WHAT IS VAGINAL CANCER?
Vaginal cancer (also known as cancer of the vagina) is cancer that starts in the vagina. It should not be confused with cancer that has spread to the vagina from another site in the body (also known as secondary vaginal cancer).
Vaginal cancer is one of the rarest types of cancer affecting the female reproductive system. Each year in Australia, about 70 women are diagnosed with vaginal cancer. The average age at diagnosis is 70, however vaginal cancer can occur in younger women.
VAGINAL CANCER SYMPTOMS
There are often no obvious signs of vaginal cancer, however symptoms may include:
- pain in the pelvic area or rectum
- a lump in the vagina
- blood in the urine
- bloody vaginal discharge not related to a menstrual period
- pain during or bleeding after sexual intercourse.
CAUSES OF VAGINAL CANCER
Some factors that can increase your risk of vaginal cancer include:
- A precancerous condition called vaginal intraepithelial neoplasia (VAIN) that often has no symptoms.
- Presence of the human papillomavirus (HPV), a sexually transmitted infection that can lead to the development of VAIN.
- Tobacco smoking, which doubles your risk of vaginal cancer.
- Radiotherapy to the pelvis increases your risk of vaginal cancer, however this is very rare.
- If you have had cervical cancer you are at increased risk of vaginal cancer.
- If your mother was prescribed the synthetic hormone diethylstilboestrol (DES) during pregnancy (before 1971), you have an increased risk of vaginal cancer.
DIAGNOSIS FOR VAGINAL CANCER
Tests to diagnose vaginal cancer may include:
It is standard practice for your doctor to examine your vagina, groin and pelvic area. A nurse may be present during the examination, and you can ask for a family member to be present.
You may undergo a Pap test (also known as a Pap smear) to check the cells inside the vagina and cervix as part of the physical examination.
COLPOSCOPY AND BIOPSY
During the examination, your doctor may use a magnifying instrument called a colposcope to look at your vagina, cervix and vulva. Your doctor may also take a tissue sample (called a biopsy) to check for cell abnormalities.
If the tests described above show that you have vaginal cancer, further tests may be needed to find out if the cancer cells have spread to other parts of the body. These tests may include a blood test, chest X-ray, cystoscopy, proctoscopy, and CT and MRI scans.
TREATMENT FOR VAGINAL CANCER
Based on the results of the tests, your doctor will tell you the stage of the cancer. Staging describes the size of the cancer and if and how far it has spread beyond the vagina.
Your doctor may also tell you the grade of the cancer cells. This gives you an idea of how quickly the cancer may develop.
Knowing the stage and grade of the cancer helps your medical team decide on the most appropriate treatment. Treatment may involve radiotherapy, surgery and/or chemotherapy.
Radiotherapy is a common treatment for vaginal cancer that uses radiation, such as X-rays, to kill or damage cancer cells. Radiotherapy can also be used to control symptoms of advanced cancer. This is called palliative radiotherapy.
The cancer may need to be removed with an operation. Surgery will aim 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.
Chemotherapy uses drugs 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.
Chemotherapy may be given as tablets or by injection into a vein (intravenously). You will usually have a number of treatment sessions, followed by a break.
You may be cared for by a number of different health professionals depending on your treatment. These may include:
- a GP who can explain information given by specialists as well as monitoring your general health and well being
- a gynaecologist specialising in treating diseases of the female reproductive system
- radiation oncologist
- medical oncologist
- gynaecological oncologist who diagnoses and treats cancers of the female reproductive system
- a plastic surgeon
- cancer care coordinators and clinical nurses
- a dietitian
- other allied health professionals such as clinical psychologist, social worker, physiotherapist and occupational therapist.
In some cases of vaginal cancer, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer. As well as slowing the spread of vaginal cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies.
SCREENING FOR VAGINAL CANCER
There is currently no screening for vulvar cancer available in Australia.
PROGNOSIS FOR VAGINAL CANCER
Prognosis means the expected outcome of a disease. An individual's prognosis depends on the type and stage of cancer, as well as their age and general health at the time of diagnosis.
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. In most cases, the earlier vaginal cancer is diagnosed, the better the chances of successful treatment.
PREVENTING VAGINAL CANCER
There are no known lifestyle measures to prevent vaginal cancer, however not smoking may reduce your risk.