Cancer of the vagina

Saturday 1 October, 2016

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On this page: What is vaginal cancer? | What are the symptoms? | How common is it? | What are the risk factors? | Which health professionals will I see? | Diagnosis | Staging | Prognosis | Treatment | Key points


This section discusses symptoms, causes, diagnosis and treatment of primary vaginal cancer (also known as cancer of the vagina). Detailed information about side effects can be found in the managing side effects section.

What is vaginal cancer?

Primary vaginal cancer is any cancer that starts in the vagina. There are several types (see below). Some cancers of the vagina have spread from a cancer elsewhere in the body. These are called secondary vaginal cancers (see below).

Types of primary vaginal cancer
Squamous cell carcinoma (SCC)
  • starts in thin, flat (squamous) cells that line the vagina
  • most likely to occur in the upper vagina
  • usually grows slowly over many years
  • makes up about 85% of vaginal cancers
Adenocarcinoma
  • develops from the mucus-producing (glandular) cells of the vagina
  • more likely to spread to the lungs and lymph nodes
  • makes up 5–10% of vaginal cancers
  • includes clear cell carcinoma
Vaginal melanoma
  • a type of skin cancer that develops from the cells that give the skin its colour (melanocytes)
  • a rare form of vaginal cancer
Sarcoma
  • develops from muscle, fat and other tissue deep in the wall of the vagina
  • a rare form of vaginal cancer
Secondary vaginal cancer

Secondary cancer in the vagina is more common than primary vaginal cancer. This means the cancer has spread from another part of the body, such as the cervix, uterus, vulva, bladder, bowel or other nearby organs. Secondary vaginal cancer is managed differently to primary vaginal cancer. For more information, speak to your treatment team, see Living with Advanced Cancer or call Cancer Council 13 11 20.

What are the symptoms?

There are often no obvious symptoms of vaginal cancer. The cancer is sometimes found by a routine Pap test.

You may have one or more of the following symptoms:

  • bloody vaginal discharge not related to your menstrual period, which may have an offensive or unusual odour
  • pain during sexual intercourse
  • bleeding after sexual intercourse
  • pain in the pelvic area or rectum
  • a lump in the vagina
  • bladder problems, such as blood in the urine or passing urine frequently or during the night.

Not everyone with these symptoms has vaginal cancer. Other conditions can also cause these changes, but if you have any symptoms, make an appointment with your GP.

How common is it?

Vaginal cancer is one of the rarest types of cancer affecting the female reproductive system (gynaecological cancer). Each year in Australia, about 70 women are diagnosed with vaginal cancer, and the average age at diagnosis is 70. However, vaginal cancer, particularly adenocarcinoma, can sometimes occur in younger women.

What are the risk factors?

The exact cause of vaginal cancer is unknown, but factors known to increase the risk include:

Vaginal intraepithelial neoplasia (VAIN)

This is a precancerous condition that often has no symptoms. It means that the cells in the lining of the vagina are abnormal and may develop into cancer after many years. However, most women with VAIN do not develop vaginal cancer.

Human papillomavirus (HPV)

Also known as the wart virus, HPV is a sexually transmitted infection that can cause women to develop VAIN. It can be many years between the initial infection with HPV and the first signs of VAIN or vaginal cancer. HPV is a very common virus and most women with HPV don’t develop vaginal or any other type of cancer.

Smoking

Cigarette smoking doubles the risk of developing vaginal cancer. This may be because smoking can make the immune system work less effectively.

Radiotherapy to the pelvis

If you have had radiotherapy to the pelvis for another reason, you are at a slightly higher risk of vaginal cancer. This complication is very rare.

History of gynaecological cancer

Vaginal cancer is more likely to be diagnosed in women who have had cervical cancer or early cervical cell changes that were considered to be precancerous.

Diethylstilboestrol (DES)

This synthetic hormone drug has been identified as a cause of a type of vaginal adenocarcinoma called clear cell carcinoma. Between 1938 and 1971 – and occasionally beyond – DES was prescribed to pregnant women to prevent miscarriages. It is no longer prescribed to pregnant women in Australia.

