Vaginal cancer

From MayoClinic.com
Special to Health

Introduction

Vaginal cancer is a rare cancer that occurs in the vagina — the muscular tube that connects the uterus with the outer genitals. Vaginal cancer most commonly occurs in the cells that line the surface of the vagina, which is sometimes called the birth canal.

Vaginal cancer most commonly affects women older than 60. However, vaginal cancer can occur at any age.

While several cancers can spread to the vagina from other places in the body, cancer that begins in the vagina (primary vaginal cancer) is rare. Vaginal cancer comprises only 1 percent to 3 percent of gynecologic cancers. About 2,400 women are diagnosed with vaginal cancer each year in the United States, according to the American Cancer Society.

Women with early-stage vaginal cancer have the best chance for a cure. Vaginal cancer that spreads beyond the vagina is much more difficult to treat.

Signs and symptoms

Early vaginal cancer may not have any signs and symptoms. As it progresses, vaginal cancer may cause signs and symptoms such as:

• Unusual vaginal bleeding, such as after intercourse or after menopause
• Watery vaginal discharge that may be bloody and foul-smelling
• Lump or mass in the vagina
• Frequent urination
• Blood in urine
• Constipation
• Pelvic pain

Causes

In general, cancer begins when healthy cells acquire a genetic mutation that turns normal cells into abnormal cells. Healthy cells grow and multiply at a set rate, eventually dying at a set time. Cancer cells grow and multiply out of control, and they don't die. The accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby tissues and can break off from an initial tumor to spread elsewhere in the body (metastasize).

It isn't clear what causes the genetic mutation that leads to vaginal cancer. Researchers have identified factors that may increase your risk of vaginal cancer.

The majority of vaginal cancers begin in the squamous cells. These thin, flat cells line the surface of the vagina. Other less common types of vaginal cancer include:

• Vaginal adenocarcinoma, which begins in the glandular cells on the surface of the vagina
• Vaginal melanoma, which develops in the pigment-producing cells (melanocytes) of the vagina
• Vaginal sarcoma, which develops in the connective tissue cells or smooth muscles cells in the walls of the vagina

Risk factors

Certain factors may raise your risk of vaginal cancer, including:

• Atypical cells in the vagina. Women with vaginal intraepithelial neoplasia (VAIN) have an increased risk of vaginal cancer. In women with VAIN, cells in the vagina appear different from normal cells, but not different enough to be considered cancer. A small number of women with VAIN will eventually develop vaginal cancer, though doctors aren't sure what causes some cases to develop into cancer and other cases to remain benign.
• Exposure to miscarriage prevention drug. Women whose mothers took a drug called diethylstilbestrol (DES) while pregnant may have an increased risk of a certain type of vaginal cancer called clear cell adenocarcinoma. DES was used in the 1950s to prevent miscarriage in early pregnancy.
• Human papillomavirus (HPV). HPV is a sexually transmitted virus that can increase the risk of vaginal cancer and other cancers. HPV causes the majority of cervical cancers and precancerous changes in the cervix. Even if you've had your uterus and ovaries removed (hysterectomy), you may still have an increased risk of vaginal cancer if you have HPV. The Food and Drug Administration (FDA) approved a vaccine to prevent HPV in 2006.
• Previous gynecologic cancer. Women who've been treated for a different gynecologic cancer, especially cervical cancer, may have an increased risk of vaginal cancer.

Other risk factors that have been linked to an increased risk of vaginal cancer include:

• Multiple sexual partners
• Early age at first intercourse
• Smoking

When to seek medical advice

See your doctor if you have any unusual signs and symptoms, such as abnormal vaginal bleeding. Vaginal cancer is more easily treated when discovered at an early stage. Since vaginal cancer doesn't always cause signs and symptoms, follow your doctor's recommendations about when you should have routine pelvic exams.

Screening and diagnosis

Screening
While there is no general screening test for vaginal cancer, it is sometimes detected during a routine pelvic exam before any signs and symptoms become evident. During a pelvic exam, your doctor carefully inspects the outer part of your vagina, and then inserts two fingers of one hand into your vagina and simultaneously presses the other hand on your abdomen to feel your uterus and ovaries. He or she also inserts a device called a speculum into your vagina. The speculum widens your vagina so that your doctor can check your vagina and cervix for abnormalities.

Your doctor usually also conducts a pap test to screen for cervical cancer, but sometimes vaginal cancer cells can be detected on a pap test. Pap tests and pelvic exams are generally recommended every three years. How often you undergo these screenings depends on your risk factors for cancer and whether you've had abnormal pap tests in the past. Talk to your doctor about whether you should have this health screening.

Diagnosis
Based on any signs and symptoms you have, your doctor may conduct a pelvic exam and pap test to check for abnormalities that may indicate vaginal cancer. Based on those findings, your doctor may conduct other procedures to determine whether you have vaginal cancer, such as:

• Colposcopy. Colposcopy is an examination of your vagina with a special lighted microscope called a colposcope. Colposcopy allows your doctor to magnify the surface of your vagina to see any areas of abnormal cells.
• Biopsy. Biopsy is a procedure to remove a sample of suspicious tissue to test for cancer cells. Your doctor may take a biopsy of tissue during a colposcopy exam. Your doctor sends the tissue sample to a laboratory for testing.

Staging
Once your doctor diagnoses vaginal cancer, he or she takes steps to determine the extent of the cancer — a process called staging. The stage of your cancer helps your doctor decide what treatments are appropriate for you. In order to determine the stage of your cancer, your doctor may use:

• Biopsy. Tissue samples from your cervix or vulva may show whether cancer has spread to those areas.
• Imaging tests. Your doctor may order imaging tests to determine whether cancer has spread. Imaging tests may include X-rays, computerized tomography (CT) scans or magnetic resonance imaging (MRI).
• Tiny cameras to see inside your body. Procedures that use tiny cameras to see inside your body may help your doctor determine if cancer has spread to certain areas. Cameras help your doctor see inside your bladder (cystoscopy) and your rectum (proctoscopy).

Once your doctor determines the extent of your cancer, he or she assigns your cancer a stage. The stages of vaginal cancer are:

• Stage I. Cancer is limited to the vaginal wall.
• Stage II. Cancer has spread to tissue next to the vagina.
• Stage III. Cancer has spread to nearby lymph nodes, or to the pelvic wall or both.
• Stage IVA. Cancer has spread to nearby lymph nodes, and has also spread to bladder, rectum or pelvis.
• Stage IVB. Cancer has spread to areas away from the vagina, such as the lungs.