Cancer, vaginal

Page last reviewed: 13/07/2011

 

Vaginal cancer is a rare type of cancer. The most common symptom of vaginal cancer is painless bleeding from the vagina.

The vagina

The vagina is a tube of muscle that runs from the cervix (the opening of the womb) to the vulva (the external sexual organs).

The vagina has three main functions:

  • It provides a channel through which blood released during menstruation (a period) can leave the body.
  • It provides a channel that allows a baby to leave the womb during childbirth.
  • It contains a large number of nerve endings that help stimulate feelings of sexual pleasure during intercourse.

Types of vaginal cancer

There are two main types of vaginal cancer:

  • primary vaginal cancer, where the cancer begins inside the vagina, and
  • secondary vaginal cancer, where the cancer begins in another part of the body (usually the reproductive system), such as the cervix or ovaries, and then spreads to the vagina.

The rest of this article will focus on primary vaginal cancer. See Useful links for more information about other cancers of the reproductive system.

Types of primary vaginal cancer

There are three main types of primary vaginal cancer. They are classified according to the type of cells that the cancer begins in. 

  • Squamous cell carcinoma is the most common type of vaginal cancer, accounting for 85% of all cases. It usually develops in women over 50.
  • Clear cell adenocarcinoma accounts for 9% of all cases of vaginal cancer. This type of cancer usually affects teenagers and younger adults, with most cases developing in women between 14 and 20 years old.
  • Melanoma is rare and accounts for up to 2% of all cases of primary vaginal cancer. As with squamous cell carcinoma, melanoma usually develops in women over 50.

How common is vaginal cancer?

Vaginal cancer is rare and accounts for one in every 1,000 cases of cancer overall.

Each year there are an average of 10 new cases of vaginal cancer. The exact causes of vaginal cancer are unknown, but possible risk factors include:

  • smoking, and
  • being infected with the human papilloma virus (HPV).

Outlook

The outlook for squamous cell carcinoma and clear cell adenocarcinoma is generally good if the cancer is detected when it is still contained within the vagina. An estimated 70-80% of women with early-stage vaginal cancer live for at least five years after receiving a diagnosis, and many women will live much longer.

The outlook for the melanoma type of vaginal cancer is poor because it is very aggressive and spreads quickly. Only 15-20% of women live for five years or more after diagnosis.

Vaginal cancer can be treated with a combination of radiotherapy, surgery and chemotherapy.


Uterus
The uterus, also known as the womb, is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.

Page last reviewed: 13/07/2011

The most common symptom of vaginal cancer is painless vaginal bleeding.

If you are pre-menopausal (you still have regular periods), the bleeding may occur in between your normal periods. You may also notice that your period is much heavier than usual.

Some women with vaginal cancer also experience vaginal bleeding after sexual intercourse.

Less common symptoms of vaginal cancer include:

  • pain when urinating (dysuria),
  • a sudden, urgent need to urinate,
  • blood in the urine, and
  • pelvic pain.

When to seek medical advice

See your GP if:

  • you experience vaginal bleeding and you have already had the menopause,
  • your usual pattern of menstruation has changed, such as having irregular or heavier periods than usual, or
  • you experience problems with urination, such as pain when urinating.

While it is highly unlikely that these symptoms are due to vaginal cancer, they still need to be investigated by your GP.

Glossary

Discharge
Discharge is when a liquid such as pus oozes from a part of your body.
Pain
Pain is an unpleasant physical or emotional feeling and your body's way of warning you that it has been damaged.
Constipation
Constipation is when you pass stools less often than usual, or when you have difficulty going to the toilet because your stools are hard and small.
Cervical smear test
During a cervical smear test, a sample of cells from a woman's cervix is taken and examined for abnormalities.
Inflammation 
Inflammation is the body's response to infection, irritation or injury. It causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Page last reviewed: 13/07/2011

How does cancer begin?

Cancer begins with a change in the structure of DNA, which is found in all human cells. DNA provides cells with a basic set of instructions, such as when to grow and when to reproduce.

A change in the DNA's structure (genetic mutation) changes these instructions so that the cells carry on growing and reproducing uncontrollably. This produces a lump of tissue known as a tumour.

How does cancer spread?

Left untreated, cancer can quickly grow and spread to other parts of the body, usually through the lymphatic system.

The lymphatic system is a series of glands (or nodes) located throughout your body. It is similar to the blood circulatory system. Lymph glands produce many specialised cells that are needed by your immune system to fight infection.

