Vaginal Cancer: Comprehensive Health Information

This information is provided by SSCHRC to help you understand vaginal cancer and its management. It is written in a patient-friendly and medically accurate style.

1. General Information

The vagina is a muscular tube, approximately three to four inches long, connecting the cervix (the lower part of the uterus or womb) to the vulva (the external female genitals).

Vaginal cancer is classified based on the type of cell where the malignancy originates. It is also possible for cancer that began in another part of the body to spread (metastasise) to the vagina. In such instances, the cancer is named after its primary site of origin (e.g., cancer that spread from the cervix to the vagina is still called cervical cancer).

Types of Vaginal Cancer

Squamous Cell Carcinoma

This is the most common form, starting in the lining of the vagina. It often develops slowly, sometimes over many years, and may begin as a pre-cancerous condition called vaginal intraepithelial neoplasia (VAIN). VAIN is frequently found in women with a history of hysterectomy, cervical cancer, or cervical pre-cancer.

Adenocarcinoma

This cancer starts in the glandular cells of the vagina and is most often diagnosed in women over 50.

Melanoma

A rare form of vaginal cancer that originates in the pigment-producing cells.

Sarcoma

A small number of vaginal cancers are sarcomas, which start within the vaginal wall. Rhabdomyosarcoma is the most common type and usually affects children.

Vaginal Cancer Risk Factors

A risk factor increases the chance of developing vaginal cancer. Key risk factors include:

Medical History

  • • DES (Diethylstilbestrol): A drug given to some pregnant women between 1940 and 1971 to help prevent miscarriage.
  • • Vaginal Adenosis: A condition where the cells lining the vagina change from squamous to glandular cells, seen particularly in women whose mothers took DES.
  • • Cervical Cancer or Pre-cancer: Women who have a history of cervical cancer have a higher risk.

Infections & Lifestyle

  • • Human Papillomavirus (HPV): Certain types of HPV infection can cause vaginal cancer, though most HPV infections rarely lead to cancer.
  • • Smoking
  • • Excessive Alcohol Consumption
  • • HIV (Human Immunodeficiency Virus)

Important Note: If you have risk factors, you should discuss them with your doctor.

2. Symptoms

Vaginal cancer symptoms can vary from woman to woman, and may include:

Potential Symptoms

  • • Abnormal vaginal bleeding, particularly after sexual intercourse
  • • Unusual vaginal discharge
  • • A mass or bump that can be felt in the vagina
  • • Pain during sexual intercourse (dyspareunia)
  • • Constipation
  • • Pain during urination (dysuria)
  • • Persistent pain in the pelvic area

Important Note: It is important to note that these symptoms can also be caused by non-cancerous conditions, such as infections. You should see a doctor if you notice any of these signs.

3. Diagnosis

The experts at SSCHRC utilise advanced technology and techniques for the accurate diagnosis of vaginal cancer.

If you have symptoms suggestive of vaginal cancer, your doctor will conduct an examination and ask questions about your health, lifestyle (including smoking and drinking habits), and family history.

Biopsy

The only definitive way to diagnose vaginal cancer. A small piece of tissue is removed and examined under a microscope. A colposcope (a magnifying device) may be used to help the doctor see the area clearly for tissue removal.

Imaging Exams

Used to look for cancer inside the body, help locate tumours, and track response to treatment. Types used for vaginal cancer include:

  • • CT or CAT (Computed Axial Tomography) scans
  • • MRI (Magnetic Resonance Imaging) scans
  • • PET (Positron Emission Tomography) scans
  • • Chest X-ray

Endoscopic Tests

  • Proctosigmoidoscopy: An endoscope is inserted into the rectum to view the rectum and colon. Biopsies can be taken during this procedure.
  • Cystoscopy: An endoscope is inserted into the bladder through the urethra. Biopsies can also be performed during this procedure.

Vaginal Cancer Staging

If you are diagnosed with vaginal cancer, your doctor will determine the stage of the disease. Staging is a way of classifying cancer based on how much disease is in the body and where it has spread. This process helps the doctor plan the best course of treatment.

The staging is most often described using the FIGO (International Federation of Gynaecology and Obstetrics) System, combined with the AJCC (American Joint Committee on Cancer) TNM system, classifying the disease into Stages 0 through IV.

4. Treatment

At SSCHRC, a team of experienced physicians provides personalised care, ensuring you receive the most advanced treatments while focusing on your quality of life. We treat a large number of women with vaginal cancer, which provides us with a high level of expertise.

Your treatment plan will be customised based on several factors, including:

  • • The type and stage of the cancer
  • • Your age and general health
  • • If you wish to have children

Treatment may involve a single therapy or a combination of two or more, such as chemotherapy and radiation therapy used together.

Surgery

May be used for early-stage vaginal cancer, sarcomas, or melanomas. Common surgical procedures include:

  • Laser Surgery: Used to treat pre-cancerous changes by burning off abnormal cells with a laser beam, but not used for invasive cancer.
  • Excision: Surgical removal of the cancer and a margin of surrounding healthy tissue.
  • Vaginectomy: Removal of all or part of the vagina.
  • Vaginal Reconstruction: Surgery performed after vaginectomy to create a new vagina from tissue or skin, allowing for sexual intercourse.
  • Lymphadenectomy (Lymph Node Dissection): Surgical removal of lymph nodes in the groin or pelvis if cancer has spread or to check for spread. Lymphedema (swelling due to decreased fluid drainage) is a potential side effect.
  • Pelvic Exenteration: A surgery rarely used for vaginal cancer, typically for recurrent cancer or when radiation is not a viable option. It involves removing the bladder, cervix, rectum, and part of the colon.

Chemotherapy

Drugs used to kill cancer cells, control their growth, or relieve symptoms. It may involve a single drug or a combination of multiple drugs.

Radiation Therapy

Uses powerful, focused beams of energy to destroy cancer cells while minimising harm to healthy tissue. SSCHRC provides advanced radiation treatments, including:

  • External Beam Radiation: Treatment delivered with a linear accelerator to precisely target the vaginal tumour, typically given daily over five weeks.
  • Brachytherapy: Often delivered after external beam treatment, involving the precise placement of tiny radioactive seeds or rods close to the tumour.

Immunotherapy and Targeted Therapy

Immune Checkpoint Inhibitors

A type of immunotherapy that prevents the immune system from prematurely shutting down its attack on cancer cells.

Targeted Therapy

Drugs designed to interfere with specific molecules that cancer cells rely on to survive, multiply, and spread. This intervention occurs at a cellular level.

Topical Therapy

A drug applied directly onto the cancer. This is typically not used for invasive vaginal cancer.