What are the causes?
As with many cancers, the exact cause of most vaginal cancers is unknown, but research is going on all the time to try to find the cause.
DES
A hormone drug called diethystilboestrol (DES) has been identified as a cause of a particular type of cancer of the vagina.
Between 1940 and 1970, DES was prescribed to pregnant women to try to prevent miscarriages. The female children of women who took DES during pregnancy have a slightly increased risk of developing a type of cancer of the vagina called clear cell adenocarcinoma. (Only one in 1000 DES daughters develop vaginal cancer. The incidence peaked in the 1970s and is now decreasing.)
Although DES and some other female hormones (oestrogens) can be safely used to treat some other medical conditions, DES is no longer used during pregnancy.
HPV
The human papilloma virus (HPV), which is the name for a group of wart viruses, is a risk factor for vaginal cancer.
HPV is a common infection affecting the skin surface of any part of the body, including the vagina and the cervix.
More than eight out of ten women will be exposed to the genital HPV at some time in their lives and for most it will clear up on its own.
Other possible causes
Cervical cancer: women who have had cervical cancer or pre-cervical cancer in the past are more likely to get vaginal cancer.
Radiotherapy to the pelvic area: women who have had radiotherapy to the pelvic area also have a slightly higher risk, but this complication of radiotherapy is very rare, and women who have had this treatment still only have a tiny risk of developing vaginal cancer.
Symptoms
The most common symptoms of vaginal cancer are:
- blood-stained vaginal discharge
- bleeding after sexual intercourse
- pain
Problems with passing urine, such as blood in the urine, the need to pass urine frequently and the need to pass urine at night can also occur.
Pain in the back passage may sometimes occur.
Diagnosis
Usually you begin by seeing your GP, who will do a vaginal examination.
If there is a chance you have vaginal cancer, you should be referred to a gynaecological oncologist, who diagnoses and treats women with cancer of the reproductive organs.
The following tests are commonly used to diagnose vaginal cancer.
Internal vaginal examination
At the hospital, the gynaecological oncologist will do a full pelvic examination.
This will include examining the inside of your vagina to check for any lumps or swellings.
The doctor will also feel your groin and pelvic area to check for any swollen glands and may also check your back passage.
Pap smear
You will have a Pap smear to check for early cell changes in the vagina or cervix.
Colposcopy
If the cells taken in the smear test are abnormal, your doctor may ask you to have a colposcopy.
This is a closer examination of the vagina using a colposcope, which is a small low-powered microscope that allows the doctor or specialist nurse to see the vagina in more detail.
Biopsy
A small sample of tissue will be taken from any abnormal areas, and examined under a microscope.
Early cell changes
The tests may show early cell changes in the vagina known as vaginal intraepithelial neoplasia or VAIN. This is sometimes referred to as carcinoma in-situ.
VAIN is not cancer so the treatment for this condition is not the same as for cancer.
Further test
If the above tests show that you have a vaginal cancer, further tests may be necessary to find out whether any cancer cells have spread.
Cancer can spread in the body, either in the bloodstream or through the lymphatic system.
The lymphatic system is part of the body’s defence against infection and disease. The system is made up of a network of lymph glands (also known as lymph nodes) that are linked by fine ducts containing lymph fluid.
The results of these tests will help the specialist to decide on the best type of treatment for you.
Stages of vaginal cancer
The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site.
Knowing the particular type and the stage of the cancer helps doctors to decide on the most appropriate treatment.
- Stage 1: The cancer is only in the vagina and has not begun to spread.
- Stage 2: The cancer has begun to spread through the wall of the vagina, but has not spread further into the walls of the pelvis.
- Stage 3: The cancer has spread to the pelvis and may also be in the lymph nodes close to the vagina.
- Stage 4: The cancer has spread to the bladder or the bowel, or to other parts of the body such as the lungs.
If the cancer comes back after initial treatment, this is known as recurrent cancer.
Grading
Grading refers to the appearance of the cancer cells under the microscope and gives an idea of how quickly the cancer may develop.
Low grade (well differentiated) means the cancer cells look like normal vaginal cells. They are usually slow growing and are less likely to spread.
High grade (poorly differentiated) means the cells look very abnormal. They are likely to grow more quickly and to spread.
Prognosis
Prognosis means the expected outcome of a disease.
Many factors affect prognosis, including the extent of the cancer – whether it is just in the vagina or has spread – and your general health.
It is important to talk to your doctor about prognosis. Only someone who knows your medical history can tell you what to expect and the treatment options that are best for you.
Treatment
The treatment for vaginal cancer depends on:
- age
- general health
- stage
- grade
- type of cancer.
Radiotherapy
Commonly used treatment for many women with cancer of the vagina.
In some younger women, radiotherapy may be combined with chemotherapy.
Radiotherapy treats cancer by using x-rays, which destroy the cancer cells, while doing as little harm as possible to normal cells. It is given in the radiotherapy department at the hospital.
The dose needed will depend on the exact type of cancer and whether it has spread into surrounding tissue, so you may find that you are having a different radiotherapy treatment from other women you meet at the hospital.
Radiotherapy can be given in two ways:
- From outside the body (external). A machine directs radiation at the cancer and surrounding tissue.
- From inside the body (internal). Radioactive material is put in thin tubes into your body on or near the cancer.
Most women have both external and internal radiotherapy.
External radiotherapy
This involves beams of radiation being directed at the cancer from outside the body.
It is like having an x-ray.
You will be asked to visit the radiotherapy department for treatment every weekday for 4–6 weeks. Each treatment takes several minutes and is painless.
Internal radiotherapy
An applicator (similar to a tampon) containing a radioactive substance is inserted into your vagina.
The treatment may last several hours or a few days.
Sometimes, as well as the applicator, tiny radioactive needles may be placed into the area surrounding the vagina. If these are needed, they are put in under general anaesthetic and are removed once the treatment ends.
Surgery
The type of surgery you will have depends on the size and position of the cancer.
It may be possible to have an operation to remove the cancer together with some of the surrounding normal tissue.
Depending on the amount removed, the remaining vagina may be stretched so that you may still be able to have sexual intercourse.
Vaginectomy
Some women may need a larger operation that removes all of the vagina.
Sometimes it is possible to make a new vagina (vaginal reconstruction) using tissue from other parts of the body.
Radical hysterectomy
It may also be necessary to remove the uterus (womb), cervix, ovaries and Fallopian tubes. This is called a radical hysterectomy.
During this operation some of the lymph nodes in the pelvis may also be removed.