HEALTH: VAGINAL CANCER (VAGINA CANCER SYMPTOMS & TREATMENT)

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HEALTH - VAGINAL CANCER (VAGINA CANCER SYMPTOMS & TREATMENT)

What is Vaginal Cancer?

Vaginal cancer is a rare cancer that occurs in the vagina, the muscular tube that connects the uterus with the outer genitals. Vaginal cancer most commonly occurs in the cells that line the surface of the vagina, which is sometimes called the birth canal. The vagina (birth canal) is the opening through which menstrual fluid leaves the body and babies are born. It is connected to the cervix (the opening of the uterus or womb) and the vulva (folds of skin around its opening).

Usually, the vagina is in a collapsed position with its walls touching. The walls have many folds that allow the vagina to open and expand during sexual intercourse and vaginal childbirth. The vaginal lining is kept moist by mucus released from glands in the cervix.

The vaginal walls have a thin layer of cells called the epithelium, which contains cells called squamous epithelial cells. The vagina wall, underneath the epithelium, is made up of connective and involuntary muscle tissue, lymph vessels, and nerves.

Vaginal cancer begins when normal cells in the vagina begin to change, grow uncontrollably, and no longer die, forming a mass called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous).

While several cancers can spread to your vagina from other places in your body, cancer that begins in your vagina (primary vaginal cancer) is rare. Vaginal cancer comprises only 2 to 3 percent of gynecologic cancers in women. About 2,400 women are diagnosed with vaginal cancer each year in the United States, according to the American Cancer Society.

Women with early-stage vaginal cancer have the best chance for a cure. Vaginal cancer that spreads beyond the vagina is much more difficult to treat.

Four types of vaginal cancer:

Squamous cell carcinoma. Squamous cell carcinoma is a type of skin cancer that begins in the cells lining the vagina, most often in the area closest to the cervix. Squamous cell cancer makes up 85% to 90% of vaginal cancers in women. It develops slowly through a precancerous condition (changes in cells that may, but do not always, become cancer) called vaginal intraepithelial neoplasia (VAIN).

Adenocarcinoma. Adenocarcinoma begins in the vaginal gland tissue. It accounts for 5% to 10% of vaginal cancers in women.

Clear cell adenocarcinoma. This cancer occurs in young women whose mothers took the drug diethylstilbestrol (DES) during pregnancy between the late 1940s and 1971. It is estimated that one woman in 1,000 exposed to DES will develop vaginal cancer.

Melanoma. Melanoma is another type of skin cancer that is usually found on skin exposed to the sun, but it can begin on the skin of the vagina or other internal organs. Melanoma often appears as a dark-colored tumor on the lower or outer parts of the vagina.

Health: Risk Factors of Vaginal Cancer (Vagina)

Certain factors may raise your risk of vaginal cancer, though women with no known risk factors can also develop vaginal cancer.

The following factors may increase the risk of developing vaginal cancer in women:

• Vaginal intraepithelial neoplasia (VAIN). Women with VAIN have an increased risk of vaginal cancer. In women with VAIN, cells in the vagina appear different from normal cells, but not different enough to be considered cancer. A small number of women with VAIN will eventually develop vaginal cancer, though doctors aren't sure what causes some cases to develop into cancer and others to remain benign.

• Human papillomavirus (HPV) infection.HPV is a sexually transmitted virus that can increase the risk of vaginal cancer and other cancers. There are many types or strains of HPV, and some are linked with genital or anal cancer in men and women. HPV also causes the majority of cervical cancers and precancerous changes in the cervix.Many types of cancer caused by HPV are associated with precancerous conditions that develop before the cancer.

• DES. Women whose mothers took this drug during their pregnancy between the late 1940s and 1971 have an increased risk of a certain type of vaginal cancer called clear cell adenocarcinoma. The average age of diagnosis is 19. Because most women of mothers who took DES are between 30 and 60, the number of cases has declined. However, the long-term risks of DES exposure are not known.

• Hysterectomy. Women who have had a hysterectomy (removal of part or all of the uterus) have an increased risk of vaginal cancer.

• Radiation therapy. Women who have had radiation therapy in the vaginal area have an increased risk of vaginal cancer.

• Pessary. Long-term vaginal irritation from using a pessary (a device used to keep a sagging uterus in place) can increase a woman’s risk of vaginal cancer.

• Cervical cancer. Women who have had cervical cancer or cervical precancerous conditions have an increased risk of vaginal cancer.