The female children of women who took DES (called DES daughters) have an increased risk of developing a range of health problems. About one in 1000 DES daughters develops clear cell carcinoma of the vagina or cervix. If you are concerned about this risk, see your GP.

 

Vaginal cancer is not contagious and it can’t be passed to other people through sexual contact. It is not caused by an inherited faulty gene and can’t be passed on to your children. For more information on the risk factors, call Cancer Council 13 11 20.

Which health professionals will I see?

Your GP will probably arrange the first tests to assess your symptoms. You will then be referred to a gynaecologist or gynaecological oncologist. You will be cared for by a range of health professionals in a multidisciplinary team or MDT. See a list of the health professionals you may see.

Diagnosis

If you have any of the symptoms listed above, your first step will be to visit your GP, who will conduct initial tests. If you need further tests, you will see a specialist such as a gynaecologist or gynaecological oncologist.

Tests to diagnose vaginal cancer

The main tests used to diagnose vaginal cancer are a physical examination, a Pap test, a procedure called a colposcopy, and the removal of a tissue sample (biopsy).

Physical examination

Your doctor will ask to do a physical examination of your vagina, groin and pelvic area. You will remove your clothing from the waist down and lie on a table with your knees bent and legs apart.

If you feel embarrassed or scared about this examination, let your doctor know. A nurse may be present during the examination, but you can also ask for a family member to be in the room.

The doctor may arrange for you to have the examination under a general anaesthetic if the area is very painful.

Pap test

During the physical examination, you may have a Pap test (Pap smear) to check the cells inside the vagina and cervix. The results may show early cell changes in the lining of the vagina. This condition is called vaginal intraepithelial neoplasia or VAIN.

Colposcopy and biopsy

During the physical examination, the doctor may use a magnifying instrument called a colposcope to look at your vagina, cervix and vulva. This procedure is known as a colposcopy, or sometimes a vaginoscopy. The doctor may take a tissue sample (biopsy) during the colposcopy.

The biopsy is then sent to a laboratory, and a specialist doctor called a pathologist will examine the cells under a microscope. The pathologist will be able to check for cell abnormalities.

Further tests

If the tests described above show that you have vaginal cancer, further tests may be needed to find out whether the cancer cells have spread. These may include a blood test, chest x-ray, cystoscopy, proctoscopy, and CT and MRI scans.

Staging vaginal cancer

Based on the test results, your doctor will tell you the stage of the cancer. Staging is a way to describe the size of the cancer and whether and how far it has spread beyond its original site.

  • Stage I: Cancer is found only in the vagina.
  • Stage II: Cancer has begun to spread through the vaginal wall, but it has not spread into the wall of the pelvis.
  • Stage III: Cancer has spread to the pelvis. It may also be in the lymph nodes close to the vagina.
  • Stage IV: Cancer has spread beyond the pelvis or into the lining of the bladder or bowel. The cancer may also have spread to distant parts of the body.

Your doctor may also tell you the grade of the cancer cells. This gives you an idea of how quickly the cancer may develop. A low-grade (grade 1) cancer means that the cells are slow-growing and less likely to spread. High-grade (grade 3) cells look more abnormal, and are more likely to grow and spread quickly.

Knowing the stage and grade of the cancer helps your medical team recommend the most appropriate treatment.

Prognosis

Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for any doctor to predict the exact course of your disease. Instead, your doctor can give you an idea about common issues that affect women with vaginal cancer. Some women with vaginal cancer may want to know the statistics for women in similar situations, while others may not find the numbers helpful. Do what feels right for you.

In most cases, the earlier vaginal cancer is diagnosed, the better the chances of successful treatment. Test results, the type of vaginal cancer you have, the rate and depth of tumour growth, how well you respond to treatment, and other factors (such as age, fitness and medical history) are all important in assessing your prognosis.

Treatment

How vaginal cancer is treated depends on several factors, including your general health and the stage, grade and type of cancer. Treatment may involve radiotherapy, surgery and/or chemotherapy.

