Vaginal Cancer

Overview

Vaginal cancer is a rare type of cancer that affects the vagina and often does not show symptoms in its early stages. This emphasises the need for regular screenings. There are different types of vaginal cancer, with squamous cell carcinoma being the most common. Symptoms can include unusual vaginal bleeding, pain during sex, and abnormal discharge.

While the exact cause of the cancer is not yet found by researchers, HPV is believed to be a major risk factor. Treatment options that a doctor may recommend include surgery, radiation therapy, and chemotherapy. However, one may be able to prevent cancer risk by getting vaccinated against HPV, practising safe sex, and quitting smoking.

What is Vaginal Cancer?

Vaginal cancer is a rare cancer form that develops in the cells that line one’s vagina. The vagina, resembling a tube, is an organ that connects the lower uterus part (cervix) to the genitals (vulva). In many cases, uterine cancer or cervical cancer can spread to the vagina. The cancerous cells of the vagina grow rapidly and spread to distant or nearby organs and tissues in the later cancer stages. This disease is often hard to diagnose as it does not show symptoms in the early stages. Hence, getting screened regularly becomes essential.

Types of Vaginal Cancer

The different types of vaginal cancer are as follows:

Vaginal Squamous Cell Carcinoma

This cancer of the vagina accounts for about 90% of the cases. It occurs in the flat, thin squamous cells, that line the vaginal surface. The cancer may resemble ulcers (sores) or nodules (small lumps), and most commonly appears in the upper region of the vagina (most adjacent to the cervix).

Vaginal Melanoma

This rare form of vaginal cancer occurs in the skin cells that produce pigment and give colour (melanocytes) to the vagina. It accounts for about 3% of the cases and is very likely to start in the lower region of the vagina. Women in their 50s are more at risk of developing this cancer than those in their 20s or 80s.

Vaginal Adenocarcinoma

Around 10% of the vaginal cancer cases account for adenocarcinoma. The cancerous cells hide inside the vaginal canal and are challenging to diagnose or confirm if they spread into the vagina or nearby organs and tissues. These malignant cells or adenomatous cells start in the gland cells of the vaginal lining and are more common in young women.

Vaginal Sarcoma

Sarcoma is a rare type of vaginal cancer that develops in the muscle and connective tissues that build up the vaginal wall. These tissues are also responsible for the formation of bones, fats, cartilage and, muscle. Two types of sarcoma can develop in the vaginal lining, including rhabdomyosarcoma and leiomyosarcoma.

Vaginal Lymphoma

This type of vaginal cancer occurs in the lymph glands or the different parts of the lymphatic system. It is extremely rare and is found in women between the ages of 26 to 66. An individual may experience the usual symptoms of vaginal cancer, including vaginal discharge, vaginal lump and bleeding.

Symptoms of Vaginal Cancer

An individual may not experience any vaginal cancer symptoms unless their doctor observes malignant cell growth during a scheduled screening. While one’s body may often not alert them that something is wrong, common symptoms of vaginal cancer include pain during sex; bleeding from the vagina after intercourse; bloody, watery or foul-smelling vaginal discharge; vaginal bleeding after one has reached menopause; swollen legs, fistulas (in advanced cancer stages); a frequent urge to pee or feeling pain while urinating; a noticeable lump in the vagina; black-coloured stool or constipation; pelvic pain; and urging to poop even when bowels are empty.

Causes of Vaginal Cancer

The exact cause of vaginal cancer is not found yet by researchers. However, cancer occurs when the cells in the affected area show changes in their DNA. While in healthy cells, the DNA grows and multiplies at a set rate, the DNA in cancer cells make them grow and multiply rapidly. In this process, the healthy cells die and the malignant cells keep multiplying, causing abnormal growth. These cancerous cells form a tumour or mass, that grows to destroy and invade the healthy tissues/ gradually, the malignant cells spread outside the affected area and into the other body parts (metastasis).

Medical researchers believe that most vaginal cancer-causing DNA mutations are caused by the human papillomavirus (HPV), a virus that spreads through sexual contact. However, the risk of developing vaginal cancer increases due to other various factors. This includes an increasing age of at least 60 or more, being tested positive for the HPV virus (by having multiple sex partners), being diagnosed with VAIN or vaginal intraepithelial neoplasia, medical history of cervical dysplasia or cervical cancer, addiction to smoking, and exposure to diethylstilbestrol (DES - a medicine that prevents miscarriage).

