Vaginal Cancer: Causes, Symptoms, and Treatment

What is Vaginal Cancer?

Vaginal cancer is a malignant tumour that develops in the cells lining the vagina. Unlike cancers that spread to the vagina from other organs (secondary vaginal cancer), primary vaginal cancer originates directly in vaginal tissue. This distinction is crucial because treatment approaches and prognosis differ significantly between primary and secondary forms.

The vagina consists of epithelial, stromal, and muscular layers, but primary vaginal cancer almost always develops from the epithelial lining. Most commonly, vaginal cancer begins in the thin, flat squamous cells that form the vaginal lining. These cells can undergo genetic mutations that cause them to multiply uncontrollably, forming tumours that may eventually spread to nearby tissues or distant organs if left untreated.

Whilst vaginal cancer can occur at any age, this rare condition mostly affects women between 50 and 70 years old. It often develops slowly, sometimes beginning as precancerous changes called vaginal intraepithelial neoplasia (VAIN). While vaginal cancer accounts for only 1-2% of all gynaecological cancers, early detection and treatment can significantly improve outcomes and quality of life.

Types of Vaginal Cancer

Understanding the different types of vaginal cancer helps doctors determine the most effective vaginal cancer treatment approach. Each type has unique characteristics and may respond differently to various therapies:

• Squamous cell carcinoma: Accounts for approximately 85% of all vaginal cancer cases. This type develops from the squamous epithelial lining and typically grows slowly, often arising from precancerous VAIN lesions.
• Adenocarcinoma: Makes up about 10% of vaginal cancers. It originates in the glandular cells that produce vaginal fluids. A rare subtype called clear cell adenocarcinoma has been linked to prenatal exposure to diethylstilbestrol (DES).
• Melanoma: Extremely rare, representing less than 3% of cases. This aggressive form develops from melanocytes, the pigment-producing cells in vaginal tissue.
• Sarcoma: Very rare, including subtypes such as vaginal leiomyosarcoma and rhabdomyosarcoma, more common in younger patients. It forms in the connective tissue or smooth muscle cells of the vaginal wall and tends to occur in younger women.

Causes of Vaginal Cancer

Understanding the causes of vaginal cancer can help you assess your risk and take preventive measures. High-risk human papillomavirus (HPV), particularly types 16 and 18, is the most important known risk factor and is linked to the majority of vaginal squamous cell carcinoma cases. However, most women infected with HPV never develop cancer, as the immune system often clears the virus naturally.

Other risk factors include a history of cervical or vulvar cancer, as these share similar causes with vaginal cancer. Women whose mothers took diethylstilbestrol (DES) during pregnancy face a higher risk, especially for clear cell adenocarcinoma.

Smoking, chronic vaginal irritation, and weakened immunity due to HIV or immunosuppressive drugs also elevate risk. Age is another major factor, with incidence rising after 60.

Additionally, Some research from ICMR suggests metabolic syndrome increases risk for several gynecological cancers, although a direct association with vaginal cancer specifically is less clearly established.

Symptoms of Vaginal Cancer

Recognising vaginal cancer symptoms early can lead to prompt diagnosis and better treatment outcomes. Early-stage vaginal cancer often produces no symptoms, but when they do appear, they may include:

1. Abnormal vaginal bleeding: The most common of all vaginal cancer symptoms, occurring in about 80% of cases. This includes bleeding between periods, after sexual intercourse, or after menopause.
2. Unusual vaginal discharge: May be watery, blood-tinged, or have an unpleasant odour. This symptom affects approximately 20% of women with vaginal cancer.
3. Pelvic pain or discomfort: Persistent pain in the lower abdomen or pelvis, particularly during intercourse, may indicate advanced disease.
4. Vaginal lump or mass: You or your doctor may feel a growth during examination. This is present in about 30% of diagnosed cases.
5. Urinary symptoms: Painful urination, frequent urination, or blood in urine may occur when cancer affects nearby structures.
6. Bowel changes: Constipation, painful bowel movements, or rectal bleeding can happen if the tumour presses against the rectum.
7. Leg swelling: In advanced cases, cancer may block lymph nodes, causing fluid retention in one or both legs.

Imaging and Blood Tests to Diagnose Vaginal Cancer

• Pap smear test: Screens for abnormal cells in the vagina and cervix. While primarily used for cervical cancer screening, it although designed for cervical screening, it may occasionally detect vaginal abnormalities, but it is not a reliable screening tool for vaginal cancer.
• Histopathology cervix/vagina biopsy: The gold standard for diagnosis. A tissue sample is examined under a microscope to confirm cancer presence and determine the specific type.
• HPV DNA testing: Identifies high-risk HPV strains that cause most vaginal cancers. This test is particularly useful for women with abnormal Pap results.

How is Vaginal Cancer Diagnosed?

The diagnostic journey typically begins when you report concerning symptoms to your doctor or during a routine pelvic examination. Your gynaecologist will perform a thorough physical examination, feeling for any lumps or abnormalities. If suspicious areas are found, a biopsy becomes necessary. This involves removing a small tissue sample for laboratory analysis.

Following a positive biopsy result confirming vaginal cancer, your medical team will order imaging tests like an MRI scan, CT scan, or PET scan to determine the cancer's stage and whether it has spread. These scans provide crucial information for planning your vaginal cancer treatment.

Some patients may also undergo a cystoscopy or proctoscopy to check if the cancer has affected nearby organs. The diagnostic process may take several weeks, depending on test availability and the need for multiple imaging studies.

