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Everything You Need to Know About Vaginal Cancer

Vaginal cancer is a rare type of cancer that starts in the vagina. It accounts for about 2 percent of female genital cancers, the National Cancer Institute (NCI) estimates.

There are several main types of vaginal cancer, including:

  • Squamous cell. This type of cancer starts in the vaginal lining and develops slowly. It accounts for approximately 9 out of 10 vaginal cancer cases, according to the American Cancer Society (ACS).
  • Adenocarcinoma. This type of cancer starts in the vaginal gland cells. It’s the second most common type of vaginal cancer and is most prevalent in women over 50.
  • Melanoma. As with the more common skin cancer type of melanoma, this type of cancer starts in the cells that give skin color.
  • Sarcoma. This starts in the vaginal walls and accounts for only a small percentage of vaginal cancers.

In early stages, vaginal cancer treatment has a high success rate.

You’ll notice that the language used to share stats and other data points is pretty binary, fluctuating between the use of “female” and “women.”

Although we typically avoid language like this, specificity is key when reporting on research participants and clinical findings.

Unfortunately, the studies and surveys referenced in this article didn’t report data on, or include, participants who were transgender, nonbinarygender nonconforminggenderqueeragender, or genderless.

Early stage vaginal cancer that only affects the lining of the vagina may not have any symptoms. In these cases, it may be discovered during a routine pelvic exam.

What are the symptoms of vaginal cancer?

But cancer that has spread to other tissues tends to cause symptoms.

The most common is abnormal vaginal bleeding.

This includes bleeding after:

  • menopause
  • bleeding during or after sex
  • bleeding in between menstruation

The bleeding may also be heavier or go on for longer than usual.

Other symptoms include:

  • vaginal discharge that’s watery, smells, or is bloodstained
  • painful or frequent urination
  • pelvic pain, especially during sex
  • a lump or mass in the vagina
  • constant itchiness in the vagina
  • constipation
  • blood in stool or urine
  • back pain
  • swollen legs
  • fistulas, in later stage cancer

Many of these symptoms can be caused by something other than cancer, so it’s important to see a doctor or other healthcare professional (HCP) to rule these issues out.

What causes vaginal cancer and who is at risk?

The ACS says that the exact cause is unknown in most cases. But vaginal cancer has been linked to the following:

  • Human papillomavirus (HPV). This sexually transmitted infection is the most common cause of vaginal cancer, according to the National Health ServiceCancer Research UK says that in most people, HPV is harmless. But persistent infection with high risk types of the virus can result in cancer over time.
  • Previous cervical cancer. HPV often causes cervical cancer as well.
  • In utero exposure to diethylstilbestrol (DES). This medication used to be given to pregnant people to prevent miscarriage. However, doctors stopped prescribing it in the 1970s. Vaginal cancer caused by DES is now extremely rare.

There are also a number of other risk factors for vaginal cancer, including:

  • having had a previous hysterectomy, whether it was for a benign or malignant mass
  • smoking, which the ACS says more than doubles the risk of vaginal cancer
  • age — it’s rare in people younger than 40, with almost half of cases occurring in women who are 70 years or older
  • a weakened immune system, according to Cancer Research UK, which can occur as a result of conditions like HIV or lupus
  • early exposure to HPV through sexual activity
  • changes in the cells that line the vagina, known as vaginal intraepithelial neoplasia (VAIN)
  • previous womb cancer, especially if you were treated with radiotherapy

Having any of these risk factors doesn’t mean you’ll develop vaginal cancer. Similarly, having none of them doesn’t mean it’s impossible for you to develop vaginal cancer, either.

How is vaginal cancer diagnosed?

First, a doctor or other HCP will take your medical history to find out more about your symptoms and possible risk factors. They’ll then do a pelvic exam to look for possible causes of your symptoms and carry out a Pap smear to check for any abnormal cells in your vaginal area.

If the Pap smear shows any abnormal cells, your doctor will do a colposcopy. This is a procedure where a magnifying instrument called a colposcope is used to examine your vaginal walls and cervix to see where the abnormal cells are.

It’s similar to a usual pelvic exam: You’ll be in stirrups, and your doctor will use a speculum. Once your doctor knows where the abnormal cells are, they’ll take a biopsy to see if the cells are cancerous.

If the cells are cancerous, a doctor or other HCP will most likely do an MRI, CT scan, or PET scan to see if the cancer has spread to other parts of the body.

Staging

Vaginal cancer stages tell you how far the cancer has spread. There are four main stages, plus one precancerous stage of vaginal cancer:

  • Vaginal intraepithelial neoplasia (VAIN). VAIN is a type of precancer. There are abnormal cells in the vaginal lining, but they’re not growing or spreading yet. VAIN isn’t cancer.
  • Stage 1. Cancer is only in the vaginal wall.
  • Stage 2. Cancer has spread to the tissue next to the vagina but hasn’t yet spread to the pelvic wall.
  • Stage 3. Cancer has spread further into the pelvis and pelvic wall. It might’ve also spread to nearby lymph nodes.
  • Stage 4. Stage 4 is divided into two substages:
    • In stage 4A, cancer has spread to the bladder, rectum, or both.
    • In stage 4B, cancer has spread further throughout the body to organs, such as the lungs, liver, or more distant lymph nodes.

How is vaginal cancer treated?

