Vaginal Cancer

Cancer of the vagina, a rare kind of cancer in women, is a disease in which cancer (malignant) cells are found in the tissues of the vagina.

There are two types of cancer of the vagina: squamous cell cancer (squamous carcinoma) and adenocarcinoma. Squamous carcinoma is usually found in women between the ages of 60 and 80. Adenocarcinoma is more often found in women between the ages of 12 and 30.

Young women whose mothers took DES (diethylstilbestrol) are at risk for getting tumors in their vaginas. Some of them get a rare form of cancer called clear cell adenocarcinoma. The drug DES was given to pregnant women between 1945 and 1970 to keep them from losing their babies (miscarriage).

The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in the vagina or has spread to other places) and the patient's general state of health.

Our patients with vaginal cancer are treated at the Moores Gynecological Cancer Unit. See the Gynecological Cancer Unit for more information.

You can also review the tabs at top of this page for information on vaginal cancer symptoms and risks, diagnosis, and treatment.

Types of vaginal cancer

• About 85% to 90% are squamous cell carcinomas that begin in the epithelial lining, a thin layer of tissue that lines the flexible walls of the vagina. These cancers tend to occur in the upper area of the vagina near the cervix.
• About 5% to 10% of vaginal cancers are adenocarcinomas, which typically develop in women over age 50. One type, called clear cell adenocarcinoma, occurs more often in young women who were exposed to diethylstilbestrol (DES) while still in the uterus. DES was banned in the U.S. in 1971.
• Malignant melanoma develops from pigment-producing cells called melanocytes that are usually found on sun-exposed areas of the skin. Occasionally these cells form on the vagina or other internal organs, and account for about 2% to 3% of all vaginal cancers.
• Sarcomas, which account for about 2% to 3% of vaginal cancers, form deep within the wall of the vagina.
• In very rare cases, other cancers, such as lymphoma, colon cancer and endometrial cancer, may spread to the vagina.

Symptoms

According to the American Cancer Society, between 80% and 90% of women with invasive vaginal cancer have one or more symptoms. These may include:

• Abnormal vaginal bleeding, often after intercourse
• Vaginal bleeding after menopause
• Abnormal vaginal discharge
• A mass that can be felt
• Pain when urinating or during sexual intercourse
• Continuous pelvic pain

Note: Since symptoms can be caused by a number of conditions other than vaginal cancer, it's important to consult your physician if you have questions or concerns.

Risk factors

The greatest risk factor for vaginal cancer is having a mother who took the drug diethylstilbestrol (DES) while pregnant. DES is a hormonal drug that was prescribed between 1940 and 1971 for some women thought to be at increased risk of miscarriage.  About 1 of every 1,000 women whose mothers took DES while pregnant with them develops clear cell adenocarcinoma of the vagina or cervix. Most DES daughters are now between the ages of 30 and 60.

Additional risk factors:

• Age: Squamous cell cancer of the vagina occurs mainly in older women.
• Vaginal adenosis: A change in the cells of the vagina.
• Human Papilloma Virus (HPV): About 65% to 80% of vaginal intraepithelial neoplasia cancers contain HPV.
• Cervical or Vulvar Cancer: Having cervical cancer, cervical pre-cancerous conditions, or vulvar cancer can increase your risk.
• Smoking

Your doctor will take a complete medical history to look for risk factors, then perform a physical exam, including a pelvic examination. Additional tests may include:

• Colposcopy, in which an instrument with magnifying lenses is used to view the walls of the vagina and cervix.  A biopsy (tissue sample) may be taken and examined by a pathologist in the lab.
• Endoscopic tests to determine if the cancer has spread to other organs, such as the rectum or colon.  These may include a proctosigmoidoscopy or cystoscopy.
• Imaging studies such as a chest X-ray, Magnetic Resonance Imaging (MRI), Computed Tomography (CT) scan, or Positron Emission Tomography (PET) scan.

Staging

A process called staging is used to determine how much your cancer has spread and what treatment options will be considered.  According to the National Cancer Institute, the following stages are used for vaginal cancer.

• Stage 0 (Carcinoma in Situ): Abnormal cells are found in tissue lining the inside of the vagina. These abnormal cells may become cancer and spread into nearby normal tissue.
• Stage I: Cancer has formed and is found in the vagina only.
• Stage II: Cancer has spread from the vagina to the tissue around the vagina.
• Stage III: Cancer has spread from the vagina to the lymph nodes in the pelvis or groin, or to the pelvis, or both.
• Stage IVA: Cancer may have spread to lymph nodes in the pelvis or groin and has spread to one or both of the following areas:  the lining of the bladder or rectum; beyond the pelvis.
• Stage IVB: Cancer has spread to parts of the body that are not near the vagina, such as the lungs. Cancer may also have spread to the lymph nodes.

The treatment plan for vaginal cancer depends on the size, stage and location of the lesions. Surgery or radiation therapy can be highly effective in early stages, while radiation therapy is the primary treatment for more advanced stages. Your gynecologic oncologist will discuss your options with you and determine the best course of treatment.

Surgery

Surgery is the most common treatment of vaginal cancer. Your options may include:

• Laser surgery: Using a precisely targeted laser beam (a narrow beam of intense light) to destroy malignant tissue.
  
• Wide local excision: Surgically excising (removing) the cancerous tissue along with some of the normal tissue around it.
• Vaginectomy: Surgery to remove all or part of the vagina.
• Lymphadenectomy: Lymph nodes are removed and checked under a microscope for signs of cancer. This procedure is also called lymph node dissection. If the cancer is in the upper vagina, the pelvic lymph nodes may be removed. If the cancer is in the lower vagina, lymph nodes in the groin may be removed.
• Pelvic exenteration: In advanced stages, extensive surgery may be required to remove multiple organs such as the lower colon, rectum, bladder, cervix, vagina, ovaries, and nearby lymph nodes.

Note: Skin grafting may follow surgery, to repair or reconstruct the vagina.

Radiation therapy

Radiation therapy is used in the treatment of a wide variety of gynecologic cancers. It may be used alone in early stage tumors or combined with chemotherapy in locally advanced disease. In addition, it may be used before or after surgery.

• High-Dose Brachytherapy is a form of internal radiation therapy where radioactive sources are placed inside the body, close to the tumor.  Methods used at UCSD include cylinder, interstitial, tandem and ovoid, and tandem and ring.
  
• Image Guided Radiation Therapy (IGRT) is a form of external-beam radiation that uses sophisticated technologies to locate the tumor and improve treatment accuracy so that healthy tissue is not harmed.
• Intensity Modulated Radiation Therapy (IMRT) is another state-of-the-art external beam radiation therapy that improves delivery precision, thereby minimizing dosage to surrounding normal tissue. UCSD’s Dr. Arno Mundt pioneered the use of IMRT in gynecologic cancers.

Chemotherapy

Chemotherapy is the administration of drugs by mouth, injection, or IV to kills cancer cells.  In vaginal cancer, chemotherapy is often administered in early stages by applying a topical cream containing anticancer drugs to the affected area.