Once the cancer reaches the lymphatic system, it can spread to any other part of the body, including your bones, blood and organs.

Risk factors

The exact cause of vaginal cancer has not yet been identified. However, evidence suggests that a number of risk factors can increase your likelihood of developing vaginal cancer:

Human papilloma virus (HPV)

Human papilloma virus (HPV) is the name given to a family of viruses that affect the skin and the moist membranes that line the body, such as those in the cervix, anus, mouth and throat.

HPV DNA has been found in up to 80% of samples of cancerous tissue, which suggests that HPV may increase your risk of developing vaginal cancer.  

HPV is known to cause changes in the cells of the cervix, which can lead to cervical cancer. It is thought that the virus could have a similar effect on the cells of the vagina.

HPV is spread during sexual intercourse, including anal and oral sex.

See Useful links for more information about HPV.

Diethylstilbestrol (DES)

The medicine diethylstilbestrol (DES) is another known risk factor for vaginal cancer.

DES was widely prescribed for pregnant women from 1938 to 1971. At the time, it was thought (wrongly) that DES could help reduce the risk of miscarriage.

In 1971, researchers discovered a link between DES and cancer and the use of DES in pregnant women was banned.

The risk of vaginal cancer associated with using DES is small. It is estimated that only one in every 1,000 women whose mothers used DES during pregnancy go on to develop vaginal cancer.

Other possible risk factors

Other possible risk factors for vaginal cancer include:

  • smoking,
  • a history of reproductive cancers, such as cervical or ovarian cancer, and
  • alcohol consumption.

Glossary

Uterus 
The uterus, also known as the womb, is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.

Page last reviewed: 13/07/2011

Before diagnosing vaginal cancer, your GP will ask you about your symptoms and the pattern of your vaginal bleeding. They may refer you for blood tests to rule out other causes of vaginal bleeding, such as infection or an overactive thyroid gland (hyperthyroidism).

Referral to a gynaecologist

If no obvious cause of your symptoms can be found, your GP will probably refer you to a gynaecologist for further testing. A gynaecologist is a specialist in treating conditions of the female reproductive system.

If you are referred to a gynaecologist, further tests will probably include:

  • an internal vaginal examination to look for any unusual lumps or swellings, and
  • a colposcopy, using a special instrument (colposcope) that acts like a magnifying glass, to study your vagina in greater detail.

If testing reveals that there may be abnormal tissue inside your vagina, a small sample of the tissue will be removed and checked under a microscope for cancerous cells. This is known as a biopsy.

Further testing

If the results of the biopsy suggest that you have cancer, and there is a risk that the cancer may have spread, you will probably require further testing to assess how widespread the cancer is.

These tests may include:

  • X-rays,
  • computerised tomography (CT) scans, and
  • magnetic resonance imaging (MRI) scans.

Glossary

Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.  
Lymph nodes
Lymph nodes are small oval tissues that remove unwanted bacteria and particles from the body. They are part of the immune system.
Biopsy
A biopsy is a test that involves taking a small sample of tissue from the body so it can be examined.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
MRI
MRI (magnetic resonance imaging) is the use of magnets and radiowaves to take detailed pictures of inside the body.
Colposcopy
A colposcopy is a procedure where a doctor uses a special magnifying lens, known as a colposcope, to look at the cervix through the opening of the vagina.

Page last reviewed: 13/07/2011

Cancer treatment team

Hospitals that treat treat vaginal cancer have multidisciplinary teams consisting of many different health professionals.

If you have vaginal cancer, you may see several or all of these professionals as part of your treatment.

Deciding what treatment is best for you can be difficult. Your cancer team will make recommendations, but the final decision will be yours.

Before going to hospital to discuss your treatment options, you may find it useful to write a list of questions to ask the specialist. For example, you may want to find out what the advantages and disadvantages of particular treatments are.

Staging

Health professionals use a staging system to describe how far vaginal cancer has advanced. 

  • Stage 0. Cancer has not developed but the cells in the vagina are showing signs that they may turn cancerous in the future. This is also known as vaginal intraepithelial neoplasia (VAIN).
  • Stage 1. The cancer is contained inside the vagina.
  • Stage 2. The cancer is beginning to spread through the walls of the vagina towards the pelvic bones.
  • Stage 3. The cancer has spread into the bones of the pelvis and may have spread to nearby lymph nodes.
  • Stage 4a. The cancer has spread beyond the pelvis and into the linings of the bladder and bowel.
  • Stage 4b. The cancer has spread into the bladder and bowel.
  • Stage 4c. The cancer had spread to other organs, such as the lungs.

