Vaginal cancer at a glance

• Vaginal cancer is a rare form of cancer (an uncontrolled growth of cells) that most often originates in the lining of the vagina’s surface.
• Vaginal cancer types are based on what kind of cells the cancer forms in and include squamous cell carcinoma, adenocarcinoma, melanoma and sarcoma.
• There may be no symptoms of vaginal cancer early on, but may later include abnormal bleeding, discharge, a lump and other signs.
• Treatments vary according to cancer stage and a patient’s overall health history and may include radiation, chemotherapy or surgery.

What is vaginal cancer?

Vaginal cancer is an abnormal growth of cells in the vagina, the muscular tissue shaped like a tube that connects the uterus with the external genitals. Vaginal cancer is a rare form of cancer that usually originates in the vaginal surface, also known as the vaginal wall or birth canal. Each year, just over 4,000 cases of vaginal cancer are diagnosed. The squamous cells that make up the epithelial lining of the vagina are most susceptible to cancer.

The four primary types of vaginal cancer are categorized according to the types of cell where the cancer originates in the vagina:

• Squamous cell carcinoma — This is the most common form of vaginal cancer, accounting for 70 percent of all vaginal cancer diagnoses. This cancer typically forms slowly over the course of years, and begins in the squamous cells that make up the epithelia lining of the vagina. It is most common in the upper areas of the vagina.
• Andenocarcinoma — About 15 percent of all vaginal cancer cases are andenocarcinomas, cancer that originates in the cells of the mucus-generating glands of the vagina. Women over 50 are more likely to be diagnosed with this cancer type, but younger women may get this if they were exposed to diethylstilbestrol (DES) in their mother’s womb.
• Melanoma — This form of skin cancer, typically found on sun-exposed areas of the body, can also form in the vagina (or other internal organs). Melanoma accounts for about nine percent of vaginal cancers and generally occurs in the lower or outer portion of the vagina.
• Sarcoma — Sarcomas begin in the cells of bone, muscle or connective tissues. There are several types of sarcomas, but it is still fairly rare, comprising up to four percent of all vaginal cancers.

What causes vaginal cancer?

Although there are no definitive causes of vaginal cancer (or most other cancers), certain risk factors suggest a correlation to increased chance of vaginal cancer. Some risk factors include:

• Being over the age of 60
• Exposure to DES, a hormone given to prevent miscarriage, while in the mother’s womb
• Human papillomavirus (HPV), history of abnormal cervix cells or cervical cancer
• Smoking increases the risk by 40 percent.

Additionally, women with a history or uterus cancer, abnormal cells in the uterus and hysterectomy have an elevated chance of getting vaginal cancer.

Vaginal cancer symptoms and screening

Vaginal cancer typically does not present symptoms in early stages, and the cancer may be found during a pelvic or Pap smear exam. But as it develops over time symptoms that may present include:

Abnormal vaginal bleeding between periods

• A vaginal lump
• Pain while urinating and from sexual intercourse
• Constipation

Vaginal cancer is screened in numerous ways. These include a pelvic exam, Pap smear, colposcopy or biopsy.

Treating vaginal cancer

Vaginal cancer diagnoses carry a high cure rate when detected early. Treatment plans will depend on the stage of the cancer (the progression of its spread in the vagina and to other areas). Vaginal cancer diagnosed in later stages or in instances when it has spread beyond the vagina prove much more difficult to treat and cure. Treatment also depends on the cancer’s location, as well as whether the woman has had a hysterectomy or previous radiation treatments to the pelvis.

Primary treatments for vaginal cancer include surgery, radiation therapy or chemotherapy. Depending on how advanced the cancer is, treatments may be combined.

• Surgery may include removing tumors, lesions, the entire vagina or even the total removal of all pelvic organs. (Patients who undergo a vagina removal may elect to have another surgery that constructs a new vagina).
• Radiation treatments may include external or internal radiation. During external radiation, an external beam targets the entire abdomen or pelvic region. Internal radiation, a much less common radiation treatment for vaginal cancer, uses radioactive devices placed in the vagina.
• Chemotherapy uses chemicals to destroy cancer cells. Chemotherapy is often a supplemental treatment to radiation therapy and is generally not used on its own for treating vaginal cancer.

At CU Anschutz Gynecologic Oncology, experts provide advanced diagnosis and care, from surgery to radiation and chemotherapy.