What is the Vagina?
The vagina is a 3 to 4 inch (7 1/2 -10 cm) tube that at one end joins the cervix, the lower part of the uterus (womb), and at the other end opens onto the vulva, the external genitalia. The vagina is also called the birth canal. The vagina is usually in a collapsed state with its walls touching each other. The vaginal walls have many folds that help the vagina to open and expand during sexual intercourse or birth of a baby. Glands in the cervix secrete mucus to keep the vaginal lining moist.
What is Vaginal Cancer?
Cancer of the vagina, is a rare kind of cancer in women. In vaginal cancer, 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. The vagina 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).
What are causes and risk factors for vaginal cancer?
Age and exposure to the drug DES (diethylstilbestrol) before birth affect a woman's risk of developing vaginal cancer.
Anything that increases your risk of getting a disease is called a risk factor.
Risk factors for vaginal cancer include the following: -
- Being aged 60 or older.
- Being exposed to DES while in the mother's womb. In the 1950s, the drug DES was given to some pregnant women to prevent miscarriage (premature birth of a fetus that cannot survive). Women who were exposed to DES before birth have an increased risk of developing vaginal cancer. Some of these women develop a rare form of cancer called clear cell adenocarcinoma.
- Having human papilloma virus (HPV) infection.
- Having a history of abnormal cells in the cervix or cervical cancer.
Signs and SymptomsVaginal cancer is a rare disease and makes up less than 3 percent of all gynecological cancers.
There are four different types of vaginal cancer, including: -
- Squamous Cell Cancer: - The most common type and usually occurs in the upper part of the vagina. It typically affects women between the ages of 50 and 70.
- Adenocarcinoma: - The second most common type and usually affects women between the ages of 12 and 30, although it occassionally occurs in women of all age groups.
- Malignant Melanomas Sarcomas: - Extremely rare forms of the disease.
Risk FactorsAs with many cancers, the exact cause of vaginal cancer is not known for sure. However, some factors may increase a woman's risk for the disease, including:
- Age, women over the age of 50 are most commonly affected by squamous cell vaginal cancer
- History of cervical cancer
- Having had a hysterectomy
- History of genital warts caused by the human papilloma virus (HPV)
- Having had radiation therapy to the pelvic area
In some cases, vaginal cancer may not cause any symptoms and is detected by an abnormal Pap smear. However, some common symptoms of the condition include:
- Bleeding or discharge not related to menstrual periods
- Difficult or painful urination
- Pain during intercourse or in the pelvic area
DiagnosisIf you are experiencing any symptoms of vaginal cancer or other problems related to your vagina, you should visit a doctor immediately for a definite diagnosis. Your doctor will begin by asking about any symptoms you may be experiencing, as well as reviewing your medical history and conducting a thorough physical exam.
To determine the cause of your symptoms, the following tests may be performed: -
- Pelvic Exam - This test involves feeling the uterus, vagina, ovaries, fallopian tubes, bladder and rectum to find any abnormality in their shape or size.
- Pap Smear - As part of the pelvic exam, your doctor may conduct a Pap smear. He or she will use a piece of gently scrape the outside of the cervix and vagina with a small spatula and brush in order to pick up cells, which then can be analyzed for any abnormalities. Some pressure may be felt, but usually with no pain.
- Coloscopy - If any abnormal cells are found during your Pap smear, your doctor may recommend a coloscopy. During this exam, your doctor will use a colposcope, which is a small microscope to see your vagina in more detail. This is an outpatient procedure that takes about 10-15 minutes and is usually not painful, though may be a little uncomfortable.
- Biopsy - If any abnormal cells are found during your Pap smear, your doctor will then need to conduct a biopsy. During this procedure, a small sample of tissue is removed from the vagina and then examined under a microscope for any cancer cells.
- Computed tomography (CT) Scan - This imaging test takes a series of detailed pictures of areas inside the body. The pictures are created by a computer, which is linked to an X-ray machine. A special dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.
- Magnetic Resonance Imagining (MRI) - This is a painless non-invasive procedure that uses powerful magnets and radio waves to construct pictures of the body. Any imaging plane, or "slice" can be projected, stored in a computer, or printed on film. MRI can easily be performed through clothing and bones.
TreatmentTreatment for vaginal cancer typically involves surgery, radiation therapy and possibly chemotherapy. With surgery, some patients may need skin grafts and plastic surgery to make an artificial vagina. Some patients may need more than one type of treatment in combination.
At UCSF Medical Center, a team of cancer specialists and plastic surgeons work together to design the most effective treatment plan for your condition.
SurgerySurgery is the most common treatment for all stages of vaginal cancer.
A doctor may remove the cancer using one of the following: -
Laser Surgery: - A narrow beam of light is used to kill cancer cells. It may be used for the very earliest stages of when the cancer has been confined to the place of its origin which is also known as in situ cancer.
Wide Local Excision: - A type of surgery that removes the cancer and some of the tissue around it. A patient may need to have skin taken from another part of the body, or grafted, to repair the vagina after the cancer has been removed.
Vaginectomy: - In some cases, an operation in which the vagina is removed may be recommended. When the cancer has spread outside the vagina, vaginectomy may be combined with surgery to take out the uterus, ovaries and fallopian tubes. This is called a radical hysterectomy. During these operations, lymph nodes in the pelvis also may be removed.
Exenteration: - 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.
Radiation TherapyRadiation 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, called external beam radiation therapy. Another form or radiation therapy, called internal radiation, works by placing materials that produce radiation, called radioisotopes, through thin plastic tubes into the area where the cancer cells are found. Radiation may be used alone, in combination with chemotherapy, or after surgery.
ChemotherapyChemotherapy 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. Chemotherapy may be used in combination with radiation treatment, or alone.
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