Vaginal cancer

Vaginal cancer is one of the rarest gynecological cancers, accounting for around two per cent of cases. It most commonly affects women aged over 50 years. The vagina is part of the female reproductive system: a muscular canal about 7.5 cm long that extends from the neck of the uterus (the cervix) to the external genitals (the vulva).

In most cases, vaginal cancer is a secondary cancer. This means the cancer cells have spread to the vagina from somewhere else in the body, such as the cervix or vulva. About 95 per cent of cancers that start in the vagina itself are squamous cell carcinomas, which begin in the flat skin-like cells lining the vagina.

Some vaginal cancers cause no symptoms in the early stages and only become noticeable once they have invaded other parts of the body. They may first be suspected after an abnormal cervical screening test.

Symptoms of vaginal cancer#

Possible symptoms include:

• painless vaginal bleeding that is not related to menstruation
• bleeding after sexual intercourse
• a vaginal discharge that may smell unpleasant
• pain when passing urine or bowel motions
• ongoing pelvic pain

Risk factors#

Factors that can increase the risk of vaginal cancer include:

• advancing age – most women diagnosed are over 50 years
• a previous history of gynecological cancer, such as cancer of the cervix or vulva
• previous treatment for dysplasia (abnormal cells on the cervix, vagina or vulva)
• genital warts (human papillomavirus, or HPV, infection)
• cigarette smoking
• prenatal exposure to the synthetic hormone diethylstilbestrol (DES)
• vaginal adenosis, in which cells that normally line the internal cervix (endocervix) are also found on the vaginal walls

Some research suggests that long-term use of a pessary to treat a prolapsed uterus may irritate the vagina and potentially contribute to changes in vaginal cells.

DES and vaginal cancer#

Between 1938 and 1971, the synthetic hormone DES was prescribed to some pregnant women in the mistaken belief that it helped prevent miscarriage. It has not been prescribed for this purpose since 1971.

It is now known that DES exposure can cause health problems later in life for both the women who took the drug and the children they were carrying. A daughter exposed to DES before birth may have changes to her reproductive system, including an altered shape of the uterus and cervix. Many of these women have vaginal adenosis, which is a risk factor for clear-cell adenocarcinoma, the rare type of vaginal cancer associated with DES exposure. Unlike most vaginal cancers, this form tends to be diagnosed at a young age, typically between 14 and 33 years.

How vaginal cancer spreads#

As it grows, vaginal cancer usually spreads locally first, into nearby structures such as the bladder and bowel. In advanced cases it can spread through the lymphatic system or bloodstream to other organs, such as the lungs and liver.

Diagnosis#

Diagnosis is based on a number of investigations, which may include:

• a review of your medical history
• a physical examination, including a pelvic examination using an instrument called a colposcope
• a biopsy of the affected tissue, which may need to be done under anesthetic

Treatment#

Treatment depends on several factors, including your general health, the size and stage of the cancer, and whether it has spread to other parts of the body. Options can include:

• Surgery – may be used when the cancer is small. When the cancer is large or has come back, the vagina and surrounding tissues may need to be removed. Surgeons can create an artificial vagina using tissue from elsewhere in the body, such as the thigh, so that sexual intercourse is still possible. A radical hysterectomy may also be needed, in which the uterus, cervix, ovaries and fallopian tubes are removed, along with nearby lymph nodes and the upper part of the vagina. If the cancer has spread to other pelvic organs, such as the bladder or rectum, surgery may be needed to remove the affected tissues or organs.
• Radiation therapy – the use of precisely targeted x-rays to kill cancer cells. This can be given externally or as internal radiation therapy (brachytherapy), in which radioactive material is placed within or close to the tumor.

When the cancer has been diagnosed at a late stage and a cure is no longer possible, treatment focuses on improving quality of life by relieving symptoms. This is known as palliative treatment.

Key points#

• Vaginal cancer is one of the rarest gynecological cancers, and women aged over 50 are most commonly affected.
• Symptoms can include abnormal vaginal bleeding, bleeding after sex, unusual discharge, pain when passing urine or stool, and pelvic pain.
• When a cure is not possible, treatment focuses on improving quality of life by relieving symptoms.

Where to get help#