• Age. Squamous cell carcinoma most often occurs in women between 50 and 70 years old; approximately half of women with vaginal cancer are over 60 years old.

• Smoking. Smoking may increase a woman’s risk of developing vaginal cancer.

• Sexual intercourse. Engage in sex at an young age increases the risk of cancer of the vagina.

• Multiple sexual partners. Engage in sex with multiple partners raises the health risk of vaginal cancer.

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Health: Symptoms of Vaginal Cancer (Vagina)

Vaginal cancer does not often cause symptoms in the early stages, but cancer in more advanced stages can cause symptoms. Even precancerous conditions, such as VAIN, may not cause symptoms. However, many cases of VAIN and early vaginal cancer can be found through regular gynecologic examinations or Pap tests.

Women with vaginal cancer may experience the following symptoms. Sometimes, women with vaginal cancer do not show any of these symptoms. Or, these symptoms may be caused by an health condition that is not cancer. About 5 - 10% of patients have no symptoms. If you are concerned about a symptom on this list, please talk with your doctor or health care provider.

The most common symptom of vaginal cancer is abnormal vaginal bleeding. Vaginal bleeding during or after menopause is not normal and is always a sign of an health problem.

Other symptoms of vaginal cancer include:

• Abnormal vaginal discharge that may be bloody and foul smelling
  
  
• Difficulty or pain when urinating
  
  
• Pain during sexual intercourse

• Unusual vaginal bleeding, such as after intercourse or after menopause

• Lump or mass in your vagina
  
  
• Pain in the pelvic area (the lower part of the abdomen between the hip bones)
  
  
• Pain in the back or legs
  
  
• Edema (swelling) in the legs

• Constipation

Vaginal cancer may spread (metastasize) to distant areas of your body, such as your lungs, liver and pelvic bones.

Health: Diagnosis of Vaginal Cancer (Vagina)

Vaginal cancer is sometimes found during a routine pelvic exam before symptoms become evident. During a pelvic exam, your doctor carefully inspects the outer exposed part of your vagina, and then inserts two fingers of one hand into your vagina and simultaneously presses the other hand on your abdomen to feel your uterus and ovaries. He or she also inserts a device called a speculum into your vagina. The speculum widens your vagina so that your doctor can check your vagina and cervix for abnormalities.

Your doctor may consider these factors when choosing a diagnostic test:

• Age and health condition
  
  
• The type of cancer suspected
  
  
• Severity of symptoms
  
  
• Previous test results

In addition to a physical examination, the following tests may be used to diagnose vaginal cancer:

Pelvic examination. 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. The doctor gently scrapes the outside of the cervix and vagina and takes a sample of cells for testing. During the process, there is some pressure but seldom pain. 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.

Colposcopy. The doctor may do a colposcopy to check the vagina and cervix for any abnormalities. A special instrument called a colposcope (an instrument that magnifies the cells of the cervix and vagina, similar to a microscope) is used. The colposcope gives the doctor a lighted, magnified view of the tissues of the vagina and the cervix. The colposcope is not inserted into the woman’s body and the examination is not painful, can be done in the doctor’s office, and has no side effects. It can be performed on pregnant women.

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed during the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease). The type of biopsy performed will depend on the location of the tissue being biopsied.

If the biopsy indicates that vaginal cancer is present, the doctor will refer the woman to a gynecologic oncologist, a doctor who specializes in treating this type of cancer. The specialist may suggest the following tests to see if the cancer has spread beyond the vagina.

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (special dye) is injected into a patient’s vein to provide better detail.

Endoscopy. This test allows the doctor to see inside the body. The person may be sedated, and the doctor inserts a thin, lighted, flexible tube called an endoscope through the mouth, anus, vagina, urethra, or a small surgical opening.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient’s vein to create a clearer picture.

Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body and absorbed by the organs or tissues being studied. This substance gives off energy that is detected by a scanner, which produces the images.

X-ray. An x-ray is a picture of the inside of the body. For instance, a chest x-ray can help doctors determine if the cancer has spread to the lungs.

Health: Staging of Vaginal Cancer (Vagina)

After vaginal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the vagina or to other parts of the body.

The process used to find out if cancer has spread within the vagina or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.

Stage 0: The tumor is called carcinoma in situ. In other words, the cancer is found only in the first layer of cells lining the vagina, not in the deeper tissue.

Stage I: The tumor has not spread through the vaginal wall or to other parts of the body.

Stage II: The tumor has spread through the vaginal wall, but not to the walls of the pelvis.

