Understanding Vaginal Cancer and
How To Manage It

Your guide to understanding all aspects of vaginal cancer

“The most important thing in illness is never to lose heart.”

Nikolai Lenin

Early detection and diagnosis always increase your chances of receiving successful treatment and beating all forms of cancer – including vaginal cancer. Detecting vaginal cancer early will significantly boost your odds of survival. Hence, it is important to adhere to the recommended screening protocol for your age group so that you and your physician can detect and test any anomalies or changes.

You can read the section that details the various types of cancer before embarking on the journey to understand vaginal cancer better. Read more

Let’s understand
the anatomy first

The vagina is the canal extending from the outer part of the female genitals (the vulva), until the opening of the uterus (the cervix). It allows menstrual blood to drain out of your body during your period. The vagina is sometimes referred to as the birth canal as it expands to accommodate the process of childbirth.

What is VAGINAL cancer?

Vaginal cancer is a rare variant of gynecological cancers that affects the cells lining the surface of the vagina. While several types of cancer can spread to your vagina from other parts of the body, cancer that begins in your vagina (primary vaginal cancer) is rare. 

Vaginal cancer usually develops slowly over time. It begins when healthy cells in the vagina start mutating or changing. Such mutations cause these cells to grow rapidly and prevent cell death. The accumulation of these abnormal cells forms a malignant mass or tumour. Often, the cancer cells invade nearby tissues and may break off from a tumour to spread or metastasize to other parts of the body.

Types of Vaginal Cancer

Vaginal walls have a thin layer of epithelial squamous cells while the walls are made up of muscles, lymph vessels and nerves. Depending on the areas affected and place of origin, there are 4 kinds of vaginal cancers:

Squamous Carcinoma

This type of cancer begins in the epithelial lining of the vagina (comprising of the squamous cells) and is the most common type of vaginal cancer, with over 80% reported cases of vaginal cancer being squamous cell carcinomas. It is most commonly found in the upper part of the vagina near the cervix and can spread through the vaginal walls to nearby tissues.

Adenocarcinoma

Any cancer that starts in the gland cells are called adenocarcinomas. These account for 5-10% of vaginal cancer cases. While vaginal adenocarcinoma most commonly affects women over 50, another variant (Clear Cell Adenocarcinoma) is more common in young women who were exposed to diethylstilbestrol (DES, synthetic hormone) in utero (when they were in their mother’s womb). Find out more about DES in risk factors. Read more

There are other rarer types of vaginal cancer as well:

Melanoma

This is one of the most common forms of skin cancer and occurs in the melanin pigment producing cells in the skin. The most common risk factor is exposure to ultraviolet radiation (UV) from sunlight or other UV sources, which is why melanomas are extremely rare in the vagina or other internal organs and tissues. When they occur, they generally affect the lower or outer portion of the vagina and amount to 2-3% percent of the total reported cases of vaginal cancer.

Sarcoma

Sarcomas occur in the cells of bones, muscles, or connective tissue and form deep inside the vaginal walls. There are various types of sarcomas, and Rhabdomyosarcoma is the most common type that affects the vagina. Fewer than 3 out of every 100 cases of vaginal cancer are sarcomas.

While these symptoms individually might not indicate cancer, it is advisable to consult a doctor in case you experience any of these symptoms. Early detection in any form of cancer increases the chance of a complete recovery. It is important to be alert, keep an eye out for symptoms and have regular pelvic check-ups with your gynecologist.

What causes vaginal cancer?

While it is not always clear what causes vaginal cancer, there are several strains of the human papillomavirus (HPV) – one of the most common viral infections of the reproductive tract – which may play a role in causing most cervical cancers. There are several types of HPVs and many do not cause any harm. The immune system typically prevents this virus from causing damage and most people with the virus never develop cancer. However, in a small percentage of people, the virus survives for years and may contribute to the mutation of vaginal cells, which in turn results in cancer. Read more about other risk factors related to vaginal cancer below.

What are the Risk Factors?

While most vaginal cancers are caused by HPV, there are several other factors which may put you at higher risk of developing the disease:

Smoking has been associated with certain types of vaginal cancer

Having a weakened immune system

Excessive alcohol consumption

A family history of vaginal, uterine, colon, or ovarian cancer

Exposure to diethylstilbestrol (DES) –
DES was a hormone drug used to prevent miscarriages between 1940-1970. Women who were exposed to DES in the womb are at a greater risk of developing clear-cell adenocarcinoma of the vagina or cervix. However, DES is not the only risk factor for clear cell adenoma; women were diagnosed with this type of cancer even before DES was invented. DES-related clear cell adenocarcinoma is more common in the vagina than the cervix.

Having other medical conditions:

  • Vaginal adenosis – a condition where the vagina is lined with glandular cells found in the cervix instead of the squamous cells
  • Cervical cancer – A prior experience of cervical cancer or pre-cancer (cervical dysplasia) increases a woman’s risk of vaginal squamous cell cancer. This is most likely because cervical and vaginal cancers have some of the same risk factors such as HPV, along with proximity allowing for cell growth. Hysterectomy or the removal of the uterus can also sometimes be a risk factor affecting chances of vaginal cancer.

