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Cancer of the vagina, an uncommon cancer, is usually a squamous cell skin cancer (vaginal carcinoma), which typically develops in older women.
In the United States, vaginal cancer accounts for only about 1% of gynecologic cancers. The average age at diagnosis is 60 to 65.
More than 95% of vaginal cancers are squamous cell carcinomas. Vaginal squamous cell carcinoma may be caused by human papillomavirus (HPV), the same virus that causes genital warts and cervical cancer. Having HPV infection or cervical or vulvar cancer increases the risk of developing vaginal cancer.
Most other vaginal cancers are adenocarcinomas. One rare type, clear cell carcinoma, occurs almost exclusively in women whose mothers took the drug diethylstilbestrol (DES), prescribed to prevent miscarriage during pregnancy. (In 1971, the drug was banned in the United States.)
Depending on the type, vaginal cancer may begin on the surface of the vaginal lining. If untreated, it continues to grow and invades surrounding tissue. Eventually, it may enter blood and lymphatic vessels, then spread to other parts of the body.
Symptoms
The most common symptom is bleeding from the vagina, which may occur during or after sexual intercourse, between menstrual periods, or after menopause. Sores may form on the lining of the vagina. They may bleed and become infected. Other symptoms include a watery discharge and pain during sexual intercourse. A few women have no symptoms. Large cancers can also affect the bladder, causing a frequent urge to urinate and pain during urination. In advanced cancer, abnormal connections (fistulas) may form between the vagina and the bladder or rectum.
Diagnosis
Doctors may suspect vaginal cancer based on symptoms, abnormal areas seen during a routine pelvic examination, or an abnormal Papanicolaou (Pap) test result. Doctors may use an instrument with a binocular magnifying lens (colposcope) to examine the vagina. To confirm the diagnosis, doctors scrape cells from the vaginal wall to examine under a microscope. They also do a biopsy on any growth, sore, or other abnormal area seen during the examination.
Other tests, such as use of a viewing tube (endoscopy) to examine the bladder or rectum, a chest x-ray, and computed tomography (CT), may be done to determine whether the cancer has spread.
Prognosis
The prognosis depends on the stage of the cancer (see Cancers of the Female Reproductive System: Staging Cancers of the Female Reproductive System* ). If the cancer is limited to the vagina, about 65 to 70% of women survive at least 5 years after diagnosis. If the cancer has spread beyond the pelvis or to the bladder or rectum, only about 15 to 20% survive.
Treatment
Treatment also depends on the stage. For early-stage vaginal cancers, surgery to remove the vagina, uterus, and lymph nodes in the pelvis and the upper part of the vagina is the treatment of choice. Radiation therapy is used for most other cancers. It is usually a combination of internal (using radioactive implants placed inside the vagina) and external (directed at the pelvis from outside the body) radiation therapy.
Radiation therapy cannot be used if fistulas have developed. In such cases, the organs in the pelvis are removed.
Intercourse may be difficult or impossible after treatment for vaginal cancer, although sometimes a new vagina can be constructed with skin grafts or part of the intestine.
Last full review/revision November 2008 by David M. Gershenson, MD; Pedro T. Ramirez, MD
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