Vaginal cancer is the uncontrolled growth of abnormal cells in the vagina, which is also called the birth canal.

Cancer that starts in the vagina is called primary vaginal cancer. Primary vaginal cancer is rare, accounting for only about 2% of cancers affecting the female reproductive system. It is more common that cancer cells found in the vagina came from cancer that started elsewhere, such as the cervix. There are two main types of primary vaginal cancer:

• Squamous cell carcinoma � Cancer cells grow from the surface layer of the vagina's lining. This cancer usually develops slowly. It commonly develops in the upper part of the vagina near the cervix. According to the National Cancer Institute, this type of cancer usually occurs in women between ages 50 and 70. According to the American Cancer Society, squamous cell carcinomas account for 85% to 90% of vaginal cancers.



• Adenocarcinomas � Cancer cells form in the glands in the vaginal wall. According to the American Cancer Society, this type of cancer is more often diagnosed in younger women. A subtype, called clear cell adenocarcinoma, is the most common. Daughters of mothers who took the drug diethylstilbestrol (DES) while pregnant have a higher risk of developing this rare form of cancer. DES, which was introduced in the 1940s to help prevent miscarriages, was banned from use in the United States in 1971. The American Cancer Society estimates that approximately 5% to 10% of vaginal cancers are adenocarcinomas. This is the most common type of vaginal cancer in women who are younger than 20 years old.

As with cervical and vulvar cancer, there is a newly recognized precancerous lesion known as vaginal intraepithelial neoplasia or VAIN. The significance of this lesion seems to parallel that of a similar lesion that arises in the cervix and vulva. It may predispose to the development of invasive cancer and is commonly associated with human papilloma virus infections.

Other, less common types of vaginal cancer include malignant melanomas and sarcomas. Melanoma tends to affect the lower or outer part of the vagina. Sarcomas develop deep in the vaginal wall.

Symptoms of vaginal cancer can include:

• Abnormal vaginal bleeding, often after intercourse, that is not related to your period
• Unusual vaginal discharge
• A mass that can be felt
• Pain during intercourse
• Pain in the pelvic region
• Painful urination and constipation

Keep in mind that these symptoms more commonly occur in a number of less dangerous conditions, such as infections of the reproductive organs. These symptoms should always be evaluated by a health care professional.

Your doctor will ask about your medical history, symptoms and any risk factors you might have for vaginal cancer. The doctor will perform an internal pelvic exam and Pap smear. During a Pap smear, a small plastic stick and soft brush are used to collect cells from the vagina and cervix. These cells are examined for abnormalities. If the exam or Pap smear shows any abnormalities, additional tests may include:

• Colposcopy � An instrument with a magnifying lens is used to view the walls of the vagina and cervix.
• Biopsy � A small tissue sample is taken and examined in a laboratory for cancerous cells.

If cancer is diagnosed, more tests are done to determine how far the cancer has spread. These may include:

• Imaging tests, such as intravenous pyelogram to get views of the kidneys and bladder, barium enema to X-ray the colon, computed tomography (CT) scan, and bone or chest X-rays
• Endoscopic tests, such as cystoscopy to view the inside of the bladder or proctosigmoidoscopy to view the rectum and part of the colon

These are the stages of vaginal cancer:

• Stage 0 � This is a very early stage. Cancer appears only on the surface layer of the vagina.
• Stage I � Cancer is confined to the vagina but penetrates beyond the surface layer.
• Stage II � Cancer spreads to the connective tissue just beyond the vagina, but not to the pelvic wall or other organs.
• Stage III � Cancer spreads to the bones of the pelvis and/or other organs and lymph nodes in the pelvis on the same side as the tumor.
• Stage IVA � Cancer spreads to the rectum and bladder. The lymph nodes may be involved on both sides of the body.
• Stage IVB � Cancer spreads to other parts of the body, such as the lungs.
• Recurrent � Cancer returns after being treated. It can recur in the vagina or other parts of the body.

Unless treated, vaginal cancer continues to grow and spread.

To lower your risk of developing vaginal cancer, consider the following guidelines.

• Avoid human papilloma virus (HPV) infection � HPV is a common sexually transmitted disease that causes genital warts. Certain types of HPV are associated with cervical and vaginal cancer. If the vagina or cervix becomes infected with HPV, cells can grow abnormally, increasing the possibility of developing squamous cell cancer. The risk of HPV infection increases if you begin having intercourse at an early age or if you have unprotected sex at any age, have many sexual partners, or have sex with a person who has had many partners. To avoid HPV infection, always use condoms and limit the number of people you have sex with. Condoms cannot always prevent HPV infection but they can lower the risk of HIV and other sexually transmitted diseases.