Stage III: Vaginal cancer is called stage III in either of these conditions:

• Cancer has spread to the lymph nodes in the pelvis regardless of how far the tumor has spread.
  
  
• Cancer has spread to the pelvic wall (except the bladder), but not the lymph nodes.

Stage IVA: Cancer has spread to the bladder, rectum, or beyond the pelvis. The lymph nodes may or may not be involved.

Stage IVB: Cancer has spread to the lymph nodes and other parts of the body.

Recurrent vaginal cancer

Recurrent vaginal cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the vagina or in other parts of the body.

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Health: Conventional Treatment for Vaginal Cancer (Vagina)

The treatment of vaginal cancer depends on the size and location of the tumor, whether the cancer has spread, and the woman's overall health. In addition, treatment may also be based on whether the woman plans to have children. Women with vaginal cancer may have concerns about if or how their treatment may affect their sexual function and fertility, and these topics should be discussed with the health care team before treatment begins.

Vaginal cancer is most often treated with one or a combination of treatments: surgery, radiation therapy, and/or chemotherapy. Each treatment is described in more detail below, followed by an outline of treatment options based on the stage and type of the disease.

Surgery

Surgery is the primary treatment for vaginal cancer. The goal of surgery is to remove the tumor. The type of surgery used depends on the stage of the cancer and other factors. The following surgical procedures may be used:

• Laser surgery: Laser surgery is the use of a focused beam of light that burns the cancer off the skin. It can be used to remove precancerous cells or a tumor. Additional tissue surrounding the tumor (called a margin) also may be removed to be certain that all cancer has been destroyed.



• Wide local excision: A surgical procedure that takes out the cancer and some of the healthy tissue around it. Vaginal repair using skin from other parts of the woman's body may be necessary.



• Vaginectomy: Surgery to remove all or part of the vagina, which may include the pelvic lymph nodes. Often, a plastic surgeon can create a new vagina with grafts of tissue from other parts of the woman’s body. The woman will be able to have sexual intercourse, but she will need to use a lubrication aid.



• Total hysterectomy: Surgery to remove the uterus, including the cervix. If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision in the abdomen using a laparoscope, the operation is called a total laparoscopic hysterectomy.



• Lymphadenectomy: A surgical procedure in which lymph nodes are removed and checked under a microscope for signs of cancer. This procedure is also called lymph node dissection. If the cancer is in the upper vagina, the pelvic lymph nodes may be removed. If the cancer is in the lower vagina, lymph nodes in the groin may be removed.



• Pelvic exenteration: Surgery to remove the lower colon, rectum, and bladder. In women, the cervix, vagina, ovaries, and nearby lymph nodes are also removed. Artificial openings (stoma) are made for urine and stool to flow from the body into a collection bag.

Many women experience a range of feelings after vaginal surgery, such as loss, sadness, or anxiety. Some women may feel that they have lost their identity as women. Others have questions about whether sexual intercourse can continue after surgery.

Before surgery, it is important to ask the surgeon about the procedure, the possible side effects, and when sexual intercourse can resume. Women should talk with their doctors about finding additional information or support in coping with this surgery.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. Radiation therapy may be used alone or after surgery. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body.

When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. One method is intracavity radiation therapy, in which tiny tubes of a radioactive substance are placed in the vagina for one to two days. The woman must stay in bed during this time. Another method is interstitial radiation therapy, in which radioactive material is injected directly into the tumor.

Side effects depend on the dose used, the area targeted, and the type of radiation therapy (internal or external). General side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most of these side effects go away soon after treatment is finished. Specific side effects may include the narrowing of the vagina, damage to healthy vaginal tissue, and irritation of the intestines. The vagina may shorten and narrow so much that sexual intercourse is not possible. To prevent this, the vagina may need to be stretched with a plastic tube called a vaginal dilator several times a week.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. The goal of chemotherapy can be to destroy cancer remaining after surgery, slow tumor growth, or reduce side effects.

Although chemotherapy can be given orally (by mouth), most drugs are given intravenously (IV) for vaginal cancer. IV chemotherapy is either injected directly into a vein or through a catheter, a thin tube temporarily put into a large vein to make injections easier. Intravaginal chemotherapy (the drugs are put directly into the vagina) may be used to treat early-stage vaginal cancer.

The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. Other potential side effects include the inability to become pregnant and symptoms of premature menopause.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.

