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Vaginal Cancer

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What is cancer of the vagina?

Cancer of the vagina, a rare kind of cancer in women, is a disease in which cancer (malignant) cells are found in the tissues of the vagina. The vagina is the passageway through which fluid passes out of the body during menstrual periods and through which a woman has babies. It is also called the "birth canal." The vagina connects the cervix (the opening of the womb or uterus) and the vulva (the folds of skin around the opening to the vagina).

There are two types of cancer of the vagina: squamous cell cancer (squamous carcinoma) and adenocarcinoma. Squamous carcinoma is usually found in women between the ages of 60 and 80. Adenocarcinoma is more often found in women between the ages of 12 and 30.

Young women whose mothers took DES (diethylstilbestrol) are at risk for getting tumors in their vaginas. Some of them get a rare form of cancer called clear cell adenocarcinoma. The drug DES was given to pregnant women between 1945 and 1970 to keep them from losing their babies (miscarriage).

A doctor should be seen if there are any of the following:

  • Bleeding or discharge not related to menstrual periods.
  • Difficult or painful urination.
  • Pain during intercourse or in the pelvic area.
  • Also, there is still a chance of developing vaginal cancer in women who have had a hysterectomy.

A doctor may use several tests to see if there is cancer. The doctor will usually begin by giving the patient an internal (pelvic) examination. The doctor will feel for lumps and will then do a Pap smear. Using a piece of cotton, a brush, or a small wooden stick, the doctor will gently scrape the outside of the cervix and vagina in order to pick up cells. Some pressure may be felt, but usually with no pain.

If cells that are not normal are found, the doctor will need to cut a small sample of tissue (called a biopsy) out of the vagina and look at it under a microscope to see if there are any cancer cells. The doctor should look not only at the vagina, but also at the other organs in the pelvis to see where the cancer started and where it may have spread. The doctor may take an x-ray of the chest to make sure the cancer has not spread to the lungs.

The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in the vagina or has spread to other places) and the patient's general state of health.

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Treatment Option Overview

How cancer of the vagina is treated

Treatments are available for all patients with cancer of the vagina. There are three kinds of treatment:

  • Surgery (taking out the cancer in an operation).
  • Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells and shrink tumors).
  • Chemotherapy (using drugs to kill cancer cells).

Surgery is the most common treatment of all stages of cancer of the vagina. A doctor may take out the cancer using one of the following:

  • Laser surgery uses a narrow beam of light to kill cancer cells and is useful for stage 0 cancer.

  • Wide local excision takes out the cancer and some of the tissue around it. A patient may need to have skin taken from another part of the body (grafted) to repair the vagina after the cancer has been taken out.

  • An operation in which the vagina is removed (vaginectomy) is sometimes done. When the cancer has spread outside the vagina, vaginectomy may be combined with surgery to take out the uterus, ovaries, and fallopian tubes (radical hysterectomy). During these operations, lymph nodes in the pelvis may also be removed (lymph node dissection).

  • If the cancer has spread outside the vagina and the other female organs, the doctor may take out the lower colon, rectum, or bladder (depending on where the cancer has spread) along with the cervix, uterus, and vagina (exenteration).

  • A patient may need skin grafts and plastic surgery to make an artificial vagina after these operations.

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes into the area where the cancer cells are found (internal radiation). Radiation may be used alone or after surgery.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells outside the vagina. In treating vaginal cancer, chemotherapy may also be put directly into the vagina itself, which is called intravaginal chemotherapy.

Treatment by stage

Treatment of cancer of the vagina depends on the stage of the disease, the type of disease, and the patient's age and overall condition.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information.

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Stage 0 Vaginal Cancer

Treatment may be one of the following:

  1. Surgery to remove all or part of the vagina (vaginectomy). This may be followed by skin grafting to repair damage done to the vagina.
  2. Internal radiation therapy.
  3. Laser surgery.
  4. Intravaginal chemotherapy.

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Stage I Vaginal Cancer

Treatment of stage I cancer of the vagina depends on whether a patient has squamous cell cancer or adenocarcinoma.

If squamous cancer is found, treatment may be one of the following:

  1. Internal radiation therapy with or without external beam radiation therapy.
  2. Wide local excision. This may be followed by the rebuilding of thevagina. Radiation therapy following surgery may also be performed in some cases.
  3. Surgery to remove the vagina with or without lymph nodes in the pelvic area (vaginectomy and lymph node dissection).

If adenocarcinoma is found, treatment may be one of the following:

  1. Surgery to remove the vagina (vaginectomy) and the uterus, ovaries, and fallopian tubes (hysterectomy). The lymph nodes in the pelvis are also removed (lymph node dissection). This may be followed by the rebuilding of the vagina. Radiation therapy following surgery may also be performed in some cases.
  2. Internal radiation therapy with or without external beam radiation therapy.
  3. In selected patients, wide local excision and removal of some of the lymph nodes in the pelvis followed by internal radiation.

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Stage II Vaginal Cancer

Treatment of stage II cancer of the vagina is the same whether a patient has squamous cell cancer or adenocarcinoma.

Treatment may be one of the following:

  1. Combined internal and external radiation therapy.
  2. Surgery, which may be followed by radiation therapy.

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Stage III Vaginal Cancer

Treatment of stage III cancer of the vagina is the same whether a patient has squamous cell cancer or adenocarcinoma.

Treatment may be one of the following:

  1. Combined internal and external radiation therapy.
  2. Surgery may sometimes be combined with radiation therapy.

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Stage IVA Vaginal Cancer

Treatment of stage IVA cancer of the vagina is the same whether a patient has squamous cell cancer or adenocarcinoma.

Treatment may be one of the following:

  1. Combined internal and external radiation therapy.
  2. Surgery may sometimes be combined with radiation therapy.

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Stage IVB Vaginal Cancer

If stage IVB cancer of the vagina is found, treatment may be radiation to relieve symptoms such as pain, nausea, vomiting, or abnormal bowel function. Chemotherapy may also be performed. A patient may also choose to participate in a clinical trial.

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Recurrent Vaginal Cancer

If the cancer has come back (recurred) and spread past the female organs, a doctor may take out the cervix, uterus, lower colon, rectum, or bladder (exenteration), depending on where the cancer has spread. The doctor may give the patient radiation therapy or chemotherapy.

A patient may also choose to participate in a clinical trial of chemotherapy or radiation therapy.

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Vaginal Cancer