Vaginal cancer is a rare form of gynaecological cancer that arises from the cells that line the vagina. It is more commonly seen among women who are aged 50 and above. Chronic HPV infection is found to be the risk factor for vaginal cancer.
In the case of early detection, vaginal cancers can have good clinical outcomes and promising survival rates. Vaginal cancers are often treated with a multimodal approach, which involves treatment modalities, namely surgery, chemotherapy and radiation therapy.
Based on the type of cell that they originate from, vaginal cancers are categorised into the following types:
In most cases, vaginal cancer may not show any symptoms in the early stages. Vaginal cancers may be detected during the routine Pap test, which is recommended to check for the presence of abnormal cells in the cervical lining.
Following are the symptoms that are associated with vaginal cancer:
Although the exact cause of vaginal cancer is not known, researchers have identified a few risk factors that increase one’s risk of developing vaginal cancers:
Doctors may recommend various tests for the detection and diagnosis of vaginal cancers. Following are the test methods that are commonly recommended:
a. Physical Exam and Medical History Assessment: When a patient presents herself with symptoms, the first thing that a doctor does is to thoroughly go through her medical history. After understanding the symptoms experienced by the patient, the doctor physically examines the patient for signs of vaginal cancer.
b. Pelvic Exam: During a pelvic exam, the doctor examines the key organs, such as the vagina, cervix, uterus, ovaries, fallopian tubes and rectum. The doctor inserts a gloved, lubricated finger into the patient’s vagina to look for vaginal cancer signs, which could be a lump or any abnormal lesions.
c. Pap Smear: Pap smear or pap test is a procedure conducted to collect the cells that line the cervix and vagina. These cells are further analysed under a microscope for the presence of cancerous cells.
d. Colposcopy: During a colposcopy, a specialised tool called a colposcope is inserted into the vagina to check for the presence of abnormal lesions in the regions of the vagina and cervix. During this procedure, the doctor may consider collecting tissue samples for further analysis; a specialised spoon-shaped instrument called a curette is used to collect the tissue sample.
e. Biopsy: During the biopsy, the tissue sample from the vagina and cervix are collected and examined under a microscope for signs of vaginal cancer.
There are several treatment options available for the management of vaginal cancer. The treatment plans are devised upon considering various factors, such as the stage of the disease, exact location of the tumour, the tumour grade, the patient’s age and her overall condition.
The main treatment options available for vaginal cancer include surgery, radiation therapy and chemotherapy.
a. Surgery: Surgery is the main line of treatment for vaginal cancer. There are different surgical procedures recommended for vaginal cancer management depending on the stage of the disease.
Surgery is the most common treatment of vaginal cancer. The following surgical procedures may be used:
b. Radiation therapy: Radiation therapy involves the use of high-energy X-rays or other forms of radiation to destroy cancer cells or stop them from dividing and metastasising. Radiation therapy can either be administered externally (external beam radiation therapy) or internally (internal beam radiation therapy or brachytherapy).
During external beam radiation therapy, the radiation beams are directed towards the tumour from an external radiation source. Brachytherapy, on the other hand, involves placing a radiation source (radioactive substance) inside or close to the tumour. The radiation emitted by this source kills the tumour cells. The radioactive substance may be administered via needles, seeds or catheters. The radiation dose is decided by the doctor depending on the stage of vaginal cancer.
c. Chemotherapy: During chemotherapy, potent anti-cancer drugs are administered to destroy the tumour cells and limit cancer growth. Chemotherapy may be administered orally, intravenously or intramuscularly. Chemotherapy may be administered right before the surgery (neoadjuvant therapy) in order to shrink the tumour or after the surgery (adjuvant therapy) to destroy the residual cancer cells. Chemotherapy may also be administered in combination with radiation therapy to enhance the efficacy of the overall treatment.
If detected in the early stages, vaginal cancers can be treated successfully. There are multiple treatment options available today, and the doctors can devise treatment plans that not only improve survival but also have a positive impact on the quality of life.
Not all individuals with HPV infections get vaginal cancer. However, chronic HPV infection is one of the risk factors for vaginal cancer. Therefore, it is important to not ignore HPV infection and get it treated at the earliest. Apart from vaginal cancers, HPV infections also tend to increase the risk of other gynaecological cancers.
This entirely depends on the stage of the disease, the exact location of the tumour and the overall condition of the patient. Before the treatment, you can talk to your treating doctor who will be explaining the possible fertility preservation options or other methods to have a child to you.
In rare cases, vaginal cancers can come back after years. However, if they are detected in the early stages, they can be treated successfully.
Following a strict follow-up regimen is important after your vaginal cancer treatment as it helps in reducing the risk of a recurrence.
Although there are no preventive measures that can completely prevent vaginal cancers, there are a few measures that you can take to reduce your risk of developing this disease: