Overview

Vaginal cancer is a rare cancer that occurs in your vagina — the muscular tube that connects your uterus with your outer genitals. Vaginal cancer most commonly occurs in the cells that line the surface of your vagina, which is sometimes called the birth canal.

While several types of cancer can spread to your vagina from other places in your body, cancer that begins in your vagina (primary vaginal cancer) is rare.

A diagnosis of early-stage vaginal cancer has the best chance for a cure. Vaginal cancer that spreads beyond the vagina is much more difficult to treat.

Vaginal cancer care at Mayo Clinic

Source: http://www.mayoclinic.com

Symptoms

Early vaginal cancer may not cause any signs and symptoms. As it progresses, vaginal cancer may cause signs and symptoms such as:

• Unusual vaginal bleeding, for example, after intercourse or after menopause
• Watery vaginal discharge
• A lump or mass in your vagina
• Painful urination
• Frequent urination
• Constipation
• Pelvic pain

When to see a doctor

See your doctor if you have any signs and symptoms related to vaginal cancer, such as abnormal vaginal bleeding. Since vaginal cancer doesn't always cause signs and symptoms, follow your doctor's recommendations about when you should have routine pelvic exams.

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Causes

It's not clear what causes vaginal cancer. In general, cancer begins when healthy cells acquire a genetic mutation that turns normal cells into abnormal cells.

Healthy cells grow and multiply at a set rate, eventually dying at a set time. Cancer cells grow and multiply out of control, and they don't die. The accumulating abnormal cells form a mass (tumor).

Cancer cells invade nearby tissues and can break off from an initial tumor to spread elsewhere in the body (metastasize).

Types of vaginal cancer

Vaginal cancer is divided into different types based on the type of cell where the cancer began. Vaginal cancer types include:

• Vaginal squamous cell carcinoma, which begins in the thin, flat cells (squamous cells) that line the surface of the vagina, and is the most common type
• Vaginal adenocarcinoma, which begins in the glandular cells on the surface of your vagina
• Vaginal melanoma, which develops in the pigment-producing cells (melanocytes) of your vagina
• Vaginal sarcoma, which develops in the connective tissue cells or muscles cells in the walls of your vagina

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Diagnosis

Screening for vaginal cancer

Vaginal cancer is sometimes found during a routine pelvic exam before signs and symptoms become evident.

During a pelvic exam, your doctor carefully inspects the outer genitals, and then inserts two fingers of one hand into your vagina and simultaneously presses the other hand on your abdomen to feel your uterus and ovaries. He or she also inserts a device called a speculum into your vagina. The speculum opens your vaginal canal so that your doctor can check your vagina and cervix for abnormalities.

Your doctor may also do a Pap test. Pap tests are usually used to screen for cervical cancer, but sometimes vaginal cancer cells can be detected on a Pap test.

How often you undergo these screenings depends on your risk factors for cancer and whether you've had abnormal Pap tests in the past. Talk to your doctor about how often you should have these health screenings.

Tests to diagnose vaginal cancer

Your doctor may conduct a pelvic exam and Pap test to check for abnormalities that may indicate vaginal cancer. Based on those findings, your doctor may conduct other procedures to determine whether you have vaginal cancer, such as:

• Inspecting the vagina with a magnifying instrument. Colposcopy is an examination of your vagina with a special lighted magnifying instrument called a colposcope. Colposcopy allows your doctor to magnify the surface of your vagina to see any areas of abnormal cells.
• Removing a sample of vaginal tissue for testing. Biopsy is a procedure to remove a sample of suspicious tissue to test for cancer cells. Your doctor may take a biopsy of tissue during a colposcopy exam. Your doctor sends the tissue sample to a laboratory for testing.

Staging

Once your doctor diagnoses vaginal cancer, steps will be taken to determine the extent of the cancer — a process called staging. The stage of your cancer helps your doctor decide what treatments are appropriate for you. In order to determine the stage of your cancer, your doctor may use:

• Imaging tests. Your doctor may order imaging tests to determine whether cancer has spread. Imaging tests may include X-rays, computerized tomography (CT) scans, magnetic resonance imaging (MRI) or positron emission tomography (PET).
• Tiny cameras to see inside your body. Procedures that use tiny cameras to see inside your body may help your doctor determine whether cancer has spread to certain areas. Cameras help your doctor see inside your bladder (cystoscopy) and your rectum (proctoscopy).