Diagnosis of Vaginal Cancer

The diagnosis begins with a physical examination where a doctor asks about a patient’s symptoms. Staging is a process that helps medical experts see if the cancer has spread. This includes tests such as a Pap test and pelvic exam. Upon finding abnormal growth of cells, the patient may require to undergo other tests like a vaginal biopsy and a colposcopy. The imaging procedures that a doctor may recommend include cystoscopy, proctoscopy, CT scans, X-rays, MRI, and PET scans.

Further, the advancement of cancer is determined in the TNM system, which highlights if the cancer has spread to the vagina, lymph nodes or across other body parts. The stages of this system involve:

T (Tumour): This stage talks about how large the cancerous tumour is or if it has grown into the vaginal wall. It also determines if the cancer has spread near the pelvis wall.
N (Lymph Nodes): Here, the cancerous cells have spread to the lymph nodes in the groin or pelvis area.
M (Metastasis): This stage highlights that the cancer has spread to distant sites such as the distant organs or the distant lymph nodes.

Vaginal cancer is divided into 4 stages, emphasising how far has the cancer spread. This includes the following (besides the precancerous stage):
Vaginal Intraepithelial Neoplasia (VAIN): It is a precancer stage type, where there are malignant cells across the vaginal lining. These do not grow or spread yet, implying this stage is not cancer.

Stage 1: The cancer has only been found in the vaginal wall in this stage. While it has started to grow into the vaginal wall, it has not spread further.

Stage 2: The cancerous cells spread outside the walls of the vagina, into the surrounding tissues. In stage 2A, it has not reached the lymph nodes or the pelvic wall and is not bigger than 2 cm. While in stage 2B, the cancer has spread to the adjacent lymph nodes and the pelvic wall and is larger than 2 cm.

Stage 3: The malignant cells have spread outside the vagina and to the pelvic wall sides. Individuals who have blood in their wee may face complications in this stage. The cancerous cells may also be found in the lymph nodes adjacent to the vagina.

Stage 4: In this advanced vaginal cancer stage, the cancer has spread to the other, distant sites outside the vagina. In stage 4A, the cancer spreads to the rectum, the bladder, or both. In stage 4B, the cancerous cells extend to distant organs like bones, lungs, liver, and nodes.

Additionally, grading gives an overview of how slowly or quickly the cancerous cells may grow and spread across the affected and distant areas. Grading follows as:

• Grade 1: The cells resemble normal cells and can be known as well-differentiated or low-grade. They are likely to grow and spread slowly compared to higher-grade cancer cells.
• Grade 2: The cells here look prominently abnormal and tend to spread. It is also known as a moderate or moderately differentiated grade.
• Grade 3: The cancerous cells do not look like normal cells, rather look abnormal and show a tendency to divide, grow and spread rapidly. This is also called high grade or poorly differentiated grade.

Treatment for Vaginal Cancer

A doctor recommends vaginal cancer treatment based on factors such as cancer type, patient’s age and the cancer stage. However, common treatment options for invasive vaginal cancer may include chemotherapy, radiation therapy (external or internal), and surgery (partial or radical vaginectomy, pelvic exenteration and wide local excision). Precancerous cells may be treated through topical treatments and laser therapy.

Prevention of Vaginal Cancer

While one cannot prevent vaginal cancer, measures can be taken to reduce the risk of developing it. These involve quitting smoking, getting vaccinated against HPV (Cervarix, Gardasil 9 or Gardasil), and scheduling regular Pap tests and pelvic exams. Patients are also recommended to avoid heavy drinking.

Myths and Facts Related to Vaginal Cancer

Following are the myths and facts about vaginal cancer:

Myth 1: Vaginal Cancer Always Exhibits Symptoms
Fact: Vaginal cancer may not cause any symptoms in its early stages, making it difficult to diagnose. Hence, an individual must schedule regular screening tests to identify precancerous changes.

Myth 2: Vaginal Cancer is Mostly Hereditary
Fact: No, vaginal cancer is not hereditary, however, a family history of the same condition or other cancer types can increase the risk. The disease is mainly caused due to gene mutations resulting from the HPV virus, an STD acquired through intercourse.

Myth 3: One Cannot Prevent Vaginal Cancer
Fact: One can reduce the risk of developing cancer in the vagina by getting vaccinated against the HPV infection, practising hygiene and safe sex, and avoiding multiple or new sex partners and smoking.