Vaginal | Chris O'Brien Lifehouse

Whether you have just been diagnosed with vaginal cancer, or are caring for someone with vaginal cancer you may understandably be upset and have many questions.

At Lifehouse, we aim to give you the support and sanctuary you need during this difficult and vulnerable time. We hope that this information gives some of the answers you are needing now to better understand your cancer. Once you understand more what’s going on, and what may lie ahead, you will hopefully feel more comfortable talking to your doctors and your health care team and, in making decisions together for you or for those you are caring for.

What is the vagina?

The vagina is the muscular tube that connects the opening of the uterus (called the cervix) to the folds of skin between a woman’s legs (called the vulva). The vagina is where sexual intercourse occurs. It is also the passageway that menstrual blood passes through to get out of the body, and through which babies are born.

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What is vaginal cancer?

Cancer is a disease that causes cells to multiply and spread uncontrollably. Tumour oftens starts as a small lump or growth of tissue (or a lesion), that is isolated in one organ or part of the body. Tumours can be benign or cancerous (malignant). When tumour cells break off from an initial tumour and invade neardby tissues, the it becomes cancer. The cancer is then said to have metastasied. If cancer starts in the cells of your vagina, it’s called cancer of the vagina. Cancer of the vagina is very rare.

Types of vaginal cancer

There are two main types of vaginal cancer.

Squamous cell carcinoma – the most common type of cancer, affecting cells covering the surface of the vagina
Adenocarcinoma – a type of cancer that begins in the glandular cells lining the vagina.

It is more common to have secondary cancers in the vagina. This means the cancer has spread from another part of the body. The cancer may spread from the cervix, uterus (womb), vulva, or nearby organs such as the bladder or bowel.

 What are the causes?

Some factors that increase the risk of vaginal cancer include:

Vaginal intraepithelial neoplasia (VAIN) – This is a precancerous condition of the vagina that is sometimes caused by human papillomavirus (HPV). It means that the cells are abnormal and they may develop into cancer. Not all women with VAIN develop cancer.

Human papillomavirus (HPV) – Sometimes known as the wart virus, HPV is a sexually transmitted infection that increases the risk of vaginal cancer.

Smoking – Cigarette smoking doubles the risk of developing vaginal cancer.

Radiotherapy to the pelvis – If you have had radiotherapy to the pelvis for another reason, you are at a slightly higher risk of vaginal cancer. This complication is very rare.

Diethylstilboestrol (DES) – A synthetic hormone drug that has been identified as a cause of vaginal cancer. Between 1938 and 1971 – and occasionally beyond – DES was prescribed to pregnant women to prevent miscarriages. It is no longer prescribed to pregnant women in Australia. Female children of women who took DES (called DES daughters) have an increased risk of developing adenocarcinoma. The risk appears to be highest for those in their teenage years and early 20s. However, older women have also been diagnosed, so DES daughters should have regular medical examinations throughout their lifetime.

Vaginal adenosis – This condition causes abnormal cells to form in the tissue of the vagina. This is usually the result of DES exposure.

History of gynaecological cancer – Cancer of the vagina is more likely to be diagnosed in women who have had cervical cancer or early cervical cell changes considered to be precancerous. It is sometimes more common in women who have had cancer of the uterus. Vaginal cancer is not infectious and it can’t be passed to other people through sexual contact. It is not caused by an inherited faulty gene and can’t be passed on to children.

What are the symptoms?

You might not experience any obvious symtoms. The cancer may be found through a routine Pap smear. You may have one or more of the following symptoms:

  • bloody or smelly vaginal discharge not related to your menstrual period
  • pain during sexual intercourse
  • bleeding after sexual intercourse
  • pain in the pelvic area
  • a lump in the vagina

Some women also have bladder and bowel problems. You may have blood in your urine or feel the urge to pass urine frequently or during the night. Pain in the rectum can sometimes occur.

If you have any symptoms, make an appointment with your GP.

How common is it?

Cancer of the vagina is one of the rarest types of gynaecological cancer. Each year in Australia, approximately 70 women are diagnosed.