• Get regular Pap tests. � Many vaginal squamous cell cancers develop from changes in the surface of the vagina that can be detected by a Pap test and treated before full cancer develops. In general, doctors recommend that a woman start to have regular Pap tests by the time she becomes sexually active or by age 21 at the latest. After three negative Pap tests (at least one year apart), your doctor may do the test every two to three years, depending on your age and your risk of developing cervical cancer. All women older than 40 should continue to have an annual pelvic examination.



• Do not smoke/quit smoking � Women with vaginal cancer are at increased risk of developing lung cancer. Since lung cancer is related primarily to tobacco use, this finding suggests a possible link between smoking and vaginal cancer.

The choice of treatment depends upon the type of cancer and its stage at the time of diagnosis. The treatment plan also takes into account a woman's age, overall health, fertility and personal considerations.

The two major treatments for vaginal cancer are radiation therapy and surgery. Chemotherapy has not proven to be very successful for this type of cancer. It is only being used with or without radiation for very advanced cancers, and then usually as part of a clinical trial. Several chemotherapy agents have shown some activity in this disease and include cisplatin, vinblastine, vincristine, bleomycin, mitomycin, carboplatin and irinotecan.

Various types of radiation therapy may be used, including external-beam radiation, internal radiation or a combination. External-beam radiation involves carefully targeting a beam of radiation at the cancer from a machine outside of the body. In internal radiation therapy, called brachytherapy, radioactive materials are placed inside the vagina. While external-beam radiation can harm nearby healthy tissues, brachytherapy can cause greater local side effects and scarring of the vaginal tissue.

There are two other types of internal radiation therapy. Low-dose brachytherapy involves placing radioactive material inside a cylindrical container, which is placed in the vagina for one to two days. Interstitial therapy involves placing radioactive materials directly into the cancer through needles.

Surgery is the treatment of choice only for a small group of vaginal cancers because vaginal cancer tends to involve more extensive, radical surgery than other cancers and may not be any more effective than radiation therapy. One exception includes treating stage I adenocarcinomas, which may be treated with a combination of limited surgery of the tumor and surrounding tissue, removal of lymph nodes and radiation to help to preserve fertility. Preserving fertility is important because these cancers are more common in younger women. Another exception is treatment of stage II squamous cancers for women who cannot have radiation therapy, usually because they already have received radiation therapy for another cancer in the past. The extent of surgery depends on the cancer's stage and size. Types of surgery include:

• Laser surgery � Using a narrow beam of light to kill cancer (useful in stage 0 cancers)
• Loop electroexcision � Using low-voltage, high-frequency radio waves in a thin loop of wire as a cutting device to remove superficial (stage 0) cancers
• Radical vaginectomy � Removing the vagina and adjacent tissues
• Vaginectomy combined with radical hysterectomy � Removing the vagina, the uterus and adjacent tissues
• Lymphadenectomy � Removing the lymph nodes in the groin or inside the pelvis
• Pelvic exenteration � Radical hysterectomy, vaginectomy and removal of the bladder, rectum and part of the colon.

If all or part of the vagina must be removed, the vagina can be reconstructed with tissue from another part of the body.

Contact your doctor if you develop any symptoms associated with vaginal cancer. Keep in mind that these symptoms can be associated with less dangerous conditions as well. You should always call your doctor right away if you have fevers associated with abdominal or pelvic pain. You might have a serious infection that needs treatment as soon as possible. Because of the relative rarity of vaginal cancer, it is advisable to seek the opinion of a specialist in gynecological oncology.

The outlook depends on the size and stage of the cancer when it is diagnosed. Early detection and treatment improves the prognosis.

The American Cancer Society reports the following 5-year survival rates for vaginal cancer:

• Squamous cell and adenocarcinomas
  • Stage 0 � 96%
  • Stage I � 73%
  • Stage II � 58%
  • Stage III/IV � 36%
• Melanoma (all stages) � 14%

National Cancer Institute (NCI)
U.S. National Institutes of Health
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Bethesda, MD 20892-2580
Phone: 301-435-3848
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TTY: 1-800-332-8615
Email: cancergovstaff@mail.nih.gov
http://www.nci.nih.gov/

American Cancer Society (ACS)
1599 Clifton Road, NE
Atlanta, GA 30329-4251
Toll-Free: 1-800-227-2345
http://www.cancer.org/