What Is Vaginal Cancer?
The vagina is a 3 to 4 inch (7 1/2 to 10 cm) tube. Its upper part ends at the cervix, the lower part of the uterus (womb). The lower end opens to the outside onto the vulva, the external genitals. The vagina is sometimes called the birth canal. A thin layer called the epithelium lines the walls of the vagina. The epithelium is formed by squamous epithelial cells.
The part of the vaginal wall underneath the epithelium contains connective tissue, muscle tissue, lymph vessels, and nerves. The vagina is usually in a collapsed state with its walls touching each other. The vaginal walls have many folds that help the vagina to open and expand during sexual intercourse or birth of a baby. Glands in its wall secrete mucus to keep the vaginal lining moist.
There are several types of vaginal cancer. About 85% to 90% of vaginal cancers are squamous cell carcinomas that begin in the epithelial lining of the vagina. They tend to occur in the upper area of the vagina near the cervix. Vaginal squamous cell carcinomas do not appear suddenly; they develop over a period of many years from precancerous changes called vaginal intraepithelial neoplasia (often abbreviated as VAIN).
About 5% to 10% of vaginal cancers are adenocarcinomas. The usual type of vaginal adenocarcinoma typically develops in women older than 50. One special type, called clear cell adenocarcinoma, occurs more often in young women who were exposed to diethylstilbestrol (DES) in utero (when they were in their mother's womb). In the past some pregnant women were given DES to prevent miscarriage. The drug became available during the late 1940s and was banned in the USA in 1971. (See the section on risk factors for more information on DES and clear cell carcinoma.)
Malignant melanoma is a cancer that develops from pigment-producing cells called melanocytes. These cancers usually are found on sun-exposed areas of the skin but occasionally form on the vagina or other internal organs. They account for about 2% to 3% of all vaginal cancers. Melanoma tends to affect the lower or outer portion of the vagina. The tumors vary greatly in size, color, and growth pattern.
About 2% to 3% of vaginal cancers are sarcomas. These cancers form deep in the wall of the vagina, not on its surface epithelium. There are several types of vaginal sarcomas. The most common, leiomyosarcoma, typically affects women older than 50. Leiomyosarcomas resemble the involuntary muscle cells of the vaginal wall. Rhabdomyosarcoma is a childhood cancer, usually found before the age of 3. Its cells resemble voluntary muscle cells – a tissue not normally found in the vaginal wall.
Cancers of the vagina are much less common than cancers that start in other organs (such as the uterus, rectum, or bladder) and secondarily spread to the vagina. This document refers only to primary vaginal cancers, that is, those starting in the vagina.Do We Know What Causes Vaginal Cancer?
The exact cause of most vaginal cancers is not known. However, scientists have found that the disease is associated with a number of other conditions, which are described in the section on risk factors. A great deal of research is now underway to learn more about how these risk factors cause cells of the vagina to become cancerous.
Research has shown that substances called tumor suppressor gene products are made by normal cells to prevent them from growing too rapidly and becoming cancers. Two proteins (E6 and E7) produced by high-risk (like 16 and 18) HPV (human papilloma virus) types can interfere with the functioning of known tumor suppressor gene products.
As mentioned in the section on risk factors, women exposed to diethylstilbestrol (DES) as a fetus (that is, their mothers took DES during pregnancy) are at increased risk for developing clear cell carcinoma. DES clearly increases the likelihood of vaginal adenosis (gland-type cells in the vaginal lining rather than the usual squamous cells).
Studies suggest that although the majority of women with vaginal adenosis never develop vaginal clear cell carcinoma, those with an uncommon type of adenosis (atypical tuboendometrial adenosis) have an increased risk of developing this cancer.Can Vaginal Cancer Be Found Early?
Many cases of vaginal cancer can be found early in the course of the disease.
Although some early vaginal cancers may produce symptoms that cause patients to seek medical attention, other vaginal cancers do not cause symptoms until after they have reached an advanced stage. Pre-cancerous areas of vaginal intraepithelial neoplasia (VAIN) do not usually produce any symptoms. Fortunately, most cases of VAIN and early invasive vaginal cancer can be found by routine Pap testing.How Is Vaginal Cancer Treated?
This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.
The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.
Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.
After the diagnostic tests are done, your cancer care team will recommend a treatment plan. Don't feel rushed about considering your options. If there is anything you do not understand, ask to have it explained again. The choice of treatment depends largely on the type of cancer and stage of the disease when it is diagnosed.
Other factors might play a part in choosing the best treatment plan. These might include your age, your overall state of health, whether you plan to have more children, and other personal considerations. Be sure you understand all the risks and side effects of the various therapies before making a decision about treatment.
You may want to get a second opinion. This can provide more information and help you feel confident about the treatment plan you choose. Some insurance companies require a second opinion before they will pay for treatments.
The 2 main methods of treatment of vaginal cancer are radiation therapy and surgery. Chemotherapy in combination with radiation may be used to treat advanced disease (see section on chemotherapy).
Whenever possible, treatment is given with the intention of completely removing or destroying the cancer. If a cure is not possible, the goal may be to remove or destroy much of the cancer in order to prevent the tumor from growing, spreading, or returning for as long as possible. If the cancer has spread widely, the main goal of treatment is palliation (relieving pain, blockage of the urinary or intestinal system, or other symptoms).