Squamous cell carcinoma usually affects women aged 50-70. Adenocarcinoma commonly affects young women less than 25 years old, but it can also occur in other age groups.

Tests to diagnose vaginal cancer

If you have symptoms of vaginal cancer, your doctor will do a physical examination of the groin and pelvic area to check for swollen glands. The doctor may also arrange some of the following tests:

Pap smear

You may have a Pap smear (Pap test) to check the cells inside the vagina and cervix. The doctor puts an instrument with smooth, curved sides (speculum) into your vagina. The speculum gently spreads the vaginal walls, and the doctor uses a tool such as a brush or spatula to scrape cells from the cervix. The tissue sample is sent to a lab, where it is checked for abnormalities. The results of the Pap smear may show that you have early cell changes in the lining of the vagina. This condition is called VAIN.

Colposcopy and biopsy

The doctor will do an internal examination to look at your vagina. This is called a colposcopy.

In this procedure, you will lie on your back on an examination table with your buttocks near the end of the table and your feet on foot rests (stirrups). Your doctor may put some fluid inside your vagina, insert an instrument (speculum) and look though a microscope called a colposcope to examine the vaginal canal.

Your doctor may also take a tissue sample (biopsy) during the colposcopy. The tissue is sent to a laboratory where a specialist called a pathologist examines the cells under a microscope. The pathologist will be able to confirm that the cells are cancerous and tell you what type of cancer it is.

You may feel uncomfortable during the colposcopy. Some women take a pain-reliever, such as ibuprofen, about an hour beforehand to ease cramping and discomfort.

 

Further tests

If the above tests show that you have vaginal cancer, further tests may be necessary to find out whether cancer cells have spread:

Blood test

A blood sample is taken to check the number of cells in your blood, and see how well your kidneys and liver are working.

Cystoscopy

The doctor uses a slender tube with a lens and a light (cystoscope) to look into the urethra and bladder. This is done under general anaesthetic.

Chest x-ray

A painless x-ray scan of your lungs, heart or abdomen.

CT scan

A CT (computerised tomography) scan uses X-ray beams to create a detailed, three-dimensional image of the body. The CT scanner is a large, circular machine. The patient lies on a table as the scanner rotates. The scan takes approximately 30 to 40 minutes. To make the image clearer, patients may be asked to drink a special liquid that contains a dye. The dye may cause the patient to experience a hot feeling all over for a few minutes. Tell your doctor if you are allergic to iodine or any dye.

MRI scan

MRI, also called nuclear magnetic resonance imaging or NMRI uses radio waves and a powerful magnet to create a cross-sectional image of the body. The image can show the difference between healthy tissue and diseased tissue. The MRI scanner is like a big metal tube. The patient lies on a table that moves in and out of the tube. The scan takes about an hour to complete. The patient may be injected with a dye before the scan to make the image clearer. Some women feel claustrophobic during this scan – your medical team may be able to give you medication to reduce this feeling.

Staging vaginal cancer

Based on the results of the diagnostic tests, your doctor will tell you the stage of the cancer. Staging the cancer is a way to describe the size of the cancer and whether it has spread beyond its original site.

Stage I – cancer is found only in the vagina.
Stage II: Cancer has begun to spread through the wall of the vagina, but it has not spread into the walls of the pelvis.
Stage III: Cancer has spread to the pelvis. It may also be in the lymph nodes close to the vagina.
Stage IV: Cancer has spread beyond the vagina and surrounding area into the lining of the bladder or bowel. The cancer may also have spread to other parts of the body.

Your doctor may also tell you the grade of the cells. This tells you how quickly the cancer may develop. Low-grade cancer cells are slow growing and less likely to spread. High-grade cells look more abnormal and are more likely to grow and spread quickly. Knowing the stage and grade of the cancer helps your doctor decide on the most appropriate treatment.

Prognosis

Prognosis means the expected outcome of a disease. You will need 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.

The earlier the vaginal cancer is diagnosed the higher the chances of successful treatment and cure.