In stage 0 vaginal cancer, it may be possible to remove the abnormal cells using laser surgery or a special type of ointment.

In stage 1 vaginal cancer, it may be possible to achieve a cure using radiotherapy alone and/or by removing a small section of the vagina.

In stages 2, 3 and 4a vaginal cancer, a combination of radiotherapy, chemotherapy and surgery may be required to get rid of the cancer.

In stages 4b and 4c vaginal cancer, a cure is not usually possible. However, radiotherapy and chemotherapy can relieve the symptoms and slow down the spread of cancer.

Radiotherapy

There are several ways that radiotherapy can be used to treat vaginal cancer. It can be used:

  • as an initial treatment to cure the cancer,
  • in combination with chemotherapy (chemoradiation),
  • after surgery to prevent the cancer from returning, and
  • to control symptoms when a cure is not possible (palliative radiotherapy).

There are two ways that radiotherapy for vaginal cancer can be given:

  • external radiotherapy, where a machine beams high-energy rays at your vagina, and
  • internal radiotherapy, where a small radioactive device, known as a source, which looks like a tampon is inserted into your vagina.

The type of radiotherapy you receive depends on where the cancer is in the body. Many women receive a combination of internal and external radiotherapy.

External radiotherapy is usually given in short daily sessions from Monday to Friday, with a break from treatment at the weekend.

With internal radiotherapy, you usually need to keep the source in your vagina for between two and five days.

While it kills cancerous cells, radiotherapy can also affect healthy tissue and has a number of side effects, including:

  • sore, red skin (like sunburn),
  • vaginal discharge,
  • pain while passing urine,
  • loss of taste,
  • loss of appetite,
  • tiredness, and
  • nausea.

If you have external radiotherapy to the pelvis, you may experience an early menopause (if you have not had the menopause already).

See Useful links for more information about radiotherapy.

Menopausal symptoms include:

  • hot flushes,
  • vaginal dryness,
  • dry skin,
  • mood changes, such as feeling anxious or depressed, and
  • loss of interest in sex (low libido) .

If you have an early menopause, you will no longer be able to have children.

Surgery

There are four different types of surgery that are used to treat vaginal cancer:

  • partial vaginectomy, where the upper section of the vagina is surgically removed,
  • radical vaginectomy, where most or all of the vagina is surgically removed,
  • radical vaginectomy and radical hysterectomy, where the vagina and womb, ovaries and fallopian tubes are surgically removed, along with nearby lymph nodes, and
  • total pelvic exenteration, where the vagina, bladder, rectum (back passage) and part of the bowel are removed.

Partial vaginectomy

A partial vaginectomy can be used to treat stage 1 vaginal cancer, where radiotherapy has failed to remove the cancer or where a woman prefers to have surgery rather than radiotherapy because she still wants to have children.

The surgeon will remove the cancerous section of the vagina, as well as a 3-5mm margin of healthy tissue, in case a small number of cancer cells have spread.

The rest of the vagina is stretched up and stitched into place, so you will be able to have normal sexual intercourse after you have recovered from the operation.

A radical vaginectomy

A radical vaginectomy is used to treat cases of advanced stage 1 and stage 2 vaginal cancer. The surgeon will remove most or all of your vagina.

A plastic surgeon will be able to make a new vagina using skin, muscle and tissue taken from another part of your body, usually one of your thighs or buttocks. This operation is known as vaginal reconstruction.

After the operation, you will still be able to have sex, although it is unlikely that you will be able to achieve an orgasm during intercourse. This is because the many nerve endings that are normally within the vagina will no longer be there. You will need to use artificial lubrication during sex because the reconstructed vagina will not be naturally lubricated.

However, your clitoris (a sensitive part of the female genitals) should be unaffected, so you should be able to achieve an orgasm through masturbation and oral sex.

A radical hysterectomy

A radical hysterectomy is used when testing shows there is a high risk that cancerous cells have spread beyond the vagina and into other parts of the reproductive system.

During a radical hysterectomy, all of the reproductive system is removed, including the womb, fallopian tubes, ovaries and nearby lymph nodes.

See Useful links for more information about hysterectomy.

Total pelvic exenteration (TPE)

A total pelvic exenteration (TPE) is used to treat advanced cases of vaginal cancer.

