I’ve been told that I have vaginal cancer. What is it exactly?
Vaginal cancer in Ireland is very rare. About 16 women are diagnosed with it each year. It is most common in women over the age of 60.
Cancer of the vagina is when normal cells in the vagina change and grow in an abnormal way. These cells can form a malignant tumour. When cancer cells develop in the vagina itself, it is called primary vaginal cancer. When cancer has spread into the vagina from another part of your body, it is called secondary vaginal cancer. For example, cancer can spread to the vagina from the neck of the womb (cervix) or the lining of the womb.
There are two types of vaginal cancer:
Squamous cell cancer
This is the most common type of vaginal cancer. It occurs mostly in the part of the vagina nearest to the cervix. It is more common in women between the ages of 60 - 80 and is usually caused by the human papilloma virus (HPV).
Adenocarcinoma affects the glandular cells in the vagina and is usually found in young women under 30 years old. It has been associated with exposure to diethylstilbestrol (DES). This drug was given to women at risk of miscarriage between 1945 and the early 1970s.
Other rare types include:
- Sarcoma of the vagina
- Melanoma of the vagina
- Small cell vaginal cancer
What are the risk factors for vaginal cancer?
The exact cause of vaginal cancer is unknown. However, there are some risk factors that can increase your chances of developing the condition:
- Age: usually affects women over the age of 60.
- Never been pregnant or had children.
- HPV (human papilloma virus).
- Radiotherapy used on the pelvis: women who have had radiotherapy in the pelvic area have a slightly higher risk, but it is still very rare.
- DES hormone drug: a hormone drug called diethylstilbestrol (DES) causes one type of adenocarcinoma of the vagina. Over 30 years’ ago, DES was prescribed to pregnant women to prevent miscarriages. Female children of the women who took DES have an increased risk of adenocarcinoma of the vagina, although it is still very rare.
What are the symptoms of vaginal cancer?
Early vaginal cancer may not cause any signs and symptoms. As it progresses, vaginal cancer may cause signs and symptoms such as:
- Vaginal bleeding, often after sex
- Abnormal vaginal discharge
- Pain during sex
- A lump or swelling
- An itch in the vagina that won’t go away
- Frequency and discomfort when passing urine
- Pain in the back passage (rectum)
How is vaginal cancer diagnosed?
How gynaecological cancer is diagnosed depends on what type of cancer is suspected. Pelvic exams, imaging tests, biopsies, colposcopy exam and possible diagnostic surgery are all methods of diagnosing gynaecological cancer.
Once cancer is confirmed, the stage of the cancer is determined and a treatment plan is developed. Staging refers to how far the cancer has spread to nearby tissue or organs. Among each of the various types of gynaecological cancer, early detection is crucial. However, detection can be very difficult, especially in the early stages.
Tests such as the following may be used for diagnosis:
- Transvaginal ultrasound: an ultrasound used to build up a picture of the tissues in your womb. During a transvaginal ultrasound a small metal ‘probe’, covered with a gel is inserted into the vagina. This creates the images for the scan. This test is not painful but may be a little uncomfortable.
- Hysteroscopy: a hysteroscope is a thin, flexible tube with a light at the end which is passed through the vagina and into the womb. This allows the doctor to look inside the womb and take tissue samples or a biopsy.
- Biopsy: a small amount of tissue samples are taken from the womb during a hysteroscopy. Biopsies are sent to a laboratory and looked at under a microscope to detect if cancer cells are present.
- D&C - dilatation and curettage: during a D&C the cervix and entrance to the womb are gently opened. Samples of tissue from the inner lining of the womb are taken with an instrument shaped like a spoon called a curette. The samples are then sent to the laboratory to be examined.
What is the treatment for vaginal cancer?
The main treatment options are:
There are a number of surgical options available for the treatment of vaginal cancer:
- Vaginectomy - the vagina and nearby tissues are removed.
- Radical hysterectomy - the womb, cervix and upper part of the vagina are removed as well as the nearby tissues.
- Pelvic exenteration - if the cancer has spread beyond the vagina, surgery may involve removing the affected organs such as the cervix or part of the lower bowel or bladder.
- Vaginal reconstruction.
- Lymphadenectomy - the lymph nodes near the vagina are removed.