Understanding vaginal cancer

Vaginal cancer is a rare form of cancer that develops in the vagina.

The vagina is an elastic, muscular passage that connects the neck of the uterus (cervix) to the vulva. It is approximately 7.5 to 10 cm in length, and it has the following tissue layers:

• Epithelial tissue - A thin layer of squamous cells that forms the lining of the vaginal wall.
• Connective tissue - A layer of fibrous tissue with nerves, muscles, and lymph vessels beneath the epithelium.

Types of vaginal cancer

1. Squamous cell carcinoma - This is the most prevalent type of vaginal cancer, accounting for approximately 70-90% of cases. It most likely develops in the upper part of the vagina, near the cervix.
2. Adenocarcinoma - It may be more challenging to diagnose as it is more likely to be concealed within the vaginal canal. This type of vaginal cancer can affect young women.
3. Sarcoma - Vaginal sarcomas are cancers that develop in the connective tissues.
4. Melanoma - Vaginal melanoma is a rare cancer originating from melanocytes, the pigment-producing cells. It most likely affects the lower part of the vagina.

Symptoms of vaginal cancer

Almost 20% of women are asymptomatic at the time of diagnosis. These vaginal cancers may only be detected during routine cervical screening. If you experience any of the symptoms below, consult a gynaecologist.

• A growth or lump in the vagina
• Ulcers or skin changes in and around the vagina
• Postmenopausal bleeding or in between menstrual period
• Pain during sexual intercourse
• Bleeding after sexual intercourse
• Vaginal discharge that is blood-stained or smelly
• Vaginal itch

Symptoms of advanced cancer may include:

• Pelvic pain
• Constipation
• Swelling in your legs
• Blood in urine, increased frequency of urination

Risk factors for vaginal cancer

The following risk factors may increase your risk of developing vaginal cancer:

• Women aged 75 years and older. It is rarely seen in women younger than 40 years old.
• Human papillomavirus (HPV)
• History of cervical cancer
• Human immunodeficiency virus (HIV) infection or Acquired Immuno-deficiency Syndrome (AIDS)
• Weakened immune system
• Exposure to diethylstilbestrol (DES)
• Smoking

Diagnosis of vaginal cancer

Your doctor would first question your general health and symptoms before conducting a thorough physical examination. Diagnosis is made based on your reported symptoms, physical examination, and investigations.

1. Pelvic examination
   • During a pelvic examination, your doctor typically conducts an internal examination by using a speculum and colposcope to examine the vulva and inside the vagina.
   • A speculum is a device used to gently hold the vagina open to provide a clear view of the cervix.
2. Colposcopy
   • The colposcope is a specialised magnifying instrument with a light source attached. It remains outside your body and does not enter your vagina.
   • Your doctor positions the colposcope near the opening of your vagina and uses it to closely examine the vagina.
   • If any abnormal areas are identified, your doctor may perform a biopsy where a small sample of tissue is removed to be examined under the microscope.
3. Imaging tests
   • Computed tomography (CT) scan, magnetic resonance imaging (MRI), or positron emission tomography (PET) scan may be performed to determine the extent of the cancer and if it has spread to other areas.

Treatment options for vaginal cancer

The treatment recommended by your doctor will depend on several factors, including the type and stage. Radiotherapy, surgery, and chemotherapy are common treatments.

1. Radiotherapy
   • Radiation inhibits the growth of cancer cells by exposing them to high-energy X-rays.
   • It may be recommended in various situations, including for primary treatment, post-surgery, to prevent recurrence of cancer, to treat lymph nodes near the vagina, in combination with chemotherapy, and to treat vaginal cancer that could not be entirely removed by surgery.
   • You may have external radiotherapy, internal radiotherapy (brachytherapy) or a combination of both.
2. Surgery
   • Surgery may be done for the early stages of vaginal cancer.
   • Surgeries involve removing:
     • Part of the vagina, only if the tumour is small and in the upper part of the vagina.
     • All of the vagina and lymph nodes may be removed as well.
     • Vagina, cervix, uterus, and can include removal of fallopian tubes and ovaries (hysterectomy).
     • Vagina, cervix, ovaries, fallopian tubes and all or parts of the bladder, rectum, and bowel, only if cancer has spread and other treatment options are not possible.
3. Chemotherapy
   • Drugs are taken orally or intravenously to kill cancer cells.
   • Typically, chemotherapy is administered concomitantly with radiotherapy (chemoradiotherapy).

Prevention of vaginal cancer

There are currently no effective ways to prevent vaginal cancer. However, there are measures you can take to help reduce your risk of developing the disease:

• Practice safe sex - Use condoms to reduce the risk of HPV and other sexually transmitted infections (STIs).
• Reduce the number of sexual partners - This may lower your risk of exposure to HPV and other STIs.
• Go for regular screenings - Routine Pap smears and pelvic exams can help detect precancerous changes or early-stage vaginal cancer.
• Get vaccinated - Speak to your doctor about HPV vaccination.
• Healthy diet and regular exercise - Eat plenty of fruits, vegetables, and whole grains, engage in regular physical activity, and sustain a healthy body weight.
• Quit smoking - Smoking is a risk factor for various cancers, including vaginal cancer.

Make an appointment at Gleneagles Hospitals

If you are experiencing any of the symptoms of uterine cancer, get in touch with us to find out more about our Gynae-oncology Services at your nearest Gleneagles Hospital.

Gleneagles Hospital works with gynae-oncologists to assist patients through cancer treatment. The caring and multidisciplinary team of healthcare professionals are available for consultation and to provide the best care.