Vaginal cancer

Vaginal cancer is any type of cancer that forms in the tissues of the vagina. Primary vaginal cancer is rare in the general population of women and is usually a squamous-cell carcinoma. Metastases are more common. Vaginal cancer occurs more often in women over age 50, but can occur at any age, even in infancy. It often can be cured if found and treated in early stages. Surgery alone or surgery combined with pelvic radiation is typically used to treat vaginal cancer.

Types

There are two primary types of vaginal cancer: squamous-cell carcinoma and adenocarcinoma.

• Vaginal squamous-cell carcinoma arises from the thin, flat squamous cells that line the vagina. This is the most common type of vaginal cancer. It is found most often in women aged 60 or older.
• Vaginal adenocarcinoma arises from the glandular (secretory) cells in the lining of the vagina that produce some vaginal fluids. Adenocarcinoma is more likely than squamous cell cancer to spread to the lungs and lymph nodes. It is found most often in women aged 30 or younger.

• A specific subtype of adenocarcinoma (clear cell adenocarcinoma) occurs in a small percent of women (termed "DES-Daughters") born between 1938 and 1973 (later outside the United States) that were exposed to the drug diethylstilbestrol (DES) in utero. DES was prescribed to 5 to 10 million mothers in that timespan to prevent possible miscarriages and premature birth. Typically, patients present with DES-related adenocarcinoma before age 30, but increasing evidence suggests possible effects or cancers (including other forms of vaginal glandular tumors) at a later age for DES-exposed women. DES-exposure in women is also linked to various infertility and pregnancy complications. Daughters exposed to DES in utero may also have an increased risk of moderate/severe cervical squamous cell dysplasia and an increased risk of breast cancer. Approximately one in 1,000 (0.1%) DES Daughters will be diagnosed with clear cell adenocarcinoma. The risk is virtually non-existent among premenopausal women not exposed to DES.

There are also less common forms of vaginal cancer:

• Vaginal germ cell tumors (primarily teratoma and endodermal sinus tumor) are rare. They are found most often in infants and children.
• Sarcoma botryoides, a rhabdomyosarcoma also is found most often in infants and children.

Signs and symptoms

Often, there are no symptoms, and the cancer is found through a routine gynecologic exam. If there are symptoms, they are commonly abnormal vaginal bleeding, which may be post-coital, intermenstrual, prepubertal, or postmenopausal. Other, less specific signs include difficult or painful urination, pain during intercourse, and pain in the pelvic area. Women who suspect exposure to DES should undergo a more extensive gynecological exam on a regular basis because the normal exam procedure does not closely examine the areas of the vagina usually obscured by the speculum in standard gynecological exams. See: Recommendations for DES-exposed patients.

Diagnosis

Several tests are used to diagnose vaginal cancer, including:

• Physical exam and history
• Pelvic exam
• Pap smear
• Biopsy
• Colposcopy

Women with vaginal cancer should not have routine surveillance imaging to monitor the cancer unless they have new symptoms or rising tumor markers. Imaging without these indications is discouraged because it is unlikely to detect a recurrence or improve survival, and because it has its own costs and side effects.

Management

Surgery is the typical treatment for vaginal cancer.

Epidemiology

Vaginal cancer accounts for less than 1% of cancer cases and deaths in the UK. Around 260 women were diagnosed with the disease in 2011, and 110 women died in 2012.