Vaginal Cancer Health Article

Description

What is cancer of the vagina?

Cancer of the vagina, a rare kind of cancer in women, is a disease in which cancer (malignant) cells are found in the tissues of the vagina. The vagina is the passageway through which fluid passes out of the body during menstrual periods and through which a woman has babies. It is also called the "birth canal." The vagina connects the cervix (the opening of the womb or uterus) and the vulva (the folds of skin around the opening to the vagina).

There are two types of cancer of the vagina: squamous cell cancer (squamous carcinoma) and adenocarcinoma. Squamous carcinoma is usually found in women between the ages of 60 and 80. Adenocarcinoma is more often found in women between the ages of 12 and 30.

Young women whose mothers took DES (diethylstilbestrol) are at risk for getting tumors in their vaginas. Some of them get a rare form of cancer called clear cell adenocarcinoma. The drug DES was given to pregnant women between 1945 and 1970 to keep them from losing their babies (miscarriage).

A doctor should be seen if there are any of the following:

• Bleeding or discharge not related to menstrual periods.

• Difficult or painful

  urination

  .

• Pain during intercourse or in the

  pelvic

  area.

• Also, there is still a chance of developing

  vaginal

  cancer in women who have had a

  hysterectomy.

A doctor may use several tests to see if there is cancer. The doctor will usually begin by giving the patient an internal (pelvic) examination. The doctor will feel for lumps and will then do a Pap smear. Using a piece of cotton, a brush, or a small wooden stick, the doctor will gently scrape the outside of the cervix and vagina in order to pick up cells. Some pressure may be felt, but usually with no pain.

If cells that are not normal are found, the doctor will need to cut a small sample of tissue (called a biopsy) out of the vagina and look at it under a microscope to see if there are any cancer cells. The doctor should look not only at the vagina, but also at the other organs in the pelvis to see where the cancer started and where it may have spread. The doctor may take an x-ray of the chest to make sure the cancer has not spread to the lungs.

The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in the vagina or has spread to other places) and the patient's general state of health.

Stage Explanation

Stages of cancer of the vagina

Once cancer of the vagina has been found (diagnosed), more tests will be done to find out if the cancer has spread from the vagina to other parts of the body (staging). A doctor needs to know the stage of the disease to plan treatment. The following stages are used for cancer of the vagina:

Stage 0 or carcinoma in situ

Stage 0 cancer of the vagina is a very early cancer. The cancer is found inside the vagina only and is in only a few layers of cells.

Stage I

Cancer is found in the vagina, but has not spread outside of it.

Stage II

Cancer has spread to the tissues just outside the vagina, but has not gone to the bones of the pelvis.

Stage III

Cancer has spread to the bones of the pelvis. Cancer cells may also have spread to other organs and the lymph nodes in the pelvis. (Lymph nodes are small bean-shaped structures that are found throughout the body. They produce and store cells that fight infection.)

Stage IVA

Cancer has spread into the bladder or rectum.

Stage IVB

Cancer has spread to other parts of the body, such as the lungs.

Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the vagina or in another place.

Treatment Option Overview

How cancer of the vagina is treated

Treatments are available for all patients with cancer of the vagina. There are three kinds of treatment:

• Surgery

  (taking out the cancer in an operation).

• Radiation therapy

  (using high-

  dosex-rays

  or other high-energy rays to kill cancer

  cells

  and shrink

  tumors

  ).

• Chemotherapy

  (using

  drugs

  to kill cancer cells).

Surgery is the most common treatment of all stages of cancer of the vagina. A doctor may take out the cancer using one of the following:

• Laser surgery

  uses a narrow beam of light to kill cancer cells and is useful for stage 0 cancer.

• Wide local

  excision

  takes out the cancer and some of the

  tissue

  around it. A patient may need to have skin taken from another part of the body (

  grafted

  ) to repair the vagina after the cancer has been taken out.

• An operation in which the vagina is removed (vaginectomy) is sometimes done. When the cancer has spread outside the vagina, vaginectomy may be combined with surgery to take out the

  uterus

  ,

  ovaries

  , and

  fallopian tubes

  (

  radical hysterectomy

  ). During these operations,

  lymph nodes

  in the

  pelvis

  may also be removed (

  lymph node dissection

  ).

• If the cancer has spread outside the vagina and the other female

  organs

  , the doctor may take out the lower

  colon

  ,

  rectum

  , or

  bladder

  (depending on where the cancer has spread) along with the

  cervix

  , uterus, and vagina (

  exenteration

  ).

• A patient may need skin grafts and

  plastic surgery

  to make an artificial vagina after these operations.

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes into the area where the cancer cells are found (internal radiation). Radiation may be used alone or after surgery.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells outside the vagina. In treating vaginal cancer, chemotherapy may also be put directly into the vagina itself, which is called intravaginal chemotherapy.

Treatment by stage

Treatment of cancer of the vagina depends on the stage of the disease, the type of disease, and the patient's age and overall condition.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in most parts of the country for most stages of cancer of the vagina. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.