Vaginal cancer is a rare cancer but it occurs when cells that make up the vaginal tissue grow abnormally and uncontrolled - a hollow muscular tube that extends from the cervix (lower part of the uterus) to the external genitalia. Vaginal cancer appears when mutations arise in the healthy cells of the vaginal lining and this modifies their pattern of growth, division and death. The uncontrolled proliferation of cells results in the formation of benign (non-cancerous) or malignant (cancerous) tumors. Therefore, vaginal cancer is a malignant tumor capable of invading surrounding tissues and spreading to other parts of the body mostly through the lymphatic system or the bloodstream.
Vaginal cancer is defined based on its cell origin. Squamous cell carcinoma is by far the most common: it is the one that arises from the squamous cells present on the surface of the vagina, and it accounts for the majority of vaginal cancer cases. Carcinomas are usually quite slow growing, usually preceded by a precancerous condition called vaginal intraepithelial neoplasia (VAIN). This is where the abnormal cells are confined to the surface layer of the vagina and do not invade deeper tissues. Another important type is adenocarcinoma, which arises in the glandular cells of the vaginal lining that are responsible for mucus or other fluid production. Adenocarcinoma is rarer than squamous cell carcinoma but can be more aggressive, with a higher chance of metastasis to distant organs.
Some of the rarest types of vaginal cancer are vaginal melanomas, which arise from melanocytes, pigment cells in the lining of the vagina, and are characterized by their aggressive behavior and poor prognosis. Vaginal sarcoma, another rare type, arises from connective tissue such as muscles or blood vessels of the vaginal walls. The behavior of most neoplasms is dependent on the specific subtype of sarcoma. Clear cell adenocarcinoma is also another specific and less common type of vaginal cancer that is associated with exposure to diethylstilbestrol (DES) during the prenatal period, a synthetic estrogen given to pregnant women in the mid-20th century.
Vaginal cancer is considered rare but its occurrence is directly dependent on several risk factors. Persistent infection with different types of high-risk human papillomavirus (HPV), namely type 16 and especially type 18, is the most common factor. In addition, some other factors include increasing age, as vaginal cancer is most common in women 60 years and older; smoking, in which case carcinogenic substances will be allowed to come into contact with vaginal tissues; and a compromised immune system due to conditions caused by HIV infection or immunosuppressant drugs taken after organ transplantation. A history of cervical cancer or precancerous lesions in the cervix can increase the risk of vaginal cancer, as well as chronic irritation or inflammation of vaginal tissues. Intrauterine exposure to DES will increase a woman's chances of developing clear cell adenocarcinoma.
Abnormal vaginal bleeding is also one of the many clinical symptoms of vaginal cancer. This can be bleeding after menopause, bleeding after intercourse, or bleeding out of cycle with respect to menstruation. Some other symptoms include persistent vaginal discharge that may be watery, foul-smelling, or blood-tinged; a palpable lump or mass within the vagina; dyspareunia and dysuria; pelvic pain or discomfort; and changes in bowel or bladder habits such as constipation or increased urinary frequency if it invades nearby organs. However, in its early stages, vaginal cancer can be asymptomatic, making it important to undergo periodic gynecological checkups for women who may be at risk of the disease.
Imaging techniques such as CT scan, MRI, PET scan, or ultrasound are used to diagnose the cancerous process in the vagina, determine the extent of the disease, or determine if it has not spread to nearby organs or distant organs. Other steps include a thorough pelvic exam to check for abnormalities involving the vagina, cervix, and surrounding structures. Pap smears may sometimes depend on the results of abnormal cell findings associated with HPV testing for high-risk strains of the virus. In addition, when abnormal results are found, a colposcope is used to maximize the view of vaginal tissue when performing a biopsy. However, a definitive diagnosis is established through a biopsy, in which the involved tissue is examined under a microscope to confirm the presence of cancer cells.
Vaginal cancer is staged in the process of determining the progression of the cancer, ranging from stage I, where the cancer only involves the vagina, to more severe cases where the cancer has spread to organs outside the vagina, such as the liver or lungs, to stage IV. In addition, staging also informs the patient's treatment and prognosis.
Management in vaginal cancer depends on the type and stage of the condition as well as the patient's health. Common surgical approaches include surgery such as tumor excision, partial or complete vaginectomy, or pelvic exenteration in the most severe conditions. Radiotherapy is often used to damage or kill cells in high-energy beams. External and internal brachytherapy can be used to accomplish this. Chemotherapy involves the use of anti-cancer drugs to stop the progression of cancer cells. It is used in advanced cases or recurrence. Newer therapies such as targeted therapy and immunotherapy are being considered as options to improve outcomes through knocking down precise molecular pathways or enhancing the immune response against cancer.
The prognosis in case of vaginal cancer depends on several influential factors such as the type of cancer, stage at diagnosis, age, general health of the patient and efficacy or response to treatment. Although early-stage cancers confined to the vaginal lining have a relatively good prognosis with better survival rates and fewer recurrences, most of the advanced-stage cancers have escaped or metastasized to surrounding tissues; therefore, they become more difficult to treat, with lower survival rates as well.
Preventive measures against vaginal cancer include HPV vaccination, which significantly reduces the chances of high-risk strains infecting the patient from acquiring the virus. Other aspects of prevention such as gynecological checkups and Pap smear tests, with or without HPV testing, help in early detection of precancerous changes or early forms of cancer and improve treatment outcome. In addition, avoiding smoking, practicing safe sex as a means of reducing HPV risk and a good immune system are additional preventive measures. Women with a history of exposure to DES should thus inform their health providers and undergo regular screening to monitor for possible abnormalities.
Vaginal cancer which is indeed a very uncommon and serious disease occurs when there is abnormal growth of cells in the vaginal tissues. The various malignant types include squamous cell carcinoma, adenocarcinoma, melanoma, sarcoma and clear cell adenocarcinoma. Each of these cancer types has its own characteristics and different risk factors. Factors associated with the development include HPV infection, smoking, older age, immune suppression, etc. Consequently, early detection as a result of regular gynecological care is extremely important to ensure proper management, and treatment involves a matter of surgery, radiotherapy, chemotherapy and other innovative therapies. Preventive measures such as vaccination and screening at regular intervals to prevent HPV infection are some of the most important components to reduce vaginal cancer and improve outcomes.