TPE is major surgery, so you will need to be in good health before the procedure can be performed. If you are not, surgery may have to be delayed until your health improves.

The surgeon will remove your vagina, bladder, rectum and part of the colon.

Because you will no longer have a bladder, you will need another way to pass urine. One solution is for your surgeon to make a hole (stoma) in your abdomen. A bag is then attached to the stoma so that urine can be passed into it. The bag is known as a urostomy bag.

Similarly, as you will no longer have a rectum, you will need a way to pass stools (faeces) out of your digestive system. Another stoma can be made and attached to a collection bag, known as a colostomy bag. See Useful links for more information about colostomies.

It may be possible to reconstruct your rectum and attach it to the remaining section of colon once this has healed. In this case, you will only need a temporary colostomy.

As TPE is major surgery, it may take you several months to fully recover from the operation.

Chemotherapy

Chemotherapy is usually used in combination with radiotherapy or to control symptoms when a cure is not possible (called palliative chemotherapy).

Chemotherapy is usually given by injection (called intravenous chemotherapy).

Like radiotherapy, the powerful cancer-killing medicines used in chemotherapy can also damage healthy tissue and cause a range of side effects. Side effects of chemotherapy include:

  • nausea,
  • vomiting,
  • hair loss, and
  • fatigue.

Chemotherapy can also weaken your immune system, making you more vulnerable to infection. However, the side effects should stop once treatment has finished.

See Useful links for more information about chemotherapy.

Clinical trials

As vaginal cancer is rare, you may be asked to take part in a clinical trial. Clinical trials are an important way for health professionals to learn more about the best way to treat specific conditions.

Most clinical trials involve comparing a new treatment with an existing treatment to determine whether the new treatment is more or less effective.

If you do receive a new treatment, there is no guarantee that it will be more effective than an existing one.

Your care team can tell you if there are clinical trials in your area, and explain the advantages and disadvantages of taking part.

Glossary

Uterus
The uterus, also known as the womb, is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.
Bladder
The bladder is a small organ near the pelvis that holds urine until it is ready to be passed from the body.
Radiotherapy
Radiotherapy uses X-rays to treat disease, especially cancer.
Chemotherapy
Chemotherapy is the treatment of an illness or disease with a chemical substance, for example in the treatment of cancer.

An MDT is made up of a number of different specialists. These include:

  • a surgeon,
  • a clinical oncologist (a specialist in the non-surgical treatment of cancer,
  • a pathologist (a specialist in diseased tissue),
  • a radiologist (a specialist in radiotherapy),
  • a gynaecologist,
  • a social worker,
  • a psychologist, and
  • a specialist cancer nurse, who will usually be your first point of contact . 

Page last reviewed: 13/07/2011

Emotional effects of treatment

Treatment for vaginal cancer can have a significant emotional impact, particularly in women who have not yet reached the menopause and need to have radiotherapy or a hysterectomy.

Both these treatments trigger an early menopause, which means that many women have to come to terms with the fact that they will never be able to have children. This can be particularly traumatic for women with clear cell adenocarcinoma because they are usually teenagers when the cancer develops.

The removal of some or all of the vagina can be traumatic for pre- and post-menopausal women alike, and many women feel less 'womanly' than before.

It is not uncommon to feel a sense of loss and bereavement after treatment and, in some women, this may trigger the start of depression.

Talking to other women who have had similar treatment can give you emotional support and reassurance. Your GP or the hospital staff may be able to recommend a suitable local support group.

If feelings of depression persist, your GP can arrange further treatment.

Page last reviewed: 13/07/2011

HPV vaccination

There is a strong link between certain types of human papilloma virus (HPV) and the development of abnormalities that may develop into vaginal cancer.

There is now a vaccine that provides protection against the two strains of HPV that are thought to be responsible for most cases of vaginal cancer. HPV vaccination also protects against cervical cancer, which is far more common than vaginal cancer.

Girls should be offered the HPV vaccine as part of their routine childhood immunisation programme. The vaccine should be given to girls who are 12 to 13 years old, with three doses given over six months.

The HPV vaccine will not provide protection against all strains of HPV. As HPV is spread through unprotected sex, using a condom is the best way to avoid it.

Before beginning a sexual relationship with a new partner, it is a good idea for you both to be tested for sexually transmitted infections (STIs) at a sexual health (GUM) clinic. All tests are free and confidential.

See Useful links for more information about the HPV vaccination and to find your a sexual health clinic in your area.

 

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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