Radiotherapy

Also known as radiation therapy, this treatment uses radiation, such as x-rays, to kill or damage cancer cells. Radiotherapy is a common treatment for vaginal cancer. Some women with vaginal cancer are treated with a combination of radiotherapy and chemotherapy (see below). This is called chemoradiotherapy or chemoradiation. Radiotherapy can also be used to control symptoms of advanced cancer (palliative treatment).

There are two main ways of delivering radiotherapy: externally or internally. Most women with vaginal cancer have both types of radiotherapy. Your radiation oncologist will recommend the course of treatment most suitable for you.

External radiotherapy

Also known as external beam radiotherapy (EBRT), external radiotherapy directs the treatment at the cancer from outside the body. You will lie on a treatment table under a machine called a linear accelerator, which delivers the radiation.

External radiotherapy is usually given as a series of 20-minute daily treatments, Monday to Friday, over 4–6 weeks. The exact number of sessions you have will depend on the type and size of the cancer, and whether it has spread to the lymph nodes.

Radiotherapy to the vagina and groin is painless, but it can cause side effects (see below).

Internal radiotherapy

Also called brachytherapy, internal radiotherapy is a way of delivering radiotherapy directly to the tumour from inside your body. You may have this after finishing a course of external radiotherapy.

Brachytherapy can be given as low-dose rate (LDR), which requires a hospital stay over a number of days, or high-dose rate (HDR), which delivers an intense dose and usually means you can go home the same day. For vaginal cancer, HDR has been shown to be as effective as LDR, so LDR is rarely used.

At each HDR treatment session, you will be given pain medicine to make you more comfortable, and then a thin radioactive applicator, shaped like a tampon, will be put into your vagina. You will have to lie still while this is in place. Some women are given a general anaesthetic and have other small probes inserted near the cancer.

A machine delivers the radiation through the applicator for about 10–15 minutes. The applicator is taken out after the dose of radiation is delivered. If several sessions are needed, the applicator will be reinserted each time, but the doctor can use techniques that make it easier to get the applicator in the right place.

During a brachytherapy session, the tissue around the applicator will become temporarily inflamed and swollen. This will settle by the time the applicator is removed, but the treated area will feel sore afterwards. The pain should ease over a couple of weeks. Your doctor can prescribe painkillers to help relieve the discomfort.

Side effects of radiotherapy

The side effects you experience vary depending on the radiotherapy dose and the areas treated. Many will be short-term side effects that occur during treatment or within a few weeks of finishing. They often get worse 1–2 weeks after the end of treatment, before starting to get better. Some side effects may be late effects, not appearing until some time after treatment.

Radiotherapy that is targeted to the vaginal area has similar side effects to radiotherapy targeted to the vulvar area. See a description of common side effects.

External radiotherapy and HDR brachytherapy will not make you radioactive. It is safe for you to be with both adults and children after your treatment sessions are over and when you are at home.

For more information see radiotherapy, or call Cancer Council 13 11 20.

Surgery

The cancer may need to be removed with an operation. The surgeon will try to remove all of the cancer along with some of the surrounding healthy tissue (called a margin). This helps reduce the risk of the cancer coming back. Some lymph nodes in your pelvis may also be removed.

There are a number of different operations for vaginal cancer. The type of surgery you have depends on the size and position of the cancer.

Removing part of the vagina (partial vaginectomy)

The affected part of the vagina is removed.

Removing the whole vagina (radical vaginectomy)

The entire vagina is removed. In some cases, a reconstructive (plastic) surgeon can make a new vagina using skin and muscle from other parts of your body. This is called vaginoplasty or vaginal reconstruction, and it may be done to improve the appearance of your genitals.

Hysterectomy

Some women also need to have a radical hysterectomy. This means the uterus and cervix are removed. Your gynaecological oncologist will let you know whether it is also necessary to remove your ovaries and fallopian tubes (salpingo oophorectomy). If you have this type of surgery, it will cause menopause.

Recovery after surgery

The length of your hospital stay and the side effects that you experience will depend on the type of surgery you have. Most women are in hospital for a few days to a week. See what to expect as you recover from surgery.

