What is Vaginal Cancer?
Vaginal cancer occurs when normal cells in the vagina undergo changes and become uncontrolled. However, it is also possible for cancer to start in another part of the body and later spread to the vagina. Although vaginal cancer is a rare disease, it is recommended to monitor changes in the body and consult the gynecology department when an abnormal condition arises.
What Are the Types of Vaginal Cancer?
Vaginal cancer is divided into different types based on the relevant cells.
Vaginal Squamous Cell Carcinoma
Vaginal squamous cell carcinoma constitutes the majority of vaginal cancers. The average age of diagnosis for squamous cell carcinomas is around 60. Histologically, they resemble squamous cell tumors in other regions. Vaginal cancer is also associated with the human papillomavirus (HPV).
Verrucous carcinoma is a rare variant of vaginal squamous cell carcinoma. It has a low likelihood of being malignant, is generally locally aggressive, but appears as a large, wart-like, fungus-forming mass that rarely spreads to other organs. Histologically, it consists of large papillary leaves covered with dense keratin.
Vaginal Adenocarcinoma
Adenocarcinomas represent nearly all primary vaginal cancers in women under 20. Adenocarcinomas can arise in vaginal adenosis, Wolffian remnants, periurethral glands, and endometriosis foci. At the time of diagnosis, cancer is found in the early stages in about 70% of patients.
Vaginal Melanoma
Melanomas that occur in the vaginal mucosa are rare. The vast majority of reported cases have occurred in women of Caucasian descent. This type of vaginal cancer typically appears around the age of 60 (ranging from 22 to 84 years). The most common initial symptom is vaginal bleeding. They may appear as a blue-black or black-brown mass, plaque, or ulcer. More importantly, they are often non-pigmented.
Vaginal Sarcoma
The most common vaginal sarcoma is embryonal rhabdomyosarcoma (sarcoma botryoides), which appears in infancy and early childhood (average age, three years) as a highly malignant tumor. This sarcoma typically presents as soft nodules resembling a bunch of grapes that fill the vagina and sometimes protrude from it (botryoides comes from the Greek word botrys meaning “grape”).
What Are the Causes of Vaginal Cancer?
The risk factors for vaginal cancer are as follows:
- Human papillomavirus (HPV) infection
- Multiple sexual partners throughout life
- Early age at first intercourse
- Smoking and tobacco use
What Are the Symptoms of Vaginal Cancer?
- Vaginal bleeding is the most common clinical symptom of vaginal cancer. Many women do not show significant symptoms. Unexplained vaginal bleeding should be investigated to determine if the source is vaginal.
- Watery, bloody, or foul-smelling vaginal discharge can also be a symptom of vaginal cancer.
- The patient may notice a vaginal mass.
- Pain in the pelvis, resulting from the disease extending beyond the vagina, is present in 5% of patients.
How Is Vaginal Cancer Diagnosed?
The main components of diagnostic evaluation are as follows;
Physical Examination
First, the patient’s medical, surgical, and medication history should be taken. Then comes the physical examination. In this context, a complete pelvic examination is performed. A biopsy, or tissue sample, should be taken as soon as any abnormal area or lesion is detected.
Vaginal Cytology
Cytological examination is the study of cells taken from tissues or organs. A vaginal cytology sample should also be taken during the pelvic examination. 20% of vaginal cancers are incidentally detected as a result of cytological screening for cervical cancer.
Vaginal Colposcopy
If a lesion is not visualized and there are abnormal cytology results, colposcopy of the cervix and vagina should be performed with the aid of a contrast agent. Additionally, if a large lesion is visualized, some specialists may recommend performing vaginal colposcopy to examine the rest of the vagina.
Vaginal Biopsy
If an abnormal lesion is detected during the vaginal examination, a tissue sample is taken. This procedure is called a biopsy. The sample taken is sent to the laboratory for pathological examination to determine whether cancerous cells are present. Although anesthesia is generally not performed during the biopsy procedure, anesthesia may be applied for women with significant vaginal narrowing, elderly women, or for examination and biopsy.
Imaging Studies
Advanced imaging methods such as computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET), along with chest and skeletal radiography, can be used together or alone in treatment planning. The tests conducted provide detailed information about the tumor’s location, size, stages, and any metastases, leading to the most appropriate treatment planning.
What Are the Stages of Vaginal Cancer?
Vaginal cancer is classified into stages based on the spread of the tumor.
Stage 1
The tumor is at its smallest size. The spread is limited to the vaginal wall.
Stage 2
The tumor has grown a bit more and has invaded the vaginal wall.
Stage 3
Cancerous tissue has crossed the vaginal wall and spread to adjacent tissues. However, it has not yet spread to distant organs.
Stage 4
This is the most advanced stage of vaginal cancer. The tumor has spread to distant organs such as the lungs, liver, and bones, meaning it has metastasized.
How Is Vaginal Cancer Treated?
The most appropriate treatment is largely determined by the stage of cancer, its size, the patient’s age, any other medical issues, and the desire for pregnancy.
In vaginal cancer, treatment is generally performed surgically to remove the uterus, cervix, and upper part of the vagina. This is called a “radical hysterectomy.” Additionally, radiotherapy and chemotherapy are also preferred treatment methods depending on the stage of cancer and the location of the tumor.
Frequently Asked Questions
Does Vaginal Cancer Transmit Between Partners?
A patient with vaginal cancer cannot transmit cancer to their partner. However, if they carry the HPV virus, they can transmit that.
At What Age Is Vaginal Cancer Generally Seen?
Approximately 1 in 100,000 women will be diagnosed with in situ or invasive vaginal cancer (typically squamous cell histology). The average age of diagnosis for the most common vaginal cancer, squamous cell carcinoma, is around 60. However, the disease can occasionally be seen in women in their 20s and 30s. The older the patient, the more frequently squamous carcinoma is observed.
Does Vaginal Cancer Cause Pain?
The primary symptom of vaginal cancer is bleeding. Pain in vaginal cancer is detected in patients with advanced cancer that has involved bones and nerves.
Does Vaginal Cancer Recurrence?
As with any cancer, there is a risk of recurrence in vaginal cancer.
Does Vaginal Cancer Cause Irregular Menstruation?
Vaginal cancer itself does not cause irregular menstruation. However, bleeding caused by vaginal cancer may be perceived as irregular menstruation.