Vaginal Cancer Stages

Understanding the stages of vaginal cancer helps predict outcomes and guide treatment decisions. The staging system indicates how far the cancer has spread:

• Stage I: Cancer is confined to the vaginal wall only
• Stage II: Cancer has spread to tissues adjacent to the vagina but hasn't reached the pelvic wall
• Stage III: Cancer has extended to the pelvic wall and may involve nearby lymph nodes
• Stage IVA: Cancer has spread to nearby organs like the bladder or rectum
• Stage IVB: Cancer has spread to distant parts of the body, such as the lungs or liver.

Treatment Options for Vaginal Cancer

Your vaginal cancer treatment plan depends on the cancer type, stage, location, and your overall health. Options include:

1. Surgery: Removal of the tumour through local excision, partial vaginectomy (removing part of the vagina), or total vaginectomy with reconstruction
2. Radiation therapy: High-energy rays target and destroy cancer cells; often combined with chemotherapy for better results
3. Chemotherapy: Systemic medications kill cancer cells throughout the body, particularly useful for advanced stages
4. Chemoradiation: Combines chemotherapy with radiation for enhanced effectiveness in locally advanced cases
5. Immunotherapy: Used in selected recurrent or metastatic cases, typically involving agents such as PD-1 inhibitors
6. Targeted therapy: Drugs that specifically target cancer cell abnormalities while sparing healthy cells
7. Palliative care: Focuses on symptom management and quality of life, especially important in advanced stages

Preventing Vaginal Cancer

Can you reduce your risk of developing vaginal cancer? Absolutely! Prevention strategies focus primarily on minimising HPV exposure and maintaining regular health screenings. The HPV vaccine, recommended for girls and boys aged 11-12 (though it can be given up to age 45), provides strong protection against high-risk HPV strains linked to the development of vaginal cancer.

Regular Pap smears and pelvic examinations remain your best defence for early detection. Women should begin cervical screening at age 21 and continue as recommended by their doctor. Practising safe sex by using condoms and limiting sexual partners reduces HPV transmission risk. Avoiding tobacco use is crucial, as smoking doubles the risk of developing vaginal cancer. If your mother took DES during pregnancy, inform your doctor for specialised screening protocols.

Living with Vaginal Cancer

A vaginal cancer diagnosis understandably brings emotional and physical challenges. Many women worry about how treatment will affect their sexuality, fertility, and overall quality of life. These concerns are completely valid, and addressing them with your healthcare team is essential. Support groups, whether in-person or online, connect you with others facing similar experiences.

Treatment side effects vary but may include vaginal dryness, narrowing, or scarring that affects sexual function. Your medical team can recommend dilators, lubricants, and other interventions to maintain vaginal health. Regular follow-up appointments are crucial for monitoring potential recurrence and managing long-term effects. Remember, with proper support and care, many vaginal cancer survivors lead fulfilling lives post-treatment.

Vaginal Cancer in Different Age Groups

Vaginal cancer affects women differently across age groups:

• Women aged 50-70: Represent the majority of diagnoses, primarily squamous cell carcinoma cases
• Postmenopausal women: Face higher risk due to age-related cellular changes and accumulated HPV exposure
• Younger women (under 40): Rare cases often linked to DES exposure in utero or immunosuppression
• Women with previous gynaecological cancers: Require vigilant monitoring regardless of age due to increased risk

At Metropolis Healthcare, we understand the importance of early detection in managing gynaecological health conditions. Our comprehensive portfolio of over 4,000 tests includes specialised screening for HPV, pap smears, and histopathology services that play crucial roles in detecting vaginal abnormalities. With our convenient at-home sample collection service spanning 10,000+ touchpoints across India, you can prioritise your health without compromising comfort or convenience. Our advanced diagnostic labs ensure accurate results, while our user-friendly Metropolis Healthcare app delivers reports directly to you.

FAQs

What is Vaginal Cancer?

Vaginal cancer is a rare malignancy developing in vaginal tissue, most commonly from the squamous cells lining the vaginal walls. It represents only 1-2% of gynaecological cancers but requires prompt attention when diagnosed.

What are the early signs of Vaginal Cancer?

Early vaginal cancer symptoms often include unusual bleeding (especially after intercourse or post-menopause), watery discharge, and pelvic discomfort. Some women notice a palpable lump during self-examination. However, early-stage vaginal cancer frequently produces no symptoms, making regular gynaecological check-ups essential for detection.

Can vaginal cancer be cured?

Yes, Vaginal cancer can often be cured when detected early. Localised disease carries favourable five-year survival rates, though exact percentages vary by study and subtype. Treatment success depends on the cancer stage, type, and your overall health.

How do you prevent Vaginal Cancer?

Preventing vaginal cancer involves HPV vaccination, regular screening, and lifestyle modifications. The HPV vaccine provides excellent protection against high-risk strains causing most vaginal cancers. Regular cervical screening helps identify HPV-related changes in the cervix and vagina, though Pap smears are not a dedicated screening test for vaginal cancer. Practising safe sex, avoiding tobacco, and maintaining good vaginal health through proper hygiene also reduce risk.

What is the survival rate for Vaginal Cancer?

The vaginal cancer survival rate varies significantly by stage at diagnosis. Stage I cancers show five-year survival rates of 80-90%, while Stage II rates range from 50-60%. Advanced stages have lower rates, but improvements in vaginal cancer treatment continue to enhance outcomes. Early detection remains the most important factor in achieving favourable survival rates.