Vaginal cancer (patient information)

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 * Associate Editor(s)-In-Chief: Jinhui Wu, M.D.

Overview
The vagina also called birth canal goes from the cervix to open up at the vulva. It is a 3 to 4 inch tube. Vaginal cancer is a rare type of cancer. It doesn't have any early symptoms. With the development of the cancer, frequent symptoms abnormal vaginal bleeding, abnormal vaginal discharge, a mass that can be felt and pain during intercourse. A Pap test is a simple and valuable test to find abnormal cells that may be cancer. Usual treatments include laser, radiation therapy, chemotherapy and surgery.

What are the symptoms of Vaginal cancer?
Early vaginal cancer does not have any symptoms. As the tumor grows larger, people may notice one or more of the following symptoms:


 * Abnormal vaginal bleeding, often after intercourse
 * Abnormal vaginal discharge
 * A mass that can be felt
 * Pain during intercourse

Other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell the doctor so that the problems can be diagnosed and treated as early as possible.

Diseases with similar symptoms are the following:


 * Vaginal cyst
 * Vaginal node of endometriosis
 * Uterine fibroids

Who is at highest risk?
Clinical data has suggested that the development of vaginal cancer is related to several factors.


 * Vaginal adenosis: Clinical research suggest that having adenosis increases the risk of developing clear cell carcinoma. Although it is very small, many doctors feel that any woman with adenosis should have very careful screening and follow-up.
 * Cervical cancer: Surveies show having cervical cancer increases the risk of vaginal squamous cell cancer. This is most likely because cervical and vaginal cancers have similar risk factors.
 * Diethylstilbestrol (DES): Clinical data show women whose mothers took Diethylstilbestrol (DES) develop clear-cell adenocarcinoma of the vagina more often than would normally be expected. These women are called "DES daughters".
 * Human papillomavirus (HPV) infection: Certain types of HPV (type 16 and 18) have been strongly associated with vaginal cancers.
 * HIV infection: Clinical studies show human immunodeficiency virus (HIV) also increases the risk of vaginal cancer.
 * Unhealthy lifestyle: Epidemiological research demonstrates smoking and alcohol increase th erisk of vaginal cancer.
 * Age: Vaginal cancer is always found in women above 70 years old.

When to seek urgent medical care?
Call your health care provider if symptoms of vaginal cancer develop. If you experience either of the following symptoms, seeking urgent medical care as soon as possible:


 * A large amount of vaginal bleeding

Diagnosis
The cause of vaginal cancer must be identified, if possible, for this the physician may decide to do the following:
 * Pap tests: The gynecologist can complete this examination. During the procedure, the doctor inserts a speculum to keep the vagina open so that the cervix and vagina can be seen clearly. Then, the doctor scrapes a sample of cells and mucus lightly from the exocervix. Next, the samples will be examined under a microscope in the laboratory.
 * Colposcopy and biopsy: In this procedure, the doctor will use the colposcope to examine the cervix and vagina in order to see the vaginal walls and the surface of the cervix closely and clearly. If an abnormal area is seen on the cervix, a biopsy will be done.
 * Computed tomography (CT) scan: CT scans are often used to diagnose vaginal cancer. It can confirm the location of the cancer and show the organs near the vagina, as well as lymph nodes and distant organs where the cancer might have spread. These are helpful for determining the stage of the cancer and in determining whether surgery is a good treatment option.
 * Magnetic resonance imaging (MRI): An MRI uses magnetic fields but it is a different type of image than what is produced by computed tomography (CT) and produces detailed images of the body. Like computed tomography (CT), a contrast agent may be injected into a patient’s vein to create a better picture.
 * Positron emission tomography (PET) scan: When doing this test, a small amount of a radioactive medium is injected into your body and absorbed by the organs or tissues. This radioactive substance gives off energy which in turn is used to produce the images. PET can provide more helpful information than either CT or MRI scans. It is useful to see if the cancer has spread to the lymph nodes and it is also useful for your doctor to locate where the cancer has spread.
 * Chest X-ray: This plain x-ray of your chest may be done to see if the cancer has spread to your lungs.
 * Whole Bone Scan: The goal of a whole body bone scan is to show if a cancer has metastasized to your bones.

Treatment options
Patients with vaginal cancer have many treatment options. The selection depends on the stage of the tumor. The options are laser, radiation therapy, chemotherapy, surgery or a combination of these methods. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effect may not be the same for each person, and they may change from one treatment session to the next.


 * Laser surgery: This treatment is used a beam of high-energy light to vaporize the abnormal tissue. It is a very effective treatment.
 * Radiotherapy: This is a cancer treatment to kill cancer cells or keep them from growing by using high-energy x-rays or other types of radiation. It is the most common method of treating vaginal cancer.
 * Chemotherapy: The treatment is to use drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing. Besides systemic chemotherapy, topical chemotherapy is often used to treat vaginal cancer.
 * Surgery: Surgery is usually only used for small stage I tumors and for cancers that were not cured by radiation.

Where to find medical care for Vaginal cancer?
Directions to Hospitals Treating vaginal cancer

How will Vaginal cancer affect my sex life?
Impact of the cancer on sex life vary greatly among people with some people having no or little change based on the physical and emotional stress they are experiencing. Some people feel even closer to their partners and have increased desire for sex during this time. Though pregnancy may be possible during the treatment, it is not recommended as some drugs could cause birth defects.

Radiotherapy for vaginal cancer can cause an early menopause as well as scarring, dryness and vaginal narrowing and may be associated with pain when having sex, and delicate skin inside the vagina. Your doctor may advice you to use dilators to stop the vagina shrinking and narrowing and some gels and creams to moisturise the vagina and prevent soreness.

What to expect (Outlook/Prognosis)?
Prognosis of vaginal cancer depends primarily on the following:


 * Location of the tumor in vagina
 * Length of the tumor in vaginal wall
 * Stage of the cancer
 * General health of the patient

Possible complications
Vaginal cancer may spread to other areas of the body. Complications can occur from radiation, surgery, and chemotherapy.

Prevention
Although the reasons for the development of vaginal cancer are not clear, epidemic data shows the following intervention may help to reduce your risk of vaginal cancer:


 * Careful screening and follow-up vaginal adenosis
 * Avoidance of infection with human papillomavirus (HPV): Avoiding unhealthy sex, using condom or injecting HPV vaccines.
 * Changing lifestyle: Quitting tobacco and alcohol