Cancer of the Vagina
Only about 1% of gynecologic cancers occur in the vagina. Cancer of the vagina (vaginal carcinoma) usually affects women older than 45. The average age at diagnosis is 60 to 65.
More than 95% of vaginal cancers are squamous cell carcinomas. Vaginal squamous cell carcinoma may be caused by human papillomavirus (HPV), the same virus that causes genital warts and cervical cancer. Most other vaginal cancers are adenocarcinomas. One rare type, clear cell carcinoma, occurs almost exclusively in women whose mothers took the drug diethylstilbestrol (DES), prescribed to prevent miscarriage during pregnancy. (In 1971, the drug was banned in the United States.)
Depending on the type, vaginal cancer may begin on the surface of the vaginal lining. If untreated, it continues to grow and invades surrounding tissue. Eventually, it may spread to other parts of the body.
Symptoms and Diagnosis
The most common symptom is bleeding from the vagina, which may occur during or after sexual intercourse, between menstrual periods, or after menopause. Sores may form on the lining of the vagina. They may bleed and become infected. Other symptoms include a watery discharge and pain during sexual intercourse. A few women have no symptoms. Large cancers can also affect the bladder, causing a frequent urge to urinate and pain during urination. In advanced cancer, abnormal connections (fistulas) may form between the vagina and the bladder or rectum.
Doctors may suspect vaginal cancer on the basis of symptoms, abnormal areas seen during a routine pelvic examination, or an abnormal Pap test result. Doctors may use an instrument with a binocular magnifying lens (colposcope) to examine the vagina. To confirm the diagnosis, doctors scrape cells from the vaginal wall to examine under a microscope. They also perform a biopsy on any growth, sore, or other abnormal area seen during the examination.
Prognosis and Treatment
The prognosis depends on the stage of the cancer (see Section 22, Chapter 252). If the cancer is limited to the vagina, about 65 to 70% of women survive at least 5 years after diagnosis. If the cancer has spread beyond the pelvis or to the bladder or rectum, only about 15 to 20% survive.
Treatment also depends on the stage. For most vaginal cancers, surgery is the treatment of choice, with or without radiation therapy. Radiation therapy may be internal (using radioactive implants placed inside the vagina) or external (directed at the pelvis from outside the body). Radiation therapy is often combined with or followed by surgical removal of the cancer. For cancer in the upper third of the vagina, a hysterectomy with removal of lymph nodes in the pelvis and the upper part of the vagina may be needed. For very advanced cancer, surgery is often not possible. In such cases, radiation therapy and chemotherapy are usually used.
Intercourse may be difficult or impossible after treatment for vaginal cancer, although sometimes a new vagina can be constructed with skin grafts or part of the intestine.
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