Vaginal cancers are rare malignancies that develop in the vagina, a long, muscular canal leading from the cervix to the outside of the body. The vaginal opening is where menstrual bloodthe red bodily fluid that transports oxygen and other nutrients around the body flows out during menstruation, sexual intercourse occurs, and a baby comes out during labour.
Vaginal cancera disease where abnormal cells split without control and spread to other nearby body tissue and/or organs is most common in women over 60, however, it can affect anyone with a vagina – including women, teenagers, transgender men, non-binary individuals, and intersex people – at any age.
Types of Vaginal Cancers
There are several types of vaginal cancer, which are categorised by the type of cellsthe basic structural and functional unit of all living things they originate from.
Squamous Cell Carcinoma (SCC)
Vaginal squamous cell carcinomas (SCCs) are the most common subtype of vaginal cancer, and are often found in the upper portion of the vagina. Squamous cell carcinomas (SCCs) are cancers that arise from the squamous cells that line organs, such as the vagina. They are usually not aggressive, but can metastasise if left untreated. Vaginal SCCs can have a good prognosisto predict how a disease/condition may progress and what the outcome might be when found early.
Adenocarcinoma
Vaginal adenocarcinomas are a rarer subtype of the disease, which arise from mucus-producing glands in organs, such as the vagina. Some forms of vaginal adenocarcinomas, especially clear cell adenocarcinomacancer arising from mucus-producing glands in organs, have been linked to diethylstilbestrol (DES) exposure prior to birth. They can be aggressive, can metastasise and can have a good prognosis when caught early.
Mucosal Melanoma
Melanomas are a type of cancer that develop from melanocytes, which are the cells that produce pigment. While these are generally in the skin, they can also occur in mucosal surfaces. Vaginal melanomas are very rare.
For more information about mucosal melanomaa type of cancer that develops from melanocytes, which are the cells that produce pigment generally in the skin (but can develop in other areas of the body), please refer to the Rare Cancers Australia Melanoma (Mucosal) page.
Rare forms of Vaginal Cancer
These types of vaginal cancers are considered extremely rare:
- Vaginal Sarcomacancer arising from bones and/or soft tissue.
- Vaginal Small Cell Carcinomacancer arising from tissues that line organs.
- Vaginal Lymphomacancers of the lymphatic system.
Treatment
If vaginal cancer is detected, it will be staged and graded based on size, metastasiswhen the cancer has spread to other parts of the body, also known as mets, and how the cancer cells look under the microscope. Stagingthe process of determining how big the cancer is, where it started and if it has spread to other areas and grading helps your doctors determine the best treatment for you.
FIGO Staging System
Gynaecological cancers, such as vaginal cancers, can be staged using the Federation of Gynaecologythe study of the female reproductive system and related diseases and Obstetrics (FIGO) system from stage I to IV:
- Stage I: cancer cells are confined to cervix tissuea group of cells that work together to perform a function only. This stage is also known as early-stage cancer.
- Stage II: cancer cells have spread to the upper two-thirds of the vagina and/or other nearby tissue. This is also known as localisedaffecting only one area of body cancer.
- Stage III: the cancer has become larger and has spread to lower third of the vagina and/or the side of the pelvic wall. Lymph nodessmall bean-shaped structures that filters harmful substances from lymph fluid and kidneys may be affected. This is also known as advancedat a late stage, far along or metastatic cancer.
- Stage IV: the cancer has spread to the bladdera hollow, muscular sac in the pelvis that stores urine or rectumthe last section of the large intestine/bowel that holds waste until it is ready to be removed from the body, or to more distant organs, such as the lungs or the liver. This is also known as advanced or metastatic cancer.
TNM Staging System
The TNM system can also be used to classify a vaginal cancer. The TNM system is comprised of:
- T (tumoura tissue mass that forms from groups of unhealthy cells) indicates the size and depth of the tumour.
- N (nodea small lump or mass of tissue in your body) indicates whether the cancer has spread to nearby lymph nodes.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissue.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localised cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advanced or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Gradea description of how abnormal cancer cells and tissue look under a microscope when compared to healthy cells I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testinga procedure that analyses DNA to identify changes in genes, chromosomes and proteins, which can be used to analyse tumour DNA to help determine which treatment has the greatest chance of success, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment Options
Treatment is dependent on several factors, including fertility, type, stage of disease and overall health.
Treatment options for vaginal cancers may include:
- Radiation therapya treatment that uses controlled doses of radiation to damage or kill cancer cells.
