Conditions > Vaginal cancer

Vaginal cancer

Clinical picture

Vaginal cancer, also known as vaginal carcinoma, arises when cells in the vagina show spontaneous and unbridled growth. This is a rare type of cancer that normally does not spread until an advanced stage is reached. The vagina is also known as the birth channel and is located between the cervix and the labia.

There are different types of vagina cancer.

Squamous cell carcinoma: this type occurs when tumours form in the cells on the surface of the vagina. This is a slow-growing type of cancer that affects 90% of all vaginal cancer sufferers.
Adenocarcinoma: this type of tumour forms in the vaginal glands. It is a more aggressive, faster growing cancer with a greater risk of spreading that affects around 5% of vagina cancer patients.
The remaining 5% of vagina cancers are very rare types such as sarcoma botryoides and malignant melanoma.

Often, a tumorous growth in the vagina is actually a metastases from another cancer in a different part of the body. Most frequently these are the uterus, endometrium or ovaries, or the urinary tract.

Vaginal cancer makes up around 2% of all the cancers in the female reproductive organs. Most women diagnosed are between the ages of 40 and 70. The survival rate for vaginal cancer has gone up around 10% over the last few years. Currently, patients diagnosed with a stage I tumour have a 74% 5-year survival rate. This falls to just 19% for women diagnosed in stage IV.

Symptoms

Women with vagina cancer only develop noticeable symptoms at a relatively late stage. These can include:

a watery discharge
blood loss after intercourse
bladder and/or intestinal complaints
blood loss unrelated to menstruation
pain in the pelvic area
pain during intercourse
swelling of the vagina
post-menopausal bleeding
pain during urination

Cause

There is no clearly identifiable cause for vagina cancer. However, there are a number of risk-enhancing factors. These include:

Being a so-called ‘DES-daughter’. These are the daughters of women who took the medication diethylstilbestrol (DES) during pregnancy in the years between 1947 and 1976. These women all have a higher chance of developing adenocarcinomas and deformation of the reproductive organs
Infection with the human papilloma virus
Having a history of cervix cancer or uterus cancer
Smoking

Having had a hysterectomy.

Diagnosis

DES-daughters are known to run a higher risk of certain cancers and will be monitored closely during their lives.

In other women, a GP will conduct a physical examination and will refer the patient to a gynaecological oncologist when they suspect a possible cancer. This specialist will conduct further tests, such as a smear test and a biopsy. If these turn out to be positive, further tests are required in order to establish the cancer stage and whether it has spread. These tests include a CT scan, blood tests, lung X-rays, an MRI scan and a PET scan.

As a result of these tests, the tumour can be graded as follows:

Stage I: the tumour has not spread beyond the vagina
Stage II: the tumour has grown deeper into the vagina but has not reached the pelvis
Stage III: the tumour has reached the pelvis
Stage IV:
- IVa: the tumour has spread to nearby organs and tissues such as the bladder, the rectum, the uterus, ovaries and cervix.
- IVb: the tumour has spread to more distant organs and tissues

The differentiation of the tumour is also important in order to come up with a treatment plan and determine the outlook. Differentiation is the measure in which tumour cells still resemble the normal cells they grew from. In order to determine the differentiation, a biopsy is performed.

Treatment

Vaginal cancer is usually treated by surgery, radiotherapy or a combination of the two. Chemotherapy is not used to initially treat vaginal cancer, but when the cancer returns, it may be considered. Chemotherapy can also form part of a palliative therapy