Vaginal Cancer
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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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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 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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Treatment may be one of the following:
- Surgery to remove all or part of the vagina (vaginectomy). This
may be followed by skin grafting to repair damage done to the vagina.
- Internal radiation therapy.
- Laser surgery.
- Intravaginal chemotherapy.
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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:
- Internal radiation therapy with or without external beam radiation
therapy.
- Wide local excision. This may be followed by the rebuilding of thevagina. Radiation
therapy following surgery may also be performed in some cases.
- 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:
- 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.
- Internal radiation therapy with or without external beam radiation therapy.
- 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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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:
- Combined internal and external radiation therapy.
- Surgery, which may be followed by radiation therapy.
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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:
- Combined internal and external radiation therapy.
- Surgery may sometimes be combined with radiation therapy.
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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:
- Combined internal and external radiation therapy.
- Surgery may sometimes be combined with radiation therapy.
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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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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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