What Is Vaginal Cancer?

Overview

Vaginal cancer is a rare condition that develops in the tissues of the vagina (known as a birth channel). Vagina is a 2 to 10 cm long tube that connects the cervix (lower part of your uterus) and the vulva (genitals).¹

The American Cancer Society estimates that 1 in 1100 individuals assigned female at birth (AFAB) may acquire vaginal cancer over their lives. 

About 1-2% of cancerous reproductive cancers are a result of primary vaginal cancer.¹ In the UK around 250 new viginal cancer cases are reported every year and globally aorund 13200 AFABs are diagnosed with vaginal cancer each year. 

Types of vaginal cancer

There are different types of vaginal cancer and the name of the types indicate the where the cancer started in your vagina. 

Squamous cell carcinoma

Squamous cell cancers, which begin in the vagina lining, account for the majority of vaginal carcinomas. These malignancies often take years to grow slowly. Vaginal intraepithelial neoplasia (VAIN), a precancerous condition, is frequently where they start. AFABs who have undergone surgery to remove their uterus or those who have cervical cancer, or cervical pre-cancer are more likely to develop VAIN.

Adenocarcinoma

The majority of AFABs over 50 are affected by this cancer, these begin in the gland cells of the vagina. A subtype of adenocarcinoma known as clear-cell adenocarcinoma affects younger AFABs (those under 50). This occurs in younger AFABs whose mothers were exposed to a drug called DES during their pregnancy. 

Melanomas

This specific variety of vaginal cancer begins in the cells that give your vigina its colour. This type of cancer is vaginal cancer is extremely rare. 

Sarcomas

Sarcomas which begin within the vaginal wall, account for a tiny percentage of vaginal cancers. Rhabdomyosarcoma, the most prevalent form, is typically detected in younger people.

Cancer that starts in another region of the body can occasionally spread to the vagina. Under such cases the cancer is named after the place where is originated first. For example, cancer in the Cervical and vaginal region is referred to as cervical cancer, similarly, cancer in the vulvar and vaginal region is called vulvar cancer. 

Stages of vaginal cancer

For staging and categorizing vaginal cancer, the FIGO and the American Joint Committee on Cancer have published recommendations. Based on the clinical standards, vaginal cancer is divided into four stages, they are ²

• Stage 1: In this stage, the cancer is found only in the vaginal wall
• Stage 2: In this stage, the cancer has spread to the tissue next to the vagina. It is spreads upto the sub-vaginal region but not to the pelvic wall
• Stage 3: In this stage, the cancer has spread to the nearby nearby lymph nodes and to the pelvic wall
• Stage 4: In this stage, the cancer has spread beyond the pelvis to other parts of the body like bladder or rectum mucosa

Causes of vaginal cancer

Most vaginal malignancies have an unknown specific source. But researchers have discovered possible risk factors that can increase your chances of getting vaginal cancer. The risk factors include_;

• Administration of Diethylstilbestrol (DES) to certain pregnant AFABs between1940 and 1971 in an effort to prevent miscarriages
• Vaginal adenosis: In certain AFABs, particularly those whose mothers used DES, the squamous cells in the vagina convert to endometrial (or glandular) cells.
• Human papillomavirus (HPV)
• HIV (human immunodeficiency virus)
• Pre-cancer or cervical cancer
• Smoking
• Excessive alcohol consumption 

Signs and symptoms of vaginal cancer

Not everyone with vaginal cancer experience symptoms. It may be unnoticed until your healthcare provider notices it during your routine screening. Some symptoms that you might experience include

• Painful, abnormal vaginal bleeding (usually not related to your mentrual cycle)
• Vaginal bleeding after menopause
• Watery, foul smelling vahinal discharge
• A mass that may be felt
• Pain during sexual intercourse
• Pain the pelvic region
• Pain when peeing
• Constipation
• The urgure to pass motion even when your bowel is empty

Diagnosis of vaginal cancer

Your healthcare provider will start the diagnosis by enquiring about your symptoms, medical history, life style etc followed by which one or more of the following test may be required. 

