Understanding Vaginal Cancer

This information has been prepared to help you understand more about vaginal cancer. The information is an introduction to the diagnosis, treatment and effects of vaginal cancer but is by no means exhaustive. We cannot advise about the best treatment for you. You need to discuss this with your doctors. However, we hope this information will answer some of your questions and help you think about the questions you want to ask your doctors.

• The vagina
• What is vaginal cancer?
• How common is it?
• Risk factors
• Symptoms
• Prevention and detection
• Diagnosis
• Further information

The vagina

The vagina is a muscular tube that extends from the opening of the womb (cervix) to the external part of a woman’s sex organs (vulva). It is the passageway through which menstrual blood flows, sexual intercourse occurs, and a baby is born.

What is vaginal cancer?

There are two main types of vaginal cancer:

• Primary vaginal cancer - The two main types of primary vaginal cancers are named after the cells from which they develop.
  
  
  • Squamous cell carcinoma - The most common type of vaginal. Usually found in the upper part of the vagina. Most commonly affects women who are 50-70 years old.
    
    
  • Adenocarcinoma - Usually affects women under 20 years of age but occasionally occurs in other age groups.
    
    
  Other types of vaginal cancer that are very rare include melanoma, small cell carcinoma, sarcoma and lymphoma.
  
  
• Secondary vaginal cancer - Secondary cancers in the vagina (those that have spread from other parts of the body) are more common than primary vaginal cancer. Secondary cancers usually come from the cervix, the lining of the womb (the endometrium), the vulva or from nearby organs such as the bladder or bowel.

How common is it?

Vaginal cancer is very rare, with around 100 women diagnosed in Australia each year.

Risk factors

As with many cancers, the exact cause of most vaginal cancers is unknown, but research is going on all the time to try to find the cause.

Known risk factors:

• DES: a hormone drug called diethystilboestrol (DES) has been identified as a cause of a particular type of cancer of the vagina. Between 1940 and 1970, DES was prescribed to pregnant women to try to prevent miscarriages. The female children of women who took DES during pregnancy have a slightly increased risk of developing a type of cancer of the vagina called clear cell adenocarcinoma. Only one in 1000 DES daughters develop vaginal cancer. The incidence peaked in the 1970s and is now decreasing. Although DES and some other female hormones (oestrogens) can be safely used to treat some other medical conditions, DES is no longer used during pregnancy.
  
  
• HPV: the human papilloma virus (HPV), which is the name for a group of wart viruses, is a risk factor for vaginal cancer. It is a common infection affecting the skin surface of any part of the body, including the vagina and cervix.
  
  
• Vaginal cancer is more likely to occur in women who have had cervical cancer or pre-cervical cancer in the past.
  
  
• Women who have had radiotherapy to the pelvic area also have a slightly higher risk, but this complication of radiotherapy is very rare, and women who have had this treatment still only have a tiny risk of developing vaginal cancer.

However, many women who have these risk factors do not develop vaginal cancer.

Symptoms

The most common symptoms of vaginal cancer are:

• Blood-stained vaginal discharge
• Bleeding after sexual intercourse
• Pain

Problems with passing urine, such as blood in the urine, the need to pass urine frequently and the need to pass urine at night, can also occur. Pain in the back passage may sometimes occur.

These symptoms don’t mean you have vaginal cancer. However, if you do have any of these symptoms you should see your doctor.

Prevention and detection

Prevention is better than cure, so The Cancer Council Australia and its state members work to raise awareness of women’s cancers and to educate women about how to lower their cancer risk.

You and your circle of friends can greatly reduce your risk of developing cancer by:

• Learning what the risk factors are and where possible taking steps to decrease your risk
• Knowing the early warning signs and monitoring your health
• Leading a healthy lifestyle

No formal screening programs exist to check well women for vaginal cancer. See your GP if you experience any of the symptoms above. Your GP will begin by doing a vaginal examination and by taking a Pap smear to check for early cell changes in the vagina or cervix. If the cells taken in the smear test are abnormal, your doctor should refer to a specialist for further tests, such as a biopsy where a tissue sample is taken for closer examination.

Diagnosis

Usually you begin by seeing your GP, who will do a vaginal examination.

If there is a chance you have vaginal cancer, you should be referred to a gynaecological oncologist, who diagnoses and treats women with cancer of the reproductive organs.

• Internal vaginal examination - At the hospital, the gynaecological oncologist will do a full pelvic examination. This will include examining the inside of your vagina to check for any lumps or swellings. The doctor will also feel your groin and pelvic area to check for any swollen glands and may also check your back passage.
  
  
• Pap smear - You will have a Pap smear to check for early cell changes in the vagina or cervix.
  
  
• Colposcopy - If the cells taken in the smear test are abnormal, your doctor may ask you to have a colposcopy. This is a closer examination of the vagina using a colposcope, which is a small low-powered microscope that allows the doctor or specialist nurse to see the vagina in more detail.
  
  
• Biopsy - A small sample of tissue will be taken from any abnormal areas, and examined under a microscope.

Note: Early cell changes

The tests may show early cell changes in the vagina known as vaginal intraepithelial neoplasia or VAIN. This is sometimes referred to as carcinoma in-situ. VAIN is not cancer so the treatment for this condition is not the same as for cancer.

Further information

For further information on cervical cancer, call The Cancer Council Helpline on 13 11 20 or contact your local state or territory office of The Cancer Council (see the contact us page for details)

© 2008 Cancer Council