Vaginal Cancer: cancer of the female reproductive system

Vaginal cancer is a disease in which malignant cells form in the vagina, an uncommon cancer of the female reproductive system. About 85% of vaginal cancers are secondary tumors, and about half are from the cervix or uterus.

There are two main types of vaginal cancer :
1. Squamous cell carcinoma (begins in squamous cells)
2. Adenocarcinoma ( begins in glandular cells).
Squamous cell carcinoma is the most common type of vaginal cancer.

Stages of vaginal cancer –

Stage 0 – Carcinoma in situ.
Stage I – Carcinoma is limited to the vaginal wall.
Stage II – Carcinoma involves the subvaginal tissue but has
not extended to the pelvic wall.
Stage III – Carcinoma has extended to the pelvic wall.
Stage IV – Carcinoma has extended beyond the true pelvis or
has clinically involved the mucosa of the bladder or
rectum.

What Causes Vaginal Cancer?

Though the cause of vaginal cancer is unknown, it was found to be linked to DNA mutations.

Vaginal cancer can be caused by one of the following reasons :

Studies have linked the role of Human papillomavirus (HPV) with vaginal cancer. Persistent infection with HPV – turn off the tumor suppressor genes. This further leads to cancerous growth affecting the cells lining the vagina.
Women exposed to diethylstilbestrol (DES) as a fetus (their mothers took DES during pregnancy) are at increased risk for developing clear cell carcinoma.

What are the Risk factors?

Age
Smoking cigarettes
Diseases such as cervical cancer or cervical precancerous conditions show an increased risk of vaginal cancer.
Vaginal intraepithelial neoplasia – Abnormal cells in the vagina
HPV infection
Diethylstilbestrol (DES)

Signs and symptoms

Vaginal bleeding after intercourse, between periods or after menopause.
Pelvic pain or pain during intercourse.
A lump in the vagina.
Pain when urinating.
Constipation.
Watery vaginal discharge
Advanced tumors may affect the rectum or bladder or extend to the pelvic wall, causing pain or leg oedema.

What are the Complications?

Vaginal cancer may metastasize to distant areas of the body, such as the lungs, liver and bones.
fatigue
Early menopause

Diagnosis: How is Vaginal cancer diagnosed?

Medical history – Check for symptoms and other risk factors.
Physical examination – Pelvic exam (manual examination of the abdomen and pelvic area to feel for abnormal nodules).
Diagnostic tests – The tests performed are:
- Screening test: 1. Pap smear test – A Papanicolaou test (Pap test) (Pap smear) is commonly used for vaginal screening. A Pap test is a procedure to collect cells from the surface of the vagina. 2. HPV test – The test involves testing cells collected from the vagina for infection with any types of HPV that are most likely to lead to vaginal cancer. HPV 16 and HPV 18 are responsible for most of the vaginal cancers worldwide.
- Biopsy: Removal of a small amount of tissue for examination under a microscope to look for precancerous cells or cancer cells ( Punch biopsy, LEEP, Conization, ECC).
- Colposcopy: an examination of the vagina and cervix colposcope.
- Imaging tests :
- CT scan : A procedure that makes a series of detailed pictures of areas inside the body
- Chest X-ray: An X-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
- MRI : A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body.
- PET scan :A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein.
- The PET scanner rotates around the body and takes a picture of where glucose is used.
- Malignant tumor cells appear brighter in the picture because they are more active and consume more glucose than normal cells.
Transvaginal ultrasound is a procedure in which high-energy sound waves (ultrasound) bounce off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
Proctosigmoidoscopy – In this procedure a thin, flexible, lighted tube is put into the rectum.
Cystoscopy – Cystoscopy looks at the inside of the bladder. It’s done to check for spread of vaginal cancer to the bladder.

Treatment: How is Vaginal cancer treated?

Surgery, radiation therapy, and chemotherapy are the typical treatment options. These can be used as single modality therapies or in combination.

Radiation therapy is the treatment most often used for vaginal cancer.

Radiation therapy – 1. External radiation therapy uses a machine outside the body to send radiation toward the cancer. 2. Internal radiation therapy uses a radioactive substance that are placed directly into or near the cancer.
Surgery – Surgery is used for small stage I or II vaginal cancers and for cancers that were not cured with radiation.
- Cold-knife conization: A surgical procedure that uses a scalpel (sharp knife) to remove abnormal tissue or cancer.
- Loop electrosurgical excision procedure (LEEP): A surgical procedure that uses electrical current passed through a thin wire loop as a knife to remove abnormal tissue or cancer.
- Laser surgery is a surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or remove a surface lesion such as a tumor.
- Wide local excision: A surgical procedure that takes out the cancer and some of the healthy tissue around it.
- Total hysterectomy: Surgery to remove the uterus, including the cervix.
- Modified radical hysterectomy: Remove the uterus, cervix, upper part of the vagina, and ligaments and tissues that closely surround these organs.
- Vaginectomy: Surgery to remove all or part of the vagina. Skin grafts from other parts of the body may be needed to reconstruct the vagina.
- lymph node dissection : Surgery to remove lymph nodes is called lymphadenectomy or.
- Trachelectomy: If only the cervix is removed (leaving the rest of uterus behind), the operation is called a trachelectomy.
- Radical trachelectomy: Surgery to remove the cervix, nearby tissue and lymph nodes, and the upper part of the vagina. The uterus and ovaries are not removed.
- Pelvic exenteration is a major operation that includes vaginectomy, removing the pelvic lymph nodes, and removing one or more of the following: the lower colon, rectum, bladder, uterus, and/or cervix.

Chemotherapy –
- Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.
- Topical chemotherapy for squamous cell vaginal cancer may be applied to the vagina in a cream or lotion.
- Drugs Approved to used in the treatment of vaginal cancer include Platinum compound : Cisplatin, carboplatin, taxanes (docetaxel, paclitaxel) and fluorouracil.

Prevention: Can we prevent it?

Prevention of Vaginal cancer –
- HPV vaccine
- Routine physical tests
- Quit smoking.

Living with Vaginal cancer –
- Follow-up care ( doctor visits and tests)
- Avoid smoking
- Staying at a healthy weight
- Regular physical activities
- Hormone replacement therapy (HRT) – treatment to relieve symptoms of the menopause. It replaces hormones that are at a lower level as females approach menopause.
- Palliative Care.

When to see a doctor? :

It is wise to consult with a gynecologist immediately if observed any symptoms, e.g. abnormal vaginal bleeding or pain in the pelvic area. The typical consultation fee for a gynaecologist ranges from Rs. 500 to Rs. 1500 in India.