Test results, the type of vaginal cancer you have, the rate and depth of tumour growth, how well you respond to treatment, and other factors such as age, fitness and medical history are all important in assessing your prognosis.

Which health professionals will I see?

Health professionals who may care for you while you are being treated for vaginal cancer include:

  • General practitioner (GP) – arranges the first tests to investigate your symptoms
  • Gynaecological oncologist – a surgeon with specialist training in cancer of the female reproductive system and its treatment
  • Medical oncologist – prescribes and coordinates targeted therapies and chemotherapy.
  • Radiation oncologist – prescribed and coordinates radiotherapy.
  • Nurses – support you through all stages of your cancer treatment.
  • Cancer care coordinator or clinical nurse consultant (CNC) – supports patients and families throughout treatment and liaises with other staff.
  • Dietician – recommends an eating plan to follow while you’re in treatment and recovery.
  • Social workers, counsellors, physiotherapists and occupational therapists – link you to support service social worker, and help with emotional, physical or practical issues.

Treatment

Treatment for cancer of the vagina depends on a number of factors including your general health and the stage, grade and type of cancer you have. Treatment may involve radiotherapy, surgery and chemotherapy.

Radiotherapy

Radiotherapy is the treatment of cancer using high-energy x-rays to kill or destroy cancer cells. It is a common treatment for women with cancer of the vagina. In some women, radiotherapy is combined with chemotherapy. It can also be used to control symptoms of advanced cancer.

Radiotherapy can be given in two ways: externally or internally (brachytherapy). Most women with vaginal cancer have both types of radiotherapy.

External radiotherapy – external radiotherapy means that radiotherapy beams are directed at the cancer from outside the body. You will lie on a treatment table and under the machine that delivers radiation.

Internal radiotherapy (Brachytherapy) – brachytherapy involves placing a radioactive material internally, on or near the cancer. You will be given a general anaesthetic and a thin radioactive applicator, shaped like a tampon, will be put into your vagina. Some women also have small radioactive needles or wires inserted on or near the cancer. You will have to lie still while the needles or wires are in place.

Surgery

The cancer may need to be removed with an operation. The type of surgery you have depends on the size and position of the cancer.

Partial vaginectomy – The affected part of the vagina is removed.
Radical vaginectomy – The entire vagina is removed. In some cases, a plastic (reconstructive) surgeon can make a new vagina using skin and muscle from other parts of your body. This is called vaginoplasty or vaginal reconstruction, and it may be done to improve the appearance of your genitals.

The doctor will try to remove all of the cancer along with some surrounding healthy tissue, called a margin. This helps ensure that the cancer doesn’t come back. The surgeon may also take out some lymph nodes in the pelvis.

Some women also need to have a radical hysterectomy. This means the uterus, cervix, ovaries and Fallopian tubes are removed. This will cause menopause.

Chemotherapy

Chemotherapy uses drugs called cytotoxins to kill or slow the growth of cancer cells. Treatment is usually given if the cancer is advanced or if it returns after treatment. Drugs are sometimes given as tablets or, more commonly, by injection into a vein (intravenously). You will usually have a treatment session, followed by a break. Treatment can often be given to you during visits to a hospital or clinic as an outpatient, but sometimes you may spend a few days in hospital.

Palliative treatment

Palliative treatment helps to improve people’s quality of life by reducing symptoms of cancer without trying to cure the disease. It is particularly important for people with advanced cancer. However, it is not just for end-of-life care and it can be used at different stages of cancer.

Often treatment is concerned with pain relief and stopping the spread of cancer, but it also involves the management of other physical and emotional symptoms. Treatment may include radiotherapy, chemotherapy or other medication.

After treatment

After your treatment is over, you will need regular checkups with your doctor or your cancer treatment centre. Blood tests will be done to check your general health and your blood count. Regular checkups can help find a recurrence early, and this gives you the best chance of getting the disease under control.

Checkups will continue for several years but will become less frequent if you have no further problems.

Between follow-up appointments, let your doctor know immediately of any health problems.

Cancer Council Australia

A guide for people with vaginal cancer.

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