Vaginal cancer is a rare malignancy that forms in the tissues of the vagina—the muscular tube that connects the external genitals (the vulva) to the cervix (the lower part of the uterus). While a diagnosis of vaginal cancer can be frightening, understanding the disease, its symptoms, and treatment options is a crucial step toward taking control of your health.
It is important to distinguish primary vaginal cancer from metastatic cancer. Primary vaginal cancer originates in the vagina itself. More commonly, cancers found in the vagina have spread (metastasized) from other organs, such as the cervix, uterus, or bladder. This article focuses exclusively on primary vaginal cancer.
Types of Vaginal Cancer
Vaginal cancer is classified by the type of cell from which the cancer originates. The treatment protocol and prognosis often depend on this classification.
1. Squamous Cell Carcinoma
This is the most common type, accounting for approximately 85% to 90% of cases. It develops in the thin, flat squamous cells that line the surface of the vagina. It typically grows slowly and is most often found in the upper part of the vagina near the cervix. It usually affects women over the age of 60.
2. Adenocarcinoma
This type arises from the glandular cells in the lining of the vagina that produce mucus. It accounts for about 5% to 10% of vaginal cancers. A rare subtype, clear cell adenocarcinoma, is linked to prenatal exposure to diethylstilbestrol (DES), a synthetic estrogen prescribed to pregnant women between 1938 and 1971 to prevent miscarriage.
3. Melanoma
Melanoma usually develops on sun-exposed skin, but it can rarely occur in the vagina. It develops from the pigment-producing cells (melanocytes) in the vaginal lining. Vaginal melanoma accounts for a very small percentage of cases.
4. Sarcoma
Sarcoma forms in the connective tissue, muscle, or bone of the vaginal wall, rather than the lining. The most common type seen in the vagina is rhabdomyosarcoma, which is a fast-growing cancer that predominantly affects infants and young children. Leiomyosarcoma affects adults.
Symptoms: What to Look Out For
One of the most challenging aspects of vaginal cancer is that early-stage disease often presents with no symptoms at all. In many cases, it is discovered during a routine pelvic exam or Pap smear.
When symptoms do manifest, they are often mistaken for other, less serious conditions (like infections or benign growths). However, if you experience any of the following, it is vital to consult a gynecologist:
- Abnormal Vaginal Bleeding: This is the most common symptom. It includes bleeding after sexual intercourse (postcoital bleeding), bleeding between periods, or bleeding after menopause.
- Unusual Vaginal Discharge: Discharge may be watery, bloody, or foul-smelling.
- Pain: Pain during sexual intercourse (dyspareunia) or a persistent pain in the pelvic area.
- A Vaginal Mass: A palpable lump or thickening in the vagina that can be felt.
- Urinary Issues: Increased frequency of urination, urgency, or pain during urination (dysuria) if the tumor presses on the bladder.
- Bowel Issues: Constipation, painful bowel movements, or black/tarry stools if the tumor presses on the rectum.
Important Note:** Having these symptoms does not mean you have cancer. Many are common to infections or benign conditions. However, a medical evaluation is required to rule out malignancy.
How Does Vaginal Cancer Look?
This is a common question patients ask. The appearance of vaginal cancer varies depending on the stage, type, and location of the tumor. It is important to note that in the very early stages (carcinoma in situ), the tissue may look completely normal to the naked eye or may appear only as a slightly rough, red, or raised area.
As the disease progresses, the visual characteristics change. During a colposcopy or pelvic exam, a physician may observe:
1. The Texture and Shape
- Ulcerative: The cancer may look like a sore or an ulcer that does not heal. It may have a “cratered” or sunken appearance in the center with raised, rolled edges.
- Exophytic: The tumor may grow outward from the vaginal wall, appearing as a cauliflower-like mass or a polypoid nodule. It can be described as a fleshy, irregular growth that bleeds easily when touched.
- Infiltrative: The area may feel hard and stiff. Instead of growing outward, the cancer grows inward into the tissue, making the vaginal wall lose its natural elasticity and appear thickened or rigid.
2. The Color
The color of the lesion often differs from the surrounding healthy pink mucosa.
- It may appear white (leukoplakia), red (erythroplakia), or darkly pigmented (in the case of melanoma, ranging from brown to black).
- Due to the growth of abnormal blood vessels, the lesion may appear highly vascular (red or purple) and bleed on contact.
3. The Location
- Most squamous cell carcinomas are located in the upper third of the vagina, near the cervix.
- Melanomas are most frequently found in the lower third of the vagina, often on the anterior (front) wall.
It is critical to understand that you cannot reliably diagnose vaginal cancer by looking at it yourself. The vagina is an internal organ, and these visual descriptions are what a clinician sees during a speculum examination. If you suspect a change, do not attempt self-diagnosis; see a professional.
Causes and Risk Factors
While the exact cause of most vaginal cancers is unknown, several factors increase the risk of developing the disease:
Human Papillomavirus (HPV)
HPV is a group of viruses, some types of which are linked to cancers of the cervix, vagina, and vulva. HPV is the primary risk factor for squamous cell carcinoma of the vagina.