- Surgerytreatment involving removal of cancerous tissue and/or tumours and a margin of healthy tissue around it to reduce recurrence, potentially including:
- Vaginectomycomplete or partial removal of the vagina.
- Vaginal reconstructionthe creation of a new vagina using skin and muscle from other parts of the body.
- Hysterectomycomplete or partial removal of the uterus.
- Unilateral salpingo-oophorectomyremoval of one ovary and fallopian tube.
- Bilateral salpingo-oophorectomyremoval of both ovaries and fallopian tubes.
- Chemotherapya cancer treatment that uses drugs to kill or slow the growth of cancer cells, while minimising damage to healthy cells.
- Clinical trialsresearch studies performed to test new treatments, tests or procedures and evaluate their effectiveness on various diseases.
- Palliative carea variety of practices and exercises used to provide pain relief and improve quality of life without curing the disease.
Vaginal Cancer Treatment and Fertility
Treatment for vaginal cancer may make it difficult to become pregnant. If fertility is important to you, discuss your options with your doctor and a fertility specialist prior to the commencement of treatment.
Risk factors
While the cause of vaginal cancer remains unknown, the following factors may increase the riskthe possibility that something bad will happen of developing the disease:
- Having vaginal intraepithelial neoplasia (VAIN).
- Having an infectiona condition where harmful pathogens, such as bacteria, viruses or parasites, have entered the body with human papillomavirus (HPV).
- Smoking.
- Having a personal history of a gynaecological cancer (such as ovarian, uterine, vulvar, fallopian etc.).
- Previous radiation therapy to the pelvic areathe lower part of the abdomen area, covers from hip to hip and waist to groin (body part that ends at top of thighs/legs)..
- Exposure to diethylstilboestrol (DES).
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Diethylstilbestrol (DES) exposure
Diethylstilbestrol (DES) is a synthetic form of the female hormonea chemical substance produced by glands in the endocrine system that regulates various functions in the body estrogen. It was prescribed to pregnant women between 1940 and 1971 to prevent miscarriage, premature labour, and related complications of pregnancy. The use of DES declined after studies in the 1950s showed that it was not effective in preventing these problems.
In 1971, researchers linked prenatal (before birth) DES exposure to a type of cancer of the cervix and vagina called clear cell adenocarcinoma in a small group of women. Soon after, the Food and Drug Administration (FDA) notified physicians throughout the country that DES should not be prescribed to pregnant women. The drug continued to be prescribed to pregnant women in Europe until 1978.
Women who have taken DES, and women whose mothers took DES whilst pregnant, may be at higher risk of vaginal cancer, as well as other conditions.
Symptoms
Many people with early-stage vaginal cancer may appear asymptomatic. As the cancer progresses, some of the following symptoms may appear:
- Unusual bloody vaginal discharge (not related to menstrual period) – occasionally having a strong and usual odour.
- Pain and/or bleeding during or after sexual intercourse.
- Pain in the pelvic area and/or rectum.
- A lump in the vagina.
- Changes in bladder/bowel habits, potentially including:
- Haematuriathe presence of blood in urine.
- Polyuriafrequent urination.
- Painful bowelportion of the digestive system that digests food (small bowel) and absorbs salts and water (large bowel); also called intestines movements.
- Unusual urination during the night.
Not everyone with the symptoms above will have cancer but see your general practitioner (GP) if you are concerned.
Diagnosis
If your doctor suspects you have vaginal cancer, they may order the following tests to confirm the diagnosisthe process of identifying a disease based on signs and symptoms, patient history and medical test results and refer you to a specialist for treatment:
- Pelvic examinationa physical exam of the external and internal female pelvic organs.
- Imagingtests that create detailed images of areas inside the body tests, potentially including:
- MRI (magnetic resonance imaging)a type of medical imaging that uses radiowaves, a strong magnet and computer technology to create detailed images of the body.
- CT (computed tomography) scana type of medical imaging that uses x-rays and computer technology to create detailed images of the body.
- Pelvic ultrasounda type of medical imaging that uses sound waves to create detailed images of the organs and structures within the pelvis, including the uterus, ovaries, and surrounding tissues.
- PET (positron emission tomography) scana type of medical imaging that uses radioactive tracers to create detailed images of the body.
- Blood teststesting done to measure the levels of certain substances in the blood.
- Colposcopyan examination of the cervix and vagina using a small, flexible instrument known as a colposcope.
- Biopsyremoval of a section of tissue to analyse for cancer cells.