What Can be Done
to Lower Your Risk of Getting Vaginal Cancer?

Based on your age, overall health and personal risk factors for vaginal cancer, there are some things that can be done to prevent pre-cancers and conditions that can lead to pre-cancers

Talk to your doctor about getting an HPV vaccine
Practice safe sex
What are the Symptoms?

The most common signs and symptoms for vaginal cancer include

Unusual vaginal bleeding, especially after sex or after menopause

Watery, blood-stained vaginal discharge

An obvious lump or mass in your vagina

Painful or frequent urination

Painful sex

Constipation

Pelvic pain

While these symptoms individually might not indicate cancer, it is advisable to consult a doctor in case you experience any of these symptoms. Early detection in any form of cancer increases the chance of a complete recovery. It is important to be alert, keep an eye out for symptoms and have regular pelvic check-ups with your gynecologist.

Screening and Diagnosis

Vaginal cancer occurs only in women. It is rare and symptoms often manifest in later stages of the disease, making early detection difficult. It therefore becomes important to rule out other possible forms of cancer first, as a method of diagnosis by elimination. If you experience any of the signs and symptoms listed above, make an appointment with your doctor for prompt evaluation. Screening tests may be done when you have no cancer symptoms at all. 

The main objective of vaginal screening is to detect precancerous changes in vaginal cells, which if untreated have a potential to develop into cancer. The secondary objective is to find vaginal cancer at an early stage, when treatment is usually more successful. 

It is important to remember that your physician does not necessarily think you have cancer if he or she suggests a screening test. They could just be following a normal screening protocol for your age group.

Screening tests for vaginal cancer
The Pelvic Exam

What to expect

A pelvic exam is a part of a woman’s routine medical check-up. Pelvic exams can help diagnose certain types of cancers, as well as reproductive problems. A Pap test can be done during a pelvic exam , but sometimes a pelvic exam is done without a Pap test. A Pap test is needed to find early cervical cancer or pre-cancers so ask your doctor if you need a Pap test along with your pelvic exam.

A pelvic exam is generally pain-free, unless you have an underlying condition that causes pain to your pelvic area. You can expect some minor discomfort while undergoing the test. It is important that you choose a doctor and clinical team that you are comfortable with to perform your check-up. 

During a pelvic exam: 

  • You will first be asked to undress the lower part of your body and lie on your back on the examination table. Ask for a sheet or blanket to cover yourself while you wait for your doctor.
  • Try to relax your pelvic area, as this will make the exam more comfortable for you.
  • Your doctor will look at your pelvic area and feel your reproductive areas. It is normal for your doctor to insert his/her gloved fingers into your vagina as part of the test.
  • Your doctor may also do routine screening tests for sexually transmitted diseases by taking a swab of cells.
  • The collected samples are then examined in the lab for any abnormalities.
  • The pelvic exam itself should take around 5-10 minutes. If you experience any pain, be sure to inform your doctor.
The Pap Test

What to expect

A Pap (Papanicolaou) test or Pap smear is done to detect abnormal cells in the cervix and vagina that could indicate an increased risk of developing cancer.

A Pap test is generally pain-free, unless you have an underlying condition that causes pain to your pelvic area. You can expect some minor discomfort while undergoing the test. It is important that you choose a doctor and clinical team that you are comfortable with to perform your test. Your clinician may tell you to avoid doing the test during your menstrual period.

How the Pap test is done:

  • You will first be asked to undress the lower part of your body and lie on the examination table. Ask for a sheet or blanket to cover yourself while you wait for your doctor.
  • Try to relax your pelvic area, as this will make the exam more comfortable for you.
  • Your doctor will first place a speculum inside your vaginal opening. The speculum is a metal or plastic instrument that keeps the vagina open so that the cervix can be seen clearly.
  • Next, using a small spatula or brush, your doctor will gently scrape a sample cells and mucus from your vaginal lining.
  • A small brush or cotton-tipped swab is then inserted into the opening of the cervix to take a sample from the endocervix.
  • The collected samples are then examined in the lab for any abnormalities.
  • The test itself should take 5-10 minutes.
Diagnostic tests for VAGINAL cancer

If the screening protocol detects abnormalities, your doctor may recommend further follow-up diagnostic tests to confirm if cancer is present. Refer to this section for more information about diagnostic tests for vaginal cancer. Read more

Staging VAGINAL Cancer

If your doctor confirms that you have vaginal cancer, some additional tests may be used to determine

If the disease has spread beyond the vagina (i.e. determine the stage of cancer)

How quickly the cancer will grow

How likely it is to spread through the body

What sort of treatments might work

The likelihood of the cancer to recur (come back)

The stage of your cancer is a key aspect in determining your treatment. Refer to this section to understand your cancer diagnosis and for more information about how vaginal cancer is staged. Read more

Treatments for
vaginal cancer
Treatment for vaginal cancer depends on several factors, like the type and stage of your cancer, or other health problems you may have. Surgery, chemotherapy, radiation, or a combination of all three may be used. Refer to this section to understand the types of cancer treatments and their effects. Read more
Your cancer journey
Everyone deals with a cervical cancer diagnosis and treatment in a different way. Refer to this section, to understand various aspects of your cancer journey and the road to recovery. Read more
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