal cancer, which can develope in infants and children, are also germ cell tumors. These cells arise from the germ layers during uterine development. Sarcoma botryoides are also found among infants and children, and is a type of a rhabdomyosarcoma.
vaginal cancer location in females
Source – pakistancancercare.
Signs and Symptoms
Vaginal cancer is often asymptomatic and the diagnosis is made through a routine gynecologic exam. If symptoms are present, they usually include:
- Abnormal vaginal bleeding that may occur after intercourse, before puberty, between menses and after menopause.
- Painful urination or dysuria.
- Painful sexual intercourse or dyspareunia.
- Pain in the pelvic area.
- Tumor in the vaginal mucosa.
Causes and Risk Factors
The exact cause of vaginal cancer is unknown, but certain risk factors contribute to its development such as:
Exposure to diethylstilbestrol. Women exposed to DES in utero or who have taken DES, have a high risk for developing vaginal cancer, especially adenocarcinoma of the vagina. The drug is not given at present because of the discovery that is increased the risk for certain diseases including cancer.
Human Papilloma Virus Infection. HPV causes genital warts in men and women. The presence of HPV increases the tendency to develop reproductive system cancers such as cervical and vaginal cancer. HPV infection is sexually transmitted, which means that having multiple sexual partners increases the risk for HPV infection.
Being sbove 50 years of age. Age has been a contributing factor for vaginal cancer because increasing age increases the long-term exposure to certain types of carcinogens, which changes the characteristics of cells.
History of other reproductive system malignancies. Previous malignancies in the reproductive system, specifically cervical cancer, increase the risk for secondary vaginal cancer.
Diagnostic tests for vaginal cancer include:
Pelvic examination involves the physical examination of the cervix, fallopian tubes, uterus, ovaries, rectum and vagina. This usually involves insertion of gloved fingers in the vagina, while the other hand palpates the abdomen. This test identifies the shape, size and positioning of the pelvic organs. The examiner also palpates the rectum for any lumps or tumors. During the pelvic examination, a vaginal speculum is also inserted to check the vagina and cervix. A tissue sample may also be taken for Pap smear purposes.
Pap smear involves the collection of vaginal and cervical tissues by the use of cotton stick, wooden stick or brush, and subjecting it to examination under a microscope. This test is able to identify any cellular changes in the vaginal cells.
This procedure involves the visualization of the vagina and cervix through a lighted scope. During colposcopy, tissue samples from the tumor may also be taken for biopsy.
The most reliable test for vaginal cancer is biopsy. This involves excision of the vaginal tumor and subjecting the specimen for biopsy to determine if the cells are malignant or benign.
Staging of vaginal cancer involves certain tests to determine extent of metastases and size of the tumor. These tests include Chest X-ray, cystoscopy (visualization of the bladder and urethra), uteroscopy (visualization of the uterus), proctoscopy (visualization of the rectum and sigmoid colon), CT scan, MRI, and lymphangiogram (x-ray of the lymphatic system). These procedures determine any metastases to the involved areas of the diagnostic tests.
Staging of vaginal cancer is outlined in the following discussion:
Stage 0 or carcinoma in situ
This stage of vaginal cancer involves the presence of malignant cells on the tissues in the vaginal lining.
Stage I vaginal cancer involves the presence of tumor on the vagina itself. This stage is also known as localized cancer.
Stage II vaginal cancer involves the spread of the malignant cells in the tissues adjacent to the vagina. This may include the muscularis area and subcutaneous layer.
In this stage, the cancer cells have already spread on the lymph nodes in the pelvic area and may have spread to other reproductive organs such as the cervix, uterus, fallopian tube and ovaries. This involves regional metastases to adjacent pelvic organs.
Stage IV vaginal cancer involves two stages:
Stage IVA- This stage involves the spread of the cancer cells on the bladder or rectum and organs beyond the pelvis such as in the abdominal cavity.
Stage IVB- In this stage, the malignant tumor has already spread to distant areas in the body such as the lungs, breasts, bones and others. The metastases are due to the lymphatic circulation.
