What is Vaginal Cancer?
Vaginal cancer is a malignant disease that starts in the vagina (primary vaginal cancer). It is the least common gynaecological cancer in Australia, with just under 100 women diagnosed each year. Typically vaginal cancer is a disease of postmenopausal women.
Types of vaginal cancer
There are several types of primary vaginal cancer. These include:
- Squamous cell carcinomas (SCC) which begins in the squamous cells lining the vagina. This is the most common type, which account for about 85% of vaginal cancers
- Adenocarcinoma which develops from the glandular mucus-producing cells of the vagina. This type can sometimes occur in younger women.
- Vaginal (mucosal) melanoma, which is a very rare form developing in the melanocyte cells
- Sarcoma, another rare form of vaginal cancer that starts in the muscle, fat or other tissue deeper in the vaginal wall.
Secondary vaginal cancer is when the cancer has spread from another part of the body (such as the uterus or cervix). This is more common than primary virginal cancer and is treated differently.
Symptoms of vaginal cancer
Vaginal cancer symptoms may include:
- Blood-stained vaginal discharge that is not related to menstrual bleeding, and may have an unusual smell
- Pain during or bleeding after sexual intercourse
- Pain in the pelvic area or rectum
- A lump in the vagina.
- Problems with passing urine, such as blood in the urine, and the need to pass urine frequently or during the night
If you have any signs or symptoms of vaginal cancer, you should speak to your GP in the first instance and request a physical examination with a biopsy of any suspicious areas.
The diagnosis of vaginal cancer involves a physical examination, a cervical screening test, and confirmation by colposcopy, which takes a sample of tissue (biopsy) if required. Other tests may include blood tests, CT or MRI scan.
Risk factors of vaginal cancer may include:
- Exposure to diethylstilboestrol (DES) in the womb, which was a synthetic hormone prescribed to pregnant women for morning sickness from 1940 to the 1970s
- Human papillomavirus (HPV) infection
- Previous cervical cancer or pre-cervical cancer
- Previous radiotherapy to the pelvic area, however this is rare.
Treatment of vaginal cancer
Primary vaginal cancer is treated with either surgery, radiation, chemotherapy, or a combination of these treatments.
Surgery may be performed to remove the affected areas of the vagina. If the vaginal cancer is localised to a small part of the vagina, surgery can be used to treat the cancer alone. The primary aim of surgery is to remove all cancerous tissue. During surgery the extent of the disease may be determined, particularly to exclude that the cancer has spread to the lymph nodes in the groins.
Surgery usually takes between 2 to 3 hours and requires general anaesthesia. The extent of surgery will be dependent on the spread of the disease. Surgery may include removing part of the vagina (partial vaginectomy), removing the whole vagina (total vaginectomy); removing the whole vagina and surrounding tissue (radical vaginectomy).
Sometimes the lymph nodes in the pelvis may also be removed. If the cancer is located within the upper vagina, the pelvic lymph nodes may be removed. When the cancer is located within the lower vagina, lymph nodes in the groin may be removed.
In some cases, a reconstructive (plastic) surgeon can complete a vaginal reconstruction where skin grafts from other parts of the body are used to reconstruct the vagina. Depending on the stage of the disease, a hysterectomy may also be recommended.
Prior to surgery
For surgery, no bowel prep is required. Patients are asked to fast at least 6 hours prior to surgery. I advise to stop smoking before the operation as it makes postoperative management much easier.
When you wake up from general anaesthesia a drip will give you the necessary fluids and an oxygen mask to your face will supply you with oxygen. Patients will require a catheter to drain the urine from your bladder. A drain may also collect body fluid from the groins and/or the vulva. These will be removed once I am happy that your body functions return to normal and the lymphatic fluid production from the groins slows down.
You will be required to stay in hospital for 5 to 8 days after surgery. I recommend you have a good break for 2-4 weeks following surgery. I particularly recommend avoiding intercourse, vaginal tampons and full baths and other factors that could disrupt wound healing or facilitate an infection.
The final histopathological report may take a few days, and will determine if any further treatment is required. I will discuss the histopathological findings with you and depending on the extent of the cancer I may recommend postoperative radiotherapy to the vagina and/or to the pelvis and the groins.
Surgery always carries risks. Before surgery, I do everything to minimise these risks. Risks that may occur during or after vaginal cancer surgery include:
- Wound infection. The risk of wound infection and wound breakdown is significant especially in older patients with diabetes, in smokers or in obese patients. I prescribe antibiotics before surgery to avoid skin and other infections.
- Vaginal dryness.
- Pain during sexual intercourse. Scar tissue from surgery may cause pain during intercourse
- Lymphedema. When lymph glands are removed, some fluid may accumulate in the legs. The risk of lymphedema is higher in patients who had a lymph node dissection plus radiotherapy.
- Infections to the bladder, and the lungs which can result in temperatures and septicaemia
- Thromboembolic complications (formation of blood clots) in the legs that can travel to the lungs and cause life-threatening emboli. This risk is very small because of our efforts to minimise them. I prescribe Heparin (blood thinner) or calf compression stockings to prevent the formation of blood clots in the legs.
Radiation therapy may be used alone, or after surgery for vaginal cancer. Sometimes, a low-dose of chemotherapy is also administered to make the radiation therapy more effective. If the cancer is advanced or returns after treatment, chemotherapy may also be recommended. I will refer my patients to appropriate radiation and chemotherapy specialists I regularly work with who have a specific interest in the treatment of vaginal cancer.
After treatment, you should be seen regularly for follow-up for at least 5 years. These examinations will include pelvic examinations and sometimes imaging methods if needed.
Cancers of all types and stages may recur. Recurrence may be local (vaginal), in the pelvis or at distant sites (abdomen, lungs). Treatment of recurrent cancer depends on the initial stage of the cancer (stages 1 to 4), the cell type of the cancer, the patient’s medical fitness and her wishes.
Survival rates for vaginal cancer depend on the initial stage and patient’s age at diagnosis. The five-year survival rate for women diagnosed with vaginal cancer is 48% compared to the general Australian population.