If the cancer is stage 1 and in the upper third of the vagina, you might have surgery to remove the tumor and a small area of healthy tissue around it. This is usually followed by radiotherapy.

Radiotherapy is the most commonly used treatment in all stages of vaginal cancer. In some cases, you might have chemotherapy to support the radiotherapy. However, there’s little evidence for the benefit of chemotherapy for vaginal cancer.

If you’ve already received radiotherapy in the vaginal area, a doctor or other HCP will likely recommend surgery. This is because each part of the body can only undergo a certain amount of radiation.

Depending on the size, location, and margins of your tumor, they might remove:

  • only the tumor and a small area of healthy tissue around it
  • part or all of the vagina
  • most of your reproductive or pelvic organs

Stage 4b cancer is generally not curable, but treatment can relieve symptoms. If this is the case, a doctor or other HCP might recommend radiotherapy or chemotherapy. It might also be possible to enroll in a clinical trial to help test new treatments.

Are complications possible after treatment?

Some side effects are short term, but others can be permanent — this is often because organs that sit close to the vagina, like the bladder and rectum, can be damaged during treatment.

Radiotherapy

As radiotherapy can affect healthy cells as well as cancerous ones, Cancer Research UK says you may experience the following during treatment and for a short while after it finishes:

  • soreness in the area being treated
  • pain while urinating
  • tiredness
  • nausea or vomiting
  • diarrhea
  • vaginal discharge

Radiotherapy can affect your sex life, too — it can cause scar tissue, making the vagina narrower and sex potentially uncomfortable.

Vaginal dryness can also lead to further discomfort during sex.

Your medical team should be able to support you in this area, offering the likes of dilators and lubricants to help.

Additionally, your bladder may become less elastic. You may feel the need to urinate more often.

External radiotherapy to the pelvis can also cause early menopause, which means you won’t be able to become pregnant. People in early menopause can have children by other means, such as adoption and surrogacy.

Surgery

All forms of surgery can come with pain immediately afterward, as well as a risk of infection and blood clots.

But smaller operations tend to have fewer risks than bigger ones.

Sex can be affected.

If you have a vaginal reconstruction, the lining of your vagina won’t be able to produce mucus. So you’ll likely need to use lubricant during sexual activity to avoid dryness and irritation.

Similarly, scar tissue can narrow the vaginal entrance. This can potentially make penetrative vaginal sex painful and more difficult.

In some cases, the bladder or rectum may need to be removed. If this happens, you’ll need to pass urine or feces in a different way. A surgeon can make a hole in your stomach and attach a bag, called a colostomy bag, to collect waste products.

Sometimes, the rectum can be reconstructed, making a colostomy bag only a temporary measure.

Other potential risks of surgical treatment include:

  • lymphedema, or swollen legs, which is more likely if you have lymph nodes removed from your groin
  • early menopause if the ovaries are removed
  • a higher risk of deep vein thrombosis

Chemotherapy

Chemotherapy comes with a similar list of side effects as radiotherapy. It, too, can damage healthy cells.

Side effects include:

  • nausea or vomiting
  • tiredness
  • breathlessness
  • hair loss or thinning
  • a higher risk of infections

Is there anything you can do to prevent vaginal cancer?

While you may not be able to decrease your risk of vaginal cancer to zero, there are steps you can take to help reduce it:

  • Take steps to lower your risk of HPV. This includes using condoms and other barrier methods whenever you have any type of sex (vaginal, oral, or anal) and getting the HPV vaccine. To find out more about the HPV vaccine, talk with a doctor or other HCP.
  • If you currently smoke, consider quitting. Smoking is a major lifestyle risk factor for vaginal cancer and other cancers.
  • Drink only in moderation. There’s some evidence that heavy drinking increases your risk of vaginal cancer.
  • Get regular pelvic exams and Pap smears. This will help your doctor or other HCP find precancers before they turn into vaginal cancers or find vaginal cancer early before it spreads or causes serious symptoms.

What’s the outlook for people who have vaginal cancer?

Overall, the ACS estimates vaginal cancer has a five-year survival rate of 49 percent. Survival rates differ greatly by stage.

For localized cancers, there’s a five-year survival rate of 66 percent. Vaginal cancer that has spread to distant parts of the body has a survival rate of 21 percent. Survival rates also depend on how far the cancer has spread and where it has spread to.

The NCI lists certain other factors that can affect survival rates, too. For example, women over the age of 60 have lower survival rates. Women with symptomatic vaginal cancer upon diagnosis and those with tumors in the middle or the lower third of the vagina also have lower survival rates.

These stats were based on cancer diagnoses and treatments from 5 years ago and may not reflect your experience. New breakthroughs in treatment mean that the outlook for cancer diagnosed today could be different.

Sources:

https://www.healthline.com/health/vaginal-cancer#outlook

https://www.nhs.uk/conditions/vaginal-cancer/#:~:text=Vaginal%20cancer%20is%20a%20very,the%20human%20papillomavirus%20(HPV).

https://www.mayoclinic.org/diseases-conditions/vaginal-cancer/symptoms-causes/syc-20352447

https://www.cancerresearchuk.org/about-cancer/vaginal-cancer/risk-causes

https://www.cancer.org/cancer/vaginal-cancer/causes-risks-prevention/what-causes.html

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