Biopsy

A biopsy is the only method to determine for certain if you have vaginal cancer. A tiny portion of tissue is taken, and it is examined under a microscope after that. A colposcope may be used by your doctor to enlarge the region and make it simpler to remove the tissue.

Image analysis

Imaging examinations, such as:

• Computed axial tomography, or CAT scans
• Scans using magnetic resonance imaging (MRI)
• Scans using PET (positron emission tomography)
• Chest X-ray

Endoscopy

Endoscopic examinations, such as:

• Proctosigmoidoscopy: This procedure uses an endoscope to examine the colon and rectum.
• Cystoscopy: The urethra is used to put an endoscope into the bladder

Management and treatment for vaginal cancer

Vaginal cancer treatment depends on varioys factors like type of cancer, stage of the cancer, age of the patient etc.Your doctor might encourage you to take part in clinical trials to try new treatments.  

Treatments for vaginal pre-cancer

Many low-grade VAIN incidents can resolve on their own, therefore some doctors might choose to closely monitor patients without introducing therapy. Treatment is often begun if the VAIN area doesn't go away or worsens. 

Treatments for invasive vaginal cancer includes

Radiation therapy for vaginal cancer

The most popular kind of treatment for vaginal cancer is radiation therapy. It includes destroying cancer cells using high-energy rays (such as gamma rays or x-rays) or particles (like electrons, protons, or neutrons). The radiation theraphy can be external radiation theraphy or internal radion theraphy.

Surgery for vaginal cancer

Only minor stage I or stage II vaginal cancers and tumours that did not respond to radiation therapy are often treated with surgery. The size, location, and stage of the cancer will all affect how extensive the operation will be. Types of surgery, include¹

• Local excision
• Vaginectomy
• Trachelectomy 
• Hysterectomy

Chemotherapy

Chemotherapy medications either kill cancer cells, slow their development, or alleviate symptoms of the disease. Depending on the cancer's kind and rate of growth, chemotherapy may use a single medicine or a mixture of two or more.

Additionally, it can be administered together with other therapies, including radiation therapy and targeted therapy. Patients may also get chemotherapy to reduce tumour size prior to surgery. It can also be used following surgery to get rid of any residual cancer cells.

According to research from the National Cancer Database, combination chemoradiation treatment (CCRT) is increasingly being used for AFABs with vaginal cancer and is linked to considerable improvement. 

Treatment guidelines for vaginal cancer should include CCRT. CCRT has been used well enough to treat vaginal cancer in addition to cervical cancer. Data on CCRT vs radiation treatment alone is limited due to the rarity of vaginal cancer.¹

Prevention of vaginal cancer

Prevention of vaginal cancer is not possible but you can minimise your risk of getting vaginal cancer by

• Vaccination with HPV vaccines
• Going for regular pelvic exams
• Avoid smoking and drinking

FAQs

How can I prevent vaginal cancer?

It is not possible to prevent vaginal cancer from occuring but you can reduce your risk of getting vaginal cancer by scheduling regular pelvic exams, taking HPV Vaccinations and making like style changes. 

How common is vaginal cancer? 

Vaginal cancer is a very rare cancer. In the UK only around 250 cases get reported annually and around 13200 cases get reported globally. 

When should I see a doctor?

It is advisible to visit your doctor in you experience any of the symptoms of vaginal cancer.

It is ideal to schedule regular pelvic exams with your healthcare provider as sometimes people with vaginal cancer experience no symptoms. 

Summary

Vaginal cancers are rare cancers that occur in the vagina. Despite the rarity of vaginal cancer, AFABs should take extra precautions to avoid contracting it. AFABs over 50 should undergo periodic medical examinations to ensure their safety. You should also try to avoid the potential risk factors to reduce your chances of getting vaginal cancer. If you or your loved ones are diagnosed with vaginal cancer, proper treatment should begin right away.