General Information About Vaginal Cancer

Vaginal cancer is a disease in which malignant (cancer) cells form in the vagina.

The vagina is the canal leading from the cervix (the opening of the uterus) to the outside of the body. At birth, a baby passes out of the body through the vagina (also called the birth canal).

Vaginal cancer is not common. There are two main types of vaginal cancer:

• Squamous cell carcinoma: Cancer that forms in the thin, flat cells lining the inside of the vagina. Squamous cell vaginal cancer spreads slowly and usually stays near the vagina, but may spread to the lungs, liver, or bone. This is the most common type of vaginal cancer.
• Adenocarcinoma: Cancer that begins in glandular cells. Glandular cells in the lining of the vagina make and release fluids such as mucus. Adenocarcinoma is more likely than squamous cell cancer to spread to the lungs and lymph nodes. A rare type of adenocarcinoma (clear cell adenocarcinoma) is linked to being exposed to diethylstilbestrol (DES) before birth. Adenocarcinomas that are not linked with being exposed to DES are most common in women after menopause.

Older age and having an HPV infection are risk factors for vaginal cancer.

Anything that increases a person's chance of getting a disease is called a risk factor. Not every person with one or more of these risk factors will develop vaginal cancer, and it will develop in people who don't have any known risk factors. Talk with your doctor if you think you may be at risk. Risk factors for vaginal cancer include the following:

• Being 60 years or older.
• Having a human papilloma virus (HPV) infection, which can be linked to squamous cell carcinoma of the vagina.
• Being exposed to DES while in the mother's womb. In the 1950s, the drug DES was given to some pregnant women to prevent miscarriage (premature birth of a fetus that cannot survive). This is linked to a rare form of vaginal cancer called clear cell adenocarcinoma. The rates of this disease were highest in the mid-1970s, and it is extremely rare now.
• Having had a hysterectomy for tumors that were benign (not cancer) or cancer.

Signs and symptoms of vaginal cancer include pain or abnormal vaginal bleeding.

Vaginal cancer often does not cause early signs or symptoms. It may be found during a routine pelvic exam and Pap test. Signs and symptoms may be caused by vaginal cancer or by other conditions. Check with your doctor if you have any of the following:

• Bleeding or discharge not related to menstrual periods.
• Pain during sexual intercourse.
• Pain in the pelvic area.
• A lump in the vagina.
• Pain when urinating.
• Constipation.

Tests that examine the vagina and other organs in the pelvis are used to diagnose vaginal cancer.

In addition to asking about your personal and family health history and doing a physical exam, your doctor may perform the following tests and procedures:

• Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. A speculum is inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test of the cervix is usually done. The doctor or nurse also inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
• Pap test: A procedure to collect cells from the surface of the cervix and vagina. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the cervix and vagina. The cells are viewed under a microscope to find out if they are abnormal. This procedure is also called a Pap smear.
• Human papillomavirus (HPV) test: A laboratory test used to check DNA or RNA for certain types of HPV infection. Cells are collected from the cervix and DNA or RNA from the cells is checked to find out if an infection is caused by a type of HPV that is linked to cervical cancer. This test may be done using the sample of cells removed during a Pap test. This test may also be done if the results of a Pap test show certain abnormal cervical cells.
• Colposcopy: A procedure in which a colposcope (a lighted, magnifying instrument) is used to check the vagina and cervix for abnormal areas. Tissue samples may be taken using a curette (spoon-shaped instrument) or a brush and checked under a microscope for signs of disease.
• Biopsy: The removal of cells or tissues from the vagina and cervix so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a Pap test shows abnormal cells in the vagina, a biopsy may be done during a colposcopy.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis depends on the following:

• The stage of the cancer (whether it is in the vagina only or has spread to other areas).
• The size of the tumor.
• The grade of tumor cells (how different they look from normal cells under a microscope).
• Where the cancer is within the vagina.
• Whether there are signs or symptoms at diagnosis.
• Whether the cancer has just been diagnosed or has recurred (come back).

Treatment options depend on the following:

• The stage and size of the cancer.
• Whether the cancer is close to other organs that may be damaged by treatment.
• Whether the tumor is made up of squamous cells or is an adenocarcinoma.
• Whether the patient has a uterus or has had a hysterectomy.
• Whether the patient has had past radiation treatment to the pelvis.