History of Cervical Cancer or Precancer
Women who have had cervical cancer or cervical dysplasia (precancerous changes) are at a significantly higher risk of developing vaginal cancer.
Diethylstilbestrol (DES) Exposure
Women whose mothers took DES during pregnancy to prevent miscarriage between 1938 and 1971 have a higher risk of developing clear cell adenocarcinoma of the vagina or cervix.
Age
The risk of squamous cell carcinoma increases with age, with most cases diagnosed in women over 60.
Smoking
Smoking doubles the risk of vaginal cancer, likely due to the systemic effects of carcinogens on the body.
HIV/AIDS
A weakened immune system reduces the body’s ability to fight off HPV infections, increasing cancer risk.
Diagnosis: How is it Detected?
Diagnosis typically involves a multi-step process:
- Pelvic Examination: The doctor feels the uterus, vagina, ovaries, and rectum to check for abnormalities.
- Pap Smear: Cells are scraped from the cervix and vagina to check for dysplasia or cancer.
- Colposcopy: A magnifying instrument (colposcope) is used to examine the vaginal walls and cervix in detail.
- Biopsy: If an abnormality is found, a small sample of tissue is removed (biopsy) and sent to a pathologist to confirm the presence of cancer cells.
Staging
If cancer is confirmed, imaging tests such as MRI, CT scans, or PET scans may be performed to determine the “stage” (how far the cancer has spread).
| Stage | Description |
|---|---|
| Stage I | The cancer is limited to the vaginal wall. |
| Stage II | The cancer has grown through the vaginal wall but has not spread to the pelvic wall. |
| Stage III | The cancer has spread to the pelvic wall and/or nearby lymph nodes. |
| Stage IVA | The cancer has spread to the bladder or rectum lining, or beyond the pelvis. |
| Stage IVB | The cancer has spread to distant organs, such as the lungs or liver. |
Treatment Options
Treatment for vaginal cancer is highly individualized and depends on the type, stage, and location of the tumor, as well as the patient’s overall health and desire for future fertility.
- Surgery:
- Local Excision: Removal of a small, localized tumor.
- Vaginectomy: Removal of part or all of the vagina.
- Hysterectomy: Removal of the uterus (often performed alongside a vaginectomy).
- Lymph Node Dissection: Removal of lymph nodes in the groin or pelvis to check for spread.
- Radiation Therapy: This is a common treatment for vaginal cancer. It uses high-energy beams (External Beam Radiation) or implanted radioactive seeds (Brachytherapy) to kill cancer cells.
- Chemotherapy: The use of drugs to kill cancer cells. It is often combined with radiation (chemoradiation) to increase effectiveness, especially in advanced stages.
- Targeted Therapy: For specific types, like melanoma, drugs may be used to target specific vulnerabilities in the cancer cells.
Prognosis and Survival Rates
Survival rates are statistical averages and cannot predict an individual’s outcome. Generally, the earlier the cancer is caught, the better the prognosis.
According to aggregate data from the American Cancer Society and other oncology registries, the 5-year relative survival rates are roughly:
- Localized (Confined to the vagina): ~65-70%
- Regional (Spread to nearby lymph nodes): ~50-55%
- Distant (Metastasized): ~20%
Note: These figures are based on historical data; modern treatment advancements may offer improved outcomes.
Prevention and Screening
- HPV Vaccination: The HPV vaccine (Gardasil 9) protects against the strains of HPV most likely to cause cancer. It is recommended for preteens and young adults.
- Regular Pelvic Exams: Even if you have had a hysterectomy, regular gynecological check-ups are vital.
- Smoking Cessation: Quitting smoking lowers your risk.
- Safe Sex Practices: Using condoms reduces the transmission of HPV.
Summary
Vaginal cancer is rare, but awareness is key. Persistent abnormal bleeding, pain, or discharge should always be evaluated by a healthcare professional. With early detection and modern medical intervention, vaginal cancer is treatable, and many women go on to live full, healthy lives.
References
- American Cancer Society, 2024. Vaginal Cancer. [online] Available at: <https://www.cancer.org/cancer/types/vaginal-cancer.html> [Accessed 24 May 2024].
- Cancer Research UK, 2023. About vaginal cancer. [online] Available at: <https://www.cancerresearchuk.org/about-cancer/vaginal-cancer> [Accessed 24 May 2024].
- Hacker, N.F., 2015. Vaginal cancer. In: Berek, J.S. and Hacker, N.F., eds., Berek & Hacker’s Gynecologic Oncology. 6th ed. Philadelphia: Lippincott Williams & Wilkins, pp. 608-624.
- Mayo Clinic, 2022. Vaginal cancer – Symptoms and causes. [online] Available at: <https://www.mayoclinic.org/diseases-conditions/vaginal-cancer/symptoms-causes/syc-20352447> [Accessed 24 May 2024].
- National Cancer Institute, 2024. Vaginal Cancer Treatment (PDQ®)–Patient Version. [online] Available at: <https://www.cancer.gov/types/vaginal/patient/vaginal-treatment-pdq> [Accessed 24 May 2024].
- NHS, 2023. Vaginal cancer. [online] Available at: <https://www.nhs.uk/conditions/vaginal-cancer/> [Accessed 24 May 2024].