The vagina is a tube that joins the cervix and the lower part of the uterus at one end and opens onto the vulva (the external genitalia) at the other end. The epithelium, which is formed by squamous epithelial cells, is a thin layer that lines the vagina. Underneath the epithelium is the vaginal wall's connective tissue, involuntary muscle tissue, and lymph vessels and nerves. Between 85 and 90 percent of vaginal cancers are squamous cell cancers that begin in the epithelial lining of the vagina. The cancer develops over a period of years. Other types of vaginal cancers include adenocarcinoma, malignant melanoma (a type of skin cancer), and sarcomas that develop deep in the vaginal walls.
Vaginal cancer is a rare disease. It accounts for about 3 percent of all gynecologic cancer cases. In 2007, the American Cancer Society estimates that 2,000 women will be diagnosed with vaginal cancer in the United States.
The Cancer Center's Division of Gynecologic Oncology also provides:
- minimally invasive laparoscopic surgical procedures
- a twice-monthly gynecologic oncology clinic
- sophisticated diagnostic testing anf imaging studies
- clinical trials to investigate new medications and treatment methods
- monthly meetings of the Gynecologic Tumor Board, where cases are discussed and treatment plans are developed by a multidisciplinary team of cancer specialists
- a full range of support services
Risk factors for vaginal cancer include:
- increased age (most cases occur between the ages of 50 and 70)
- being born to a mother who took DES when pregnant
- vaginal adenosis (the presence of cells in the vagina that resemble those found in the glands of the lower uterus or endometrium)
- human papillomavirus (HPV) infection
- a personal history of cervical cancer or pre-cancer
- irritation of the vagina caused by a pessary (a device that keeps a prolapsed uterus in place)
Symptoms of vaginal cancer include abnormal vaginal bleeding, frequently after sex; an abnormal vaginal discharge; a mass that can be felt; or pain during intercourse. Signs of advanced vaginal cancer may include painful urination, constipation, and continuous pelvic pain.
The two main methods used to treat vaginal cancer are radiation therapy and surgery. They may be combined for optimal treatment. Systemic chemotherapy is rarely used to treat vaginal cancer.
Radiation therapy is usually the primary treatment for vaginal cancer. Several different methods of radiation therapy may be used:
- external beam therapy (beams of radiation are directed to the cancer site from outside the body)
brachytherapy (the radiation is administered internally):
- low-dose brachytherapy, also called intracavity brachytherapy, involves placing radioactive materials inside a special container that is inserted into the vagina
- interstitial brachytherapy involves placing radioactive materials inside needles that are placed directly into the cancer
- high-dose-rate brachytherapy may be combined with external beam radiation therapy
Surgery is usually used to treat smaller stage I lesions, stage I clear-cell adenocarcinomas and non-epithelial tumors (sarcomas), and other types of tumors that have failed to respond to radiation therapy. Your gynecologic oncologist will decide the extent of surgery based on the size and stage of the cancer:
- laser surgery (to vaporize cancer cells)
- local excision (removal of the tumor and some surrounding healthy tissue)
- radical vaginectomy (removal of the vagina and adjacent tissues; may be combined with a radical hysterectomy and lymphadectomy-removal of lymph nodes from the groin area or inside the pelvis near the vagina)