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Vaginal Cancer: Symptoms, Causes, Tests and Treatment

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Vaginal cancer is a rare type of cancer that affects women. The vagina is a tube-like organ that connects the cervix (the lower part of the uterus) to the vulva (the outside female genitals). The vagina is lined by a layer of flat cells called squamous cells. This layer of cells is also called epithelium because it is formed by epithelial cells. At birth, a baby passes through the vagina as he or she is born, so the vagina is sometimes also known as the birth canal.

Vaginal cancer

Who gets vaginal cancer?

Vaginal cancer is more common in women age 60 and older. Almost half of cases occur in women who are 70 years old or older. Only about 15% of cases are found in women younger than 40.

What are the different types of vaginal cancer?

There are different types of vaginal cancer, which affect different types of cells in the vagina. These include:

  • Squamous cell carcinoma: The most common type of vaginal cancer. Squamous cell carcinoma accounts for about 70% of all cases. This cancer begins in the cells that line the vagina and occurs near to the cervix.
  • Adenocarcinoma: This type of cancer begins in gland cells in the vagina. It accounts for about 15% of vaginal cancer, usually affecting women over age 50. Clear cell adenocarcinoma is the exception, often affecting younger women who were exposed to DES in their mother’s womb.
  • Melanoma: A more rare form of vaginal cancer, making up about 9% of all cases. Melanoma usually occurs in the outer portion of the vagina.
  • Sarcoma: A rare form of vaginal cancer that makes up about 4% of cases. This type of cancer begins within the walls of the vagina, not on the surface. There are different types of sarcoma. Rhabdomyosarcoma is the most common and is mostly found in children. Leiomyosarcoma occurs more commonly in women over 50.

What causes vaginal cancer?

Women who have the human papillomavirus (HPV) are more likely than other women to develop this rare cancer. Women who have been infected with herpes simplex virus are also at higher risk for vaginal cancer.

A stronger risk factor, however, is if a woman’s mother took a medicine called diethylstilbestrol (DES) when she was pregnant between 1940 and 1971. Women whose mothers took DES – known as DES daughters – develop clear-cell adenocarcinoma of the vagina or cervix more often than women in the general population. There is about one case of this type of cancer in every 1,000 daughters of women who took DES during their pregnancy.

Another risk factor is having had cancer of the cervix.

Smoking doubles a woman’s risk of vaginal cancer.

What are the symptoms of vaginal cancer?

Vaginal cancer often has no noticeable symptoms, meaning it is often advanced by the time it is diagnosed. For this reason, it is important to get regular well-woman exams, which can sometimes diagnose vaginal and cervical cancer before any symptoms are noticed.

Symptoms may include:

  • Bleeding from the vagina, often after intercourse, not related to menstruation
  • Pain during intercourse
  • Abnormal vaginal discharge
  • A noticeable mass in the vagina
  • Painful urination
  • Constipation
  • Pelvic pain

Although 8 out of 10 women with invasive vaginal cancer have one or more of these symptoms, most of the time these symptoms are likely to be much less serious than vaginal cancer. Still, you should see your doctor as soon as possible if you have any of these symptoms.

How is vaginal cancer diagnosed?

Your doctor will begin your examination by asking about your symptoms. You will then most likely be given several tests, including a pelvic exam, a Pap test, and a vaginal biopsy. These can all be done in your doctor’s office.

If your Pap test shows abnormal cells in your vagina or cervix, you will need to have a test called a colposcopy. This can also be done in your doctor’s office. In this procedure, your doctor will use an instrument called a colposcope to examine the cervix and vagina and look for abnormal cells. He or she will also likely take a tissue sample, called a biopsy, to examine your cells for cancer in the laboratory.

How is vaginal cancer treated?

Treatment for vaginal cancer depends on the type of cell, the stage of cancer (how advanced it is), and your age. A young woman who has not yet had children may receive a different type of treatment with the goal of preserving her fertility.

Your doctor will determine the best treatment plan for you. In general, early non-advanced types of cancer and precancerous cells may be treated with laser surgery and topical treatments.

Vaginal cancer is staged in three ways, based on how far the tumor has progressed in the vagina, whether it has spread to the lymph nodes, and whether it has spread to other parts of the body. These three categories are called T (tumor), N (nodes), and M (whether it has metastasized, or spread).

Invasive or advanced vaginal cancer will often require radiation, surgery, and chemotherapy. Often, all three may be used by your doctors in treating your cancer.

What is the outlook for vaginal cancer?

Your prognosis for vaginal cancer depends on the stage at which is it diagnosed. Early stage vaginal cancers can often be successfully treated, and you can go on to a full life. The National Institutes of Health reports an overall 5-year survival rate of 80% to 90% for early stages.

Later stage cancers are harder to treat and may require ongoing chemotherapy and other treatment options. For this reason it is important to get regular gynecological exams, even when you feel healthy, and seek medical advice at the first sign of symptoms.

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