Vaginal cancer also tends to reoccur even after treatment. Recurrence of vaginal cancer is usually more serious and may reoccur in other areas of the body.
Vaginal cancer, just like any other cancers have three standard treatment regimens, which includes surgery, chemotherapy and radiation.
Surgery is the usual management for vaginal tumors. Surgery may involve one or more of the following:
- Wide local excision. This surgical procedure involves the removal of the tumor along with some normal tissues around it to make sure that all malignant cells are removed.
- Laser surgery. This type of surgery is used to allow bloodless incisions on the tissue or tumor using a laser beam. This technique may be used for localized tumor growth.
- Lymphadenectomy. This involves the surgical removal of the affected lymph nodes. Pelvic and groin lymph nodes may be removed to prevent further spread of the malignant cells in the lymphatic circulation.
- Vaginectomy. This involves the partial or total removal of the vagina. Skin grafting may be done to repair the vagina.
- Pelvic exenteration. In cases of late stage vaginal cancer, where almost all organs in the pelvic cavity has been affected, removal of the rectum, bladder, descending colon, cervix, ovaries, vagina and adjacent lymph nodes may be done. In this case, a stoma is created for the evacuation of feces and urine from the body into a collection bag. This surgery is disfiguring and the patient may deal with social and personal difficulties.
- Hysterectomy. Removal of the uterus and cervix may be done if the malignant tumor has spread on this area. Removal of the fallopian tubes (salpingectomy) and ovaries (oophorectomy) may also be done as indicated.
Chemotherapy is usually given as adjunct therapy after surgery to remove all cancer cells that have probably circulated to other parts of the body. Chemotherapy may be systemic, regional or local. Systemic chemotherapy involves the administration of chemotherapeutic drugs by mouth or through intravenous infusions. Regional chemotherapy is administered through the spinal column, organ or specific body cavity. This type of chemotherapy releases the drugs on a regional area of the body. Lastly, local chemotherapy may involve the topical application of chemotherapeutic drugs on the vaginal wall in cases of Stage I squamous cells carcinoma.
This is also an adjunct therapy for surgery to prevent spread of malignant cells and stop the growth of tumors. Radiation therapy uses high energy radiation that may either be placed internally or externally. Internal radiation is placed on the tissues affected through seeding, needles, catheters or wires. On the other hand, external radiation involves the exposure of the body to radiation from a machine. The radioactive rays are usually directed to specific areas in the body.
Radiosensitizers are also given to maximize the effects of radiation therapy. These are drugs given to patients to increase the sensitivity of tumor cells to radiation.
Treatment options by stage
Treatment options for vaginal cancer also depend on the stage of the disease. These include:
Stage 0- May involve wide local excision, laser surgery, total or partial vaginectomy, topical chemotherapy and internal radiation.
Stage I- Involves either internal radiation therapy, wide local excision, vaginectomy, vaginal reconstruction, lymphadenectomy or hysterectomy.
Stage II – Treatment may include vaginectomy, pelvic exenteration, internal radiation therapy and external radiation therapy.
Stage III- Treatment may involve internal or external radiation therapy with surgery.
Stage IV- May involve radiation therapy, chemotherapy, and surgery with trial use of radiosensitizers.
Recurrent vaginal cancer may also involve the above treatment regimen.
The prognosis of vaginal cancer includes factors such as the stage of cancer, tumor size, age, general health condition, recurrence and location of the tumor. Vaginal cancer tends to be more uncommon than other cancers in the reproductive tract. Vaginal cancers treated during the early stage of the disease have far better prognosis. Early detection is essential in early management. However, since vaginal cancer tends to be asymptomatic, more cases are being detected during the late stages, which may be too late. In order to address this, a yearly gynecologic examination is essential for women above 40 years of age.
The survival rate of cancer, especially of the squamous cell carcinoma type, has a high 5-year survival rate. Stage I vaginal cancer has a survival rate of 84%, stage II has 75% and Stage III and IV has a 57% survival rate. It is, therefore, essential that vaginal cancer be detected early to increase the survival rate of patients.
Proofreaded by Alison on 22/10/2012
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