Once your doctor determines the extent of your cancer, it is assigned a stage. The stages of vaginal cancer are:

• Stage I. Cancer is limited to the vaginal wall.
• Stage II. Cancer has spread to tissue next to your vagina.
• Stage III. Cancer has spread further into the pelvis.
• Stage IVA. Cancer has spread to nearby areas, such as your bladder or rectum.
• Stage IVB. Cancer has spread to areas away from your vagina, such as your liver.

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Complications

Vaginal cancer may spread (metastasize) to distant areas of your body, such as your lungs, liver and bones.

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Prevention

There is no sure way to prevent vaginal cancer. However, you may reduce your risk if you:

• Undergo regular pelvic exams and Pap tests. You can increase the chance that vaginal cancer is discovered early by having routine pelvic exams and Pap tests. When discovered in its earliest stages, vaginal cancer is more likely to be cured. Discuss with your doctor when to begin these tests and how often to repeat them.
• Ask your doctor about the HPV vaccine. Receiving a vaccination to prevent HPV infection may reduce your risk of vaginal cancer and other HPV-related cancers. Ask your doctor whether an HPV vaccine is appropriate for you.
• Don't smoke. If you smoke, quit. If you don't smoke, don't start. Smoking increases the risk of vaginal cancer.

Coping and support

How you respond to your cancer diagnosis is unique. You might want to surround yourself with friends and family, or you may ask for time alone to sort through your feelings. The shock and confusion of your diagnosis may leave you feeling lost and unsure of yourself. To help you cope, try to:

• Learn enough about your cancer to make decisions about your care. Write down the questions to ask at your next doctor appointment. Get a friend or family member to come to appointments with you to take notes. Ask your health care team for further sources of information. The more you know about your condition, the more comfortable you may feel when it comes time to make decisions about your treatment.

• Maintain intimacy with your partner. Vaginal cancer treatments are likely to cause side effects that make sexual intimacy more difficult for you and your partner. If treatment makes sex painful or temporarily impossible, try to find new ways of maintaining intimacy.

  Spending quality time together and having meaningful conversations are ways to build your emotional intimacy. When you're ready for physical intimacy, take it slowly.

  If sexual side effects of your cancer treatment are hurting your relationship with your partner, talk to your doctor. He or she may offer ways to cope with sexual side effects and may refer you to a specialist.

• Create a support network. Having friends and family supporting you can be valuable. You may find it helps to talk with someone about your emotions. Other sources of support include social workers and psychologists — ask your doctor for a referral if you feel like you need someone to talk to.

  Talk with your pastor, rabbi or other spiritual leader. Other people with cancer can offer a unique perspective and may better understand what you're going through, so consider joining a support group — whether it's in your community or online. Contact the American Cancer Society for more information on support groups.

Source: http://www.mayoclinic.com

Risk factors

Factors that may increase your risk of vaginal cancer include:

• Increasing age. Your risk of vaginal cancer increases as you age. Most people who are diagnosed with vaginal cancer are older than 60.

• Atypical cells in the vagina called vaginal intraepithelial neoplasia. Being diagnosed with vaginal intraepithelial neoplasia (VAIN) increases your risk of vaginal cancer.

  With VAIN, cells in the vagina appear different from normal cells, but not different enough to be considered cancer. A small number of those with VAIN will eventually develop vaginal cancer, though doctors aren't sure what causes some cases to develop into cancer and others to remain benign.

  VAIN is frequently caused by the sexually transmitted human papillomavirus (HPV), which can cause cervical, vaginal and vulvar cancers, among others. Vaccines that prevent some types of HPV infection are available.

• Exposure to miscarriage prevention drug. If your mother took a drug called diethylstilbestrol (DES) while pregnant in the 1950s you may have an increased risk of a certain type of vaginal cancer called clear cell adenocarcinoma.

Other risk factors that have been linked to an increased risk of vaginal cancer include:

• Multiple sexual partners
• Early age at first intercourse
• Smoking
• HIV infection

Source: http://www.mayoclinic.com