Vaginal Cancer Health Article

Definition

Vaginal cancer refers to an abnormal, cancerous growth in the tissues of the birth canal (vagina).

Description

Vaginal cancer is rare and accounts for only 1% to 2% of all gynecologic cancers. In the United States, there are approximately 2, 000 cases of vaginal cancer diagnosed, and approximately 600 deaths, each year. Vaginal cancer can be either primary or metastatic. Cancer that originates in the vagina is called primary vaginal cancer; if cancer spreads to the vagina from another site, it is called metastatic cancer. Eighty-percent of vaginal cancers are metastatic. Metastatic cancers carry the name of the primary cancer site. For instance, cancer that has spread from the cervix to the vagina would be called "metastatic cervical cancer, " not "vaginal cancer."

The vagina is a short tube that extends from the outer female genitalia (vulva) to the opening to the uterus (cervix). It serves to receive the penis during sexual intercourse, as an outlet for shed tissue and blood during menstruation, and as a passageway for a baby during childbirth. Most cancers are located in the upper third of the vagina.

Squamous carcinoma is the most common type of vaginal cancer and accounts for 85% of cases. Infrequent types of vaginal cancer include adenocarcinomas, melanoma, and sarcomas. Adenocarcinoma is usually found in young women (ages 12 to 30 years) while squamous cell cancer (squamous carcinoma) is usually found in older women (ages 60 to 80 years). Although vaginal melanoma can afflict adult women of any age, women are on average in their fifties at the time of diagnosis.

Demographics

Vaginal cancer is most common in women who are between the ages of 60 and 80.

Causes and symptoms

Cancer is caused when the normal mechanisms that control cell growth become disturbed, causing cells to grow and divide without stopping. This is usually the result of damage to the genetic material of the cell (deoxyribonucleic acid, or DNA). The cause of vaginal cancer is not known.

Symptoms of vaginal cancer appear when the cancer has become more advanced. Approximately 20% of vaginal cancer cases are asymptomatic (produce no symptoms) and are diagnosed following an abnormal Pap test. Symptoms of vaginal cancer include:

• abnormal vaginal bleeding or discharge
• pain during intercourse
• pain in the pelvic area
• difficult or painful urination
• constipation

Diagnosis

The diagnosis of vaginal cancer is made by physical examination and laboratory analysis of tissue samples. During the physical examination, the physician will place one or two fingers into the vagina and press down on the lower abdomen with his or her free hand to feel (palpate) the reproductive organs and any masses. During a routine speculum examination, the physician will obtain a sample of cervical and vaginal cells (using a swab, brush, or wooden applicator) for laboratory analysis (Pap test).

A special magnifying instrument, called a colpo-scope, may be used to view the vagina. Additionally, the surface of the vagina may be treated with a dilute solution of acetic acid, which causes some abnormal areas to turn white. Squamous carcinoma and adenocarcinoma usually appear as a growth on the surface of the vagina. Squamous carcinoma may present as an open sore (ulcer). Adenocarcinoma may lie deeper so that it is not visible and detected only by palpation. Vaginal melanoma appears as a brown or black skin tag (polypoid), growth attached to the vaginal wall by a stem (pedunculated), nipple-like growth (papillary), or fungus-like growth (fungating). Sarcomas often appear as a grape-like mass.

If any area appears abnormal, a tissue sample (biopsy) will be taken. The biopsy can be performed in the doctor's office with the use of local anesthetic. A small piece of tissue, which contains the suspect lesion with some surrounding normal skin and the underlying skin layers and connective tissue, will be removed. Small lesions will be removed in their entirety (excisional biopsy). The diagnosis of cancer depends on a microscopic analysis of this tissue by a pathologist.

Chest x rays and routine blood work are commonly employed in the diagnosis of any cancer. Endoscopic examination of the bladder (cystoscopy) and/or rectum (proctoscopy) may be performed if it is suspected that the cancer has spread to these organs.

Treatment team

The treatment team for vaginal cancer may include a gynecologist, gynecologic oncologist, radiation oncolo-gist, plastic surgeon, gynecologic nurse oncologist, sexual therapist, psychiatrist, psychological counselor, and social worker.