Vaginal Cancer

Vaginal cancer is a very rare disease which originates in the vagina, and is diagnosed in just over 250 women in the UK each year. It is most commonly diagnosed in women over 60 years of age and is extremely rare in women under 40.

How does it develop?

Cancer of the vagina is a skin (or squamous) cancer is very rare.

It begins when a cell changes its growth pattern and structure, increasing in size each time it reproduces, until it develops into a tumour.

Vaginal cancer is treated with surgery, however, on occasions can be treated using chemotherapy and radiotherapy depending on its particular pattern change.

Key signs and symptoms

It is rare to have symptoms if you have very early stage vaginal cancer or the pre-cancerous changes called vaginal intraepithelial neoplasia (VAIN).

Although some early stage vaginal cancers may have symptoms, many do not, however possible symptoms include:

  • Bleeding between periods, after menopause or after sex
  • Vaginal discharge that smells or may be blood stained
  • Pain during sexual intercourse
  • A lump or growth in the vagina that you or your doctor can feel
  • A vaginal itch that won’t go away

However, as many as 20 per cent of women diagnosed with vaginal cancer have no symptoms at all and many of the above symptoms are far more likely to be due to other conditions, such as infections.

Risk Factors

We don’t know the exact causes of vaginal cancers but several risk factors have been identified to include:

Age
More than 7 out of 10 vaginal cancers are in women over 60

Human papilloma virus

HPV is a group of viruses, rather than a single virus, of which there are more than 100 different types. It is spread during sexual intercourse and other types of sexual activity (such as skin-to-skin contact of the genital areas).

There are many different types of HPV, and most people are infected with the virus at some time during their lives. In most cases, the virus goes away without causing any harm and doesn’t lead to further problems.

However, HPV is present in more than two-thirds of women with vaginal cancer, which suggests that it may increase your risk of developing the condition.

Abnormal cells in the cervix or vagina

You’re more likely to develop vaginal cancer if you’ve previously been found to have abnormal cells in your:

  • Cervix – known as cervical intraepithelial neoplasia (CIN)
  • Vagina – known as vaginal intraepithelial neoplasia (VAIN)

CIN and VAIN are terms used to describe cells that are abnormal, but not different enough to be considered cancerous. Both are thought to be closely linked to having a persistent HPV infection.

The abnormal cells don’t usually cause any problems themselves and may only be detected during cervical screening, but left untreated there is a small chance they could eventually become cancerous.

How is it diagnosed?

To help diagnose vaginal cancer, your GP will ask you about your symptoms and may carry out a physical examination.

They may also refer you for blood tests to rule out other causes of your symptoms, such as infection.

If your GP cannot find an obvious cause of your symptoms, they will probably refer you to a gynaecologist for further testing.

If you are referred to a gynaecologist, you may have:

  • external and internal vaginal examinations to look for any unusual lumps or swellings
  • a colposcopy – an examination where a special instrument (colposcope) that acts like a magnifying glass is used to study your vagina in greater detail

If your gynaecologist thinks there may be abnormal tissue inside your vagina, a small sample of the tissue will be removed (a biopsy) and checked under a microscope for cancerous cells.

If the results of the biopsy suggest you have cancer, you may have further tests to see if the cancer has spread. These tests may include a more detailed internal vaginal examination carried out under general anaesthetic, an X-ray, or a CT and MRI scans.

Treatment

Treatment for vaginal cancer will depend on where the cancer is in your vagina and how far it has spread. Possible treatments include radiotherapy, surgery and chemotherapy.

Radiotherapy
Radiotherapy is the main treatment for vaginal cancer and can be performed a number of ways:

  • external radiotherapy – a machine beams high-energy rays at your vagina and pelvis
  • internal radiotherapy – a small radioactive device, which looks like a tampon, is inserted into your vagina

The type of radiotherapy you receive depends on where the cancer is in your body. For example, internal radiotherapy may be used if the cancer is in the lining of your vagina, and external radiotherapy may be used if the cancer is deeper in the tissues of the vagina. Many women receive a combination of internal and external radiotherapy.

Surgery
There are four main types of surgery used to treat vaginal cancer:

  • Partial vaginectomy – removing the upper section of your vagina
  • Radical vaginectomy – removing all of your vagina and pelvic lymph nodes
  • Radical vaginectomy and radical hysterectomy – removing all of your vagina, womb, ovaries, fallopian tubes and pelvic lymph nodes
  • Pelvic exenteration – removing all of your vagina and surrounding tissue, including the bladder and/or rectum (back passage)