Vaginal Cancer

Vaginal tumors are tissue growths that arise in the vagina. Vaginal cancer is the rarest gynecologic cancer. It usually appears as squamous cell carcinoma, but occasionally as melanoma, sarcoma, or adenocarcinoma. Vaginal cancer usually occurs in women in their early to middle 50s, but some rarer types do appear in younger women, and rhabdomyosarcoma appears in children.

Causes

Although the relation is unclear, certain factors predispose the patient to the development of squamous cell carcinoma of the vagina. These include trauma, chronic pessary use, and the use of chemical carcinogens, such as those in some sprays and douches.

The likeliest risk factor appears to be advanced age combined with any of the above. Cancer in this area may also be an extension of a previous cancer of the endometrium, vulva, or cervix. In addition, vaginal adenocarcinoma has been associated with the use of diethylstilbestrol (DES) by the patient's mother during pregnancy.

Because the vagina is a thin-walled structure with rich lymphatic drainage, cancer here varies in severity, depending on its exact location and effect on lymphatic drainage. Vaginal cancer resembles cervical cancer in that it may progress from an intraepithelial tumor to an invasive cancer. It spreads more slowly than cervical cancer, however.

A lesion in the upper third of the vagina, the most common site, usually metastasizes to the groin nodes;a lesion in the lower third, the second most common site, usually metastasizes to the hypogastric and iliac nodes. A lesion in the middle third metastasizes erratically. A posterior lesion displaces and distends the vaginal posterior wall before spreading to deep layers. By contrast, an anterior lesion spreads more rapidly into other structures and deep layers because, unlike the posterior wall, the anterior vaginal wall isn't flexible.

Signs and Symptoms

Vaginal cancer is a rare disease affecting the tissue of the vagina in the female reproductive system. The disease is often difficult to diagnose because the symptoms are very similar to other illnesses like infections. Symptoms do not usually present themselves until the disease has progressed.

Some of the symptoms of vaginal cancer are: Constipation, bleeding or discharge not related to menstrual periods, difficult or painful urination and pain during intercourse or in the pelvic area.

Diagnostic tests 

There are several tests used to diagnose vaginal cancer, including:

• pelvic examination of the vagina, and other organs in the pelvis, checking for tumors, lumps, or masses (i.e., may include colposcopy).
• Pap test (also called Pap smear) - test that involves microscopic examination of cells collected from the cervix, used to detect changes that may be cancer or may lead to cancer, and to show noncancerous conditions, such as infection or inflammation.
• Colposcopy - The doctor inserts an instrument with binocular magnifying lenses into the vagina and checks the vaginal walls and cervix.
• biopsy - removal of sample of tissue via a hollow needle or scalpel.

Treatment

Surgery, radiation therapy and chemotherapy are the most common treatments.

Surgery may be recommended only when the tumor is so extensive that exenteration is needed because the vagina's close proximity to the bladder and rectum allows only minimal tissue margins around resected vaginal tissue.

Radiation therapy is the preferred treatment for all stages of vaginal cancer. Most patients need preliminary external radiation treatment to shrink the tumor before internal radiation can begin. If the tumor is localized to the vault and the cervix is present, radiation (radium or cesium) can be given with an intrauterine tandem and colpostat (avoids); if the cervix is absent, a specially designed vaginal applicator is used instead. To minimize complications, radioactive sources and filters are carefully placed away from radiosensitive tissues, such as the bladder and rectum. Such treatment lasts 48 to 72 hours, depending on the dosage.

Chemotherapy is the use of drugs to kill cancer cells.

Prevention

No certain preventative measures are known, but early detection can be maximized by regular yearly pelvic examinations and Pap smears.