Recurrent vaginal cancer (vagina)

If the cancer returns after the original treatment, surgery may be performed to remove the cervix, uterus, lower colon, rectum, and/or bladder, depending on where the recurrence began and the type of surgery previously performed. Radiation therapy and/or chemotherapy may also be used for treatment. Participation in clinical trials is another treatment option.

Advanced vaginal cancer (vagina)

Stage IV vaginal cancer is the most advanced stage of the disease. At this stage, the cancer has spread beyond the vagina to the bladder, rectum, lymph nodes of the pelvis, or other organs, such as the bones or lungs. The symptoms of advanced vaginal cancer are similar to those experienced when the disease was first diagnosed.

• Unusual vaginal bleeding
  
  
• Abnormal vaginal discharge
  
  
• Difficulty or pain when urinating
  
  
• Pain during sexual intercourse
  
  
• Pain in the pelvic area
  
  
• Pain in the back or legs
  
  
• Nausea and vomiting
  
  
• Abnormal bowel function

Women with advanced vaginal cancer that has spread to the bladder and rectum may receive internal radiation therapy and external-beam radiation therapy or surgery, which may be combined with radiation therapy.

Treatment for advanced vaginal cancer that has spread to other parts of the body may include radiation therapy to relieve symptoms and chemotherapy. Patients with stage IV vaginal cancer may consider participating in clinical trials.

Health: Lifestyle Changes During and After Treatment of Vaginal Cancer (Vagina)

It's important to work on your overall health while you're undergoing cancer treatments and beyond. Eating well, managing stress and getting adequate exercise can all help promote good health.

Eating well
Good nutrition is especially important for people undergoing cancer treatment. But eating well can be difficult for a time if your treatment includes chemotherapy or radiation therapy. You may feel nauseated or lose your appetite, and foods may taste bland or unpleasant. You may find that the last thing you want to do is plan meals.

Even so, eating well during cancer treatment can help you maintain your stamina and your ability to cope with the side effects of treatments. Good nutrition may also help you prevent infections and remain more active.

Remember these strategies for eating well when you don't feel well:

• Eat protein-rich foods. Foods high in protein can help build and repair body tissues. Choices include eggs, yogurt, cottage cheese, peanut butter, lean meat, poultry, fish, beans and lentils.

• Keep an open mind about the foods you might eat. Something that is unappealing today might taste better to you next week.

• When you do feel well, make the most of it. Eat as many healthy foods as you can. Prepare meals that you can easily freeze and reheat. Also look for low-fat frozen dinners and other prepared foods.

• Pack calories into the foods you eat. For example, spread butter, jam or honey on bread. Sprinkle foods with chopped nuts.

• Eat smaller amounts of food more frequently. If you can't face the thought of a large meal, try eating small amounts of food more often. Keep fruits and vegetables handy for snacking.

Staying active
Even if you don't feel well, try to stay physically active. A regular, short walk or climbing the stairs can keep your muscles from deteriorating due to lack of use. Exercise can also help prevent fatigue, reduce anxiety and help prevent depression.

Health: Prevention of Vaginal Cancer (Vagina)

All women should have an annual gynecologic examination. During this exam, the doctor will take a family medical history and perform a general physical examination of the pelvis, during which the doctor will feel a woman’s uterus, vagina, cervix, and other reproductive organs to check for any unusual changes. Regular pelvic examinations can help detect cancer or precancerous conditions at an early stage. In addition, research has shown that certain factors can help prevent vaginal cancer.

• Delaying first sexual intercourse until the late teens or older
  
  
• Avoiding sexual intercourse with multiple partners
  
  
• Avoiding sexual intercourse with someone who has had many partners
  
  
• Practicing safe sex, including condom use (although condoms cannot fully protect against HPV)
  
  
• Having regular Pap tests to detect and treat precancerous conditions
  
  
• Not starting to smoke
  
  
• Quitting smoking, if a smoke

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Disclaimer:    This information is not presented by a medical practitioner.  Therefore any content of this site is strictly intended for educational and informational purpose only.  Any access to this site is strictly on a voluntary basis and at the sole discretion of the user.  No content of this site is intended as a substitute for medical advice, diagnosis or treatment, nor constitute the practice of any medical profession or health care provider.  The information provided on this site is here to educate visitors on health issues that may affect their lives.  Otherwise, always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition.  And never disregard professional medical advice or delay in seeking it because of something you have read.

Sources:  NIH News In Health/National Institutes of Health/National Library of Medicine/Dept of Health and Human Services

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