Vaginal Cancer: Symptoms, Diagnosis, Treatment

Vaginal cancer is a rare form of cancer that develops in the vagina. The vagina is the elastic, muscular passage that connects the neck of the uterus (cervix) to the vulva.

The vagina is approximately 7.5 to 10 cm in length with the following tissue layers:

• Epithelial tissue: A thin layer of squamous cells that forms the lining of the vaginal wall.
• Connective tissue: A layer of fibrous tissue with nerves, muscles, and lymph vessels beneath the epithelium.

What are the types of vaginal cancer?

1. Squamous cell carcinoma
   • This is the most prevalent type of vaginal cancer, accounting for approximately 70-90% of cases.
   • Most likely to develop in the upper part of the vagina, near the cervix.
2. Adenocarcinoma
   • It may be more challenging to diagnose as it is more likely to be concealed within the vaginal canal.
   • It can affect young women.
3. Sarcoma
   • Vaginal sarcomas are cancers that develop in the connective tissues.
4. Melanoma
   • Vaginal melanoma is a rare cancer originating from melanocytes, the pigment-producing cells.
   • Most likely affecting the lower part of the vagina.

What are the symptoms of vaginal cancer?

Common symptoms include the following:

• A growth or lump in the vagina
• Ulcers or skin changes in and around the vagina
• Postmenopausal bleeding or in between menstrual period
• Pain during sexual intercourse
• Bleeding after sexual intercourse
• Vaginal discharge that is blood-stained or smelly
• Vaginal itch

Symptoms of advanced cancer may include:

• Pelvic pain
• Constipation
• Swelling in your legs
• Blood in urine, increased frequency of urination

Almost 20% of women are asymptomatic at the time of diagnosis. These vaginal cancers may only be detected during routine cervical screening.

Note: If you experience any of the symptoms above, do consult a gynaecologist.

What are the risk factors for vaginal cancer?

The following risk factors may increase your risk of developing vaginal cancer:

• Women aged 75 years and older. It is rarely seen in women younger than 40 years old.
• Human papillomavirus (HPV)
• History of cervical cancer
• Human immunodeficiency virus (HIV) infection or Acquired Immuno-deficiency Syndrome (AIDS)
• Weakened immune system
• Exposure to diethylstilbestrol (DES)
• Smoking

How is vaginal cancer diagnosed?

Your doctor would first question your general health and symptoms before conducting a thorough physical examination. Diagnosis is made based on your reported symptoms, physical examination, and investigations.

1. Pelvic examination: Your doctor would inspect your abdomen and pelvis. During a pelvic examination, your doctor typically conducts an internal examination as well, using a speculum and colposcope, to examine the vulva and inside the vagina. A speculum is a device used to gently hold the vagina open to provide a clear view of the cervix.
2. Colposcopy: The colposcope is a specialised magnifying instrument with a light source attached. It remains outside your body and does not enter your vagina. Your doctor positions the colposcope near the opening of your vagina and uses it to closely examine the vagina. If any abnormal areas are identified, your doctor may perform a biopsy where a small sample of tissue is removed to be examined under the microscope.
3. Imaging tests: Computed tomography (CT) scan, magnetic resonance imaging (MRI), or positron emission tomography (PET) scan may be performed to determine the extent of the cancer and if it has spread to other areas.

How is vaginal cancer treated?

The treatment recommended by your doctor will depend on several factors, including the type and stage. Radiotherapy, surgery, and chemotherapy are common treatments.

1. Radiotherapy

   Radiation inhibits the growth of cancer cells by exposing them to high-energy X-rays. It may be recommended in various situations, including:

   • Primary treatment
   • Post-surgery
   • To prevent recurrence of cancer
   • Treatment of lymph nodes near the vagina
   • In combination with chemotherapy
   • To treat vaginal cancer that could not be entirely removed by surgery

   You may have external radiotherapy, internal radiotherapy (brachytherapy) or a combination of both.

2. Surgery

   Surgery may be done for the early stages of vaginal cancer. Surgeries involve removing:

   • Part of the vagina: Only if the tumour is small and in the upper part of the vagina.
   • All of the vagina: Lymph nodes may be removed as well.
   • Vagina, cervix, and uterus (hysterectomy): Can include removal of fallopian tubes and ovaries.
   • Vagina, cervix, ovaries, fallopian tubes and all or parts of the bladder, rectum, and bowel: Only if cancer has spread and other treatment options are not possible.
3. Chemotherapy

   With chemotherapy, drugs are taken orally or intravenously to kill cancer cells. Typically, chemotherapy is administered concomitantly with radiotherapy (chemoradiotherapy).

What can I do to reduce the risk of developing vaginal cancer?

There are currently no effective ways to prevent vaginal cancer. However, there are measures you can take to help reduce your risk of developing the disease:

1. Practice safe sex, such as using condoms to reduce the risk of HPV and other sexually transmitted infections (STIs).
2. Reducing the number of sexual partners may lower your risk of exposure to HPV and other STIs.
3. Attend regular gynaecological check-ups and screenings. Routine Pap smears and pelvic exams can help detect precancerous changes or early-stage vaginal cancer.
4. Speak to your doctor about HPV vaccination.
5. Have a well-rounded diet with plenty of fruits, vegetables, and whole grains, engage in regular physical activity, and sustain a healthy body weight.
6. If you smoke, quitting smoking is crucial. Smoking is a risk factor for various cancers, including vaginal cancer.

Make an appointment at Pantai Hospitals

Early detection of vaginal cancer makes it easier to treat the disease with effective and appropriate treatment. A dedicated multidisciplinary team of gynae-oncologists at Pantai Hospitals is available for consultation to provide patients with the best care and assistance.

Get in touch with us to book an appointment today if you have any concerns or questions about vaginal cancer treatment options.

Pantai Hospitals have been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.