For more information see surgery, or call Cancer Council 13 11 20.

Chemotherapy

Chemotherapy uses drugs known as cytotoxics to kill or slow the growth of cancer cells. It is usually given if the vaginal cancer is advanced or returns after treatment, and may be combined with surgery or radiotherapy.

The drugs are sometimes given as tablets or, more commonly, by injection into a vein (intravenously). You will usually have a number of treatment sessions (a cycle), followed by a break. Treatment can often be given to you during day visits to a hospital or clinic as an outpatient, but sometimes you may need to stay in hospital for a few nights.

Side effects of chemotherapy

Most people have some side effects from chemotherapy. There are many different types of chemotherapy drugs, and the side effects will vary depending on the drugs used. Your medical oncologist or nurse will discuss the likely side effects with you, including how they can be prevented or controlled with medication.

Common side effects experienced after chemotherapy for vaginal cancer include:

  • feeling sick (nausea)
  • tiredness (fatigue)
  • hair loss
  • a reduced resistance to infections.

Chemotherapy may also increase any skin soreness caused by radiotherapy. Some people find that they are able to lead a fairly normal life during their treatment, while others become very tired and need to take things more slowly.

For more information see chemotherapy, or call Cancer Council 13 11 20.

Palliative treatment

In some cases of advanced vaginal cancer, the medical team may talk to you about palliative treatment. Palliative treatment helps to improve quality of life by alleviating symptoms of cancer. It can be used at any stage of advanced cancer.

As well as slowing the spread of cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies.

Palliative treatment is one aspect of palliative care, in which a team of health professionals aim to meet your physical, emotional, practical and spiritual needs.

For more information see palliative care and advanced cancer or call Cancer Council 13 11 20.

Key points

  • The two most common types of primary vaginal cancer are squamous cell carcinoma and adenocarcinoma.
  • Symptoms may include bloody vaginal discharge, pain during sex, bleeding after sex, and a lump in the vagina.
  • A condition known as vaginal intraepithelial neoplasia (VAIN) can increase your risk. Female children of women who took a drug called diethylstilboestrol (DES) during pregnancy are also at an increased risk.
  • Diagnostic tests may include a Pap test, an examination of the vagina (colposcopy) and a tissue sample (biopsy).
  • The cancer’s stage describes its size and whether it has spread. The grade tells how quickly the cells are growing.
  • The earlier vaginal cancer is diagnosed, the better the chances that treatment will be successful.
  • You may see a range of health professionals, including a gynaecologist or gynaecological oncologist.
  • Radiotherapy uses radiation to kill cancer cells. Most women with vaginal cancer have both external and internal radiotherapy. Side effects may be short-term or long-term or may appear later.
  • During surgery, the affected part of the vagina is cut out. Other organs may also be removed.
  • Chemotherapy uses drugs to kill cancer cells. It is usually given if the cancer is advanced or if it returns after treatment.
  • For advanced vaginal cancer, palliative treatment may be given to manage symptoms and improve quality of life.

Reviewed by: Professor Selvan Pather, Senior Staff Specialist, Chris O’Brien Lifehouse, NSW; Dr Tiffany Daly, Radiation Oncologist, Mater Cancer Care Centre, South Brisbane, QLD; Anne Mellon, Gynaecological Clinical Nurse Consultant, Gynaecological Oncology, Hunter New England Centre for Gynaecological Cancer, and Chair, Gynaecological Oncology Specialist Practice Network, Cancer Nurses Society of Australia, NSW; Deb Roffe, 13 11 20 Consultant, Cancer Council SA, SA; Juliane Samara, Gynaecological and Brain/Central Nervous System Tumour Cancer Specialist Nurse, Canberra Region Cancer Centre, ACT; Robyn Teuma, Consumer; Dr Charlotte Tottman, Clinical Psychologist, Allied Consultant Psychologists and Flinders University, SA; Dr Paige Tucker, Research Registrar and Gynaecological Oncology Clinical and Surgical Assistant, St John of God Subiaco Hospital, WA.
Updated: 01 Oct, 2016