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Understanding Vaginal Cancer: Causes, Symptoms, Diagnosis, and Treatment Options

Vaginal cancer is a rare condition that occurs when cancerous cells grow in the vagina, the birth canal that connects the uterus to the outside of the body. Although many types of cancer can spread to the vagina from other parts of the body, cancer that starts in the vagina itself is uncommon, with about 6,000 new cases diagnosed in the United States each year.

Types of Vaginal Cancer

There are several main types of vaginal cancer:

  • Squamous cell carcinoma: The most common type, which develops in the flat, thin cells lining the vagina. It tends to spread slowly and stay localized.

  • Adenocarcinoma: Starts in the glandular cells that produce mucus and other fluids. It is more likely to spread to other areas, such as the lungs and lymph nodes.

  • Clear cell carcinoma: A rare form of adenocarcinoma that often affects women whose mothers took the hormone diethylstilbestrol (DES) during pregnancy between 1938 and 1971.

In very rare cases, vaginal cancer can also develop in connective tissue or muscle cells (sarcoma) or in cells that produce pigments (melanoma).

Causes and Risk Factors

While some cases of vaginal cancer have no clear cause, most are linked to infection with the human papillomavirus (HPV), the most common sexually transmitted disease. Other factors that may increase the risk of developing vaginal cancer include:

  • Being 60 years or older

  • Exposure to DES

  • Alcohol consumption

  • Having cervical cancer or precancerous lesions

  • HIV infection

  • Smoking

  • Presence of unusual cells in the vagina (vaginal intraepithelial neoplasia)

Symptoms of Vaginal Cancer

Vaginal cancer often does not cause symptoms and may be discovered during a routine exam or Pap test. However, if symptoms do occur, they can include:

  • Unusual vaginal bleeding

  • Watery or foul-smelling vaginal discharge

  • Pelvic pain

  • Pain during sexual intercourse

  • Pain when urinating

  • Frequent urination

  • Constipation

  • A lump in the vagina

It is important to note that these symptoms do not necessarily indicate vaginal cancer and could be caused by an infection. However, it is crucial to have any unusual symptoms checked by a healthcare provider.

Diagnosis and Staging

If a pelvic exam or Pap test reveals signs of a problem, the doctor may perform a colposcopy, using a lighted magnifying tool to examine the vagina and cervix more closely. A biopsy, which involves removing a small tissue sample for microscopic examination, may also be necessary.

After a diagnosis of vaginal cancer, the doctor will conduct imaging tests and other exams to determine if the cancer has spread to other parts of the body. This information helps determine the stage of the cancer and guides treatment decisions. The stages of vaginal cancer are:

  • Stage I: Cancer is confined to the vaginal wall.

  • Stage II: Cancer has spread to the tissue surrounding the vagina.

  • Stage III: Cancer has reached the wall of the pelvis.

  • Stage IVa: Cancer has spread to the lining of the bladder, rectum, or another area of the pelvis.

  • Stage IVb: Cancer has spread to distant parts of the body, such as the lungs or bones.

Treatment Options

Treatment for vaginal cancer depends on various factors, including the cancer's proximity to other organs, its stage, and the patient's history of pelvic radiation treatment or hysterectomy. Common treatment options include:

  • Surgery: The most common treatment, which may involve using a laser to remove tissue or growths, or removing part or all of the vagina. A hysterectomy to remove the cervix or other organs may also be necessary.

  • Radiation therapy: Uses high-powered X-rays or other forms of radiation to kill cancer cells. This can be delivered externally or internally (brachytherapy).

  • Chemotherapy: Uses medication to kill or stop the growth of cancer cells. It can be administered orally, intravenously, or in some cases, as a lotion or cream.

Each treatment option may have side effects, such as menopause symptoms, vaginal irritation, pain during intercourse, nausea, hair loss, and changes in body weight. However, these side effects typically improve or resolve after treatment.

Prognosis and Prevention

The prognosis for vaginal cancer depends on several factors, with the stage at diagnosis being the most crucial. Early-stage vaginal cancer has a higher chance of successful treatment, with five-year survival rates around 67% for stages I and II. The overall five-year survival rate for all stages combined is approximately 47%.

To reduce the risk of developing vaginal cancer, it is important to take steps to avoid HPV infection. The FDA-approved Gardasil 9 vaccine can prevent HPV-related diseases, including the seven most common types of HPV that cause cancer. The vaccine is recommended for people ages 9 to 45.

Other lifestyle changes that may help prevent vaginal cancer include:

  • Delaying sexual activity until the late teenage years or beyond

  • Limiting the number of sexual partners

  • Using condoms during sexual activity

  • Getting regular Pap exams

  • Avoiding smoking

By understanding the causes, symptoms, and treatment options for vaginal cancer, as well as taking proactive steps to reduce the risk of developing the condition, individuals can play an active role in maintaining their reproductive health.

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