Symptoms

Vaginal cancer often does not cause early symptoms and may be found during a routine Pap test (a type of test where the cervix is checked to see for any abnormality in the cells). Otherwise, some of the symptoms include:

• Unusual bleeding or discharge not related to menstrual periods
• Watery vaginal discharge
• Painful urination
• Frequent urination
• Constipation
• Pain during sexual intercourse
• Pain in the pelvic area
• A lump in the vagina

Causes

The various causes of vaginal cancer are:

• Age- Patient generally above the age of 60 are at a higher risk of getting the cancer
• Exposure to the drug DES (diethylstilbestrol) before birth- The DES is a synthetic form of the oestrogen hormone. It was prescribed to pregnant women to prevent miscarriage, premature labour and related complications arising during pregnancy. 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
• There has been a link to Human Papilloma Virus (HPV) infection and vaginal cancer
• A history of abnormal cells in the cervix or cervical cancer

Diagnosis

Tests that examine the vagina and other organs in the pelvis are used to detect and diagnose vaginal cancer. The following tests and procedures may be used:

• Physical exam and history: A thorough examination is done to check general signs of health including lumps or any abnormality. A history of the patient’s health habits and past illnesses and treatments is also taken into analysis.
• Pelvic exam: An examination of the vagina, cervix, uterus, fallopian tubes, ovaries and rectum is performed. The doctor inserts her finger (gloved and lubricated) into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. A speculum is also inserted into the vagina and the doctor looks at the vagina and cervix for signs of disease. A Pap test or Pap smear of the cervix is also done to check for any abnormalities. The finger may also be inserted into the rectum to feel for lumps or abnormal areas.
• Pap smear: A procedure to collect cells from the surface of the cervix and vagina. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the cervix and vagina. The cells are viewed under a microscope to find out if they are abnormal. This procedure is also called a Pap test.
• Biopsy: This process involves the removal of cells or tissues from the vagina and cervix in order to view it under a microscope and detect signs of cancer.
• Colposcopy: A procedure in which a colposcope (a lighted, magnifying instrument) is used to check the vagina and cervix for abnormal areas. Tissue samples may be taken using a curette (spoon-shaped instrument) and checked under a microscope for signs of disease.

Through the diagnosis, the doctor is able to the extent of the cancer and is able to assign a stage. The various 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

Treatment

Different types of treatments are available for patients with vaginal cancer. Treatment varies based on the stage of the cancer. The various types of treatment include:

Surgery

Surgery is the most common treatment of vaginal cancer. The following surgical procedures may be used:

• Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumour.
• Wide local excision: A surgical procedure that takes out the cancer and some of the healthy tissue around it.
• Vaginectomy: Surgery to remove all or part of the vagina.
• Total hysterectomy: Surgery to remove the uterus and the cervix. If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision in the abdomen using a laparoscope, the operation is called a total laparoscopic hysterectomy.
• Lymphadenectomy: A surgical procedure in which lymph nodes are removed and checked under a microscope for signs of cancer. This procedure is also called lymph node dissection. If the cancer is in the upper vagina, the pelvic lymph nodes may be removed. If the cancer is in the lower vagina, lymph nodes in the groin may be removed.
• Pelvic exenteration: Surgery to remove the lower colon, rectum and bladder. In women, the cervix, vagina, ovaries and nearby lymph nodes are also removed. Artificial openings (stoma) are made for urine and stool to flow from the body into a collection bag.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy after surgery. This is to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can affect cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.