Vaginal cancer is a disease in which cancer cells grow in the vagina. The vagina is a tube that connects the vulva (external female genitals) to the cervix (lower end of the uterus). The vagina is also called the “birth canal.”

Cancer occurs when cells in the body (in this case vagina cells) divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue, called a growth or tumor, forms. The term cancer refers to malignant tumors, which can invade nearby tissues and spread to other parts of the body. A benign tumor does not invade or spread.

There are two forms of vaginal cancer:

Squamous Cell Carcinoma—occurs in the lining of the vagina

Adenocarcinoma—occurs in the area of the vagina lined with cells similar to those in the cervix and uterus. A special type of this cancer called clear cell adenocarcinoma occurs in women who were exposed to a drug called diethylstilbestrol (DES)—now banned—while in their mother’s womb. This drug was introduced in the late 1930s and no longer used after 1971, so the incidence of this particular type of adenocarcinoma is expected to decline with the exposed population.

Causes

The exact cause of vaginal cancer is unknown. However, several risk factors are known.

Risk Factors

A risk factor is something that increases your chances of getting a disease or condition.

The following factors increase your chances of developing vaginal cancer:

• Age: 60 and older

• History of cervical cancer

• History of precancerous conditions in the cervix or vagina

• Having a mother who took diethylstilbestrol (DES) while pregnant

• Human papillomavirus infection (HPV)—a sexually transmitted disease (STD)

• Vaginal adenosis—when cells lining the vagina look like those found in the cervix and uterus

• Smoking

Symptoms

If you experience any of these symptoms do not assume it is due to vaginal cancer. These symptoms may be caused by other, less serious health conditions. If you experience any one of them, see your physician.

Symptoms include:

• Bleeding or discharge not related to menstrual periods

• Pain or difficulty when urinating

• Pain during intercourse

• Pain in the pelvic area

• New or worsening constipation

• A mass in the vagina that can be felt

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam, including a pelvic exam. You may be referred to a doctor who specializes in women’s health (a gynecologist).

Tests may include:

• Pap Test—scraping and testing tissue from the inside of the cervix and upper vagina

• Colposcopy—using a lighted, magnifying instrument used to examine the vagina and cervix in great detail

• Biopsy—removal of a sample of vaginal tissue for testing

If cancer is found, additional tests are usually performed to determine whether or not it has spread to other parts of the pelvis or elsewhere in the body. Imaging studies, such as computed tomography and magnetic resonance, are often used for this purpose.

Treatment

Once vaginal cancer is found, staging tests are performed to find out if the cancer has spread and, if so, to what parts of the body. Treatments for vaginal cancer depend on the stage of the cancer.

Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Radiation Therapy—the use of high-dose radiation to kill cancer cells and shrink tumors. Radiation is usually directed at the tumor from a source outside the body. In some cases, radioactive material may be temporarily placed near the tumor to expose the cancerous cells to a constant level of radiation; this is called an implant and generally requires a short hospital stay. Other radiation treatments are done as an outpatient on a daily basis.

Surgery—surgical removal of a cancerous tumor and nearby tissues, and possibly lymph nodes. Depending on how far the cancer has spread outside the vagina, the doctor may remove the vagina, cervix, uterus, and sometimes the bladder, rectum, and parts of the colon.

Chemotherapy—the use of drugs to kill cancer cells. Chemotherapy may be given as a topical cream, pill, or intravenous injection. Except for topical creams, in which the drug is applied directly on the walls of the vagina, chemotherapy drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells.

Prevention

While a Pap smear is an effective screening tool for cervical cancer, it cannot be relied upon to detect vaginal cancer. However, regular gynecologic examinations may reduce the mortality from vaginal cancer by providing your physician with the opportunity to detect it earlier rather than later. Moreover, informing your physician that you may have been exposed to DES in the womb should will enable him or her to provide even closer surveillance.

Also, a vaccine to prevent HPV infection has been developed, and can prevent both vaginal and cervical cancers related to HPV infection. Talk to your doctor to learn more about this vaccine.

RESOURCES:

American Cancer Society
http://www.cancer.org

Center for Disease Control and Prevention (CDC) DES Update
http://www.cdc.gov/des

Gynecologic Cancer Foundation
http://www.thegcf.org

National Cancer Institute
http://www.cancer.gov

CANADIAN RESOURCES:

BC Health Guide
http://www.bchealthguide.org

Canadian Women's Health Network
http://www.cwhn.ca

References:

Frank SJ, Jhingran A, Levenback C, et al. Definitive radiation therapy for squamous cell carcinoma of the vagina. Int J Radiat Oncol Biol Phys. 2005 May 1;62(1):138-47.

Vaginal cancer. American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?dt=55. Accessed July 12, 2005.

Vaginal cancer. Gynecological Oncology Health Guide website. Available at: http://www/umm.edu/gyn/vaginal.htm. Accessed July 12, 2005.

Vaginal cancer (PDQ) treatment. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/vagina/patient. Accessed July 12, 2005.