What is Vaginal Cancer?
Cancer of the vagina is a rare disease which typically develops in older women. Women over the age of 60, infection with human papillomavirus (HPV), and a history of being exposed to the drug diethylstilbestrol (DES) while in the mother’s womb seem to increase the risk of primary vaginal cancer, which is cancer originating in the vagina. Cancer may also spread to the vagina from other primary locations, such as the uterus and cervix, and is then known as secondary vaginal cancer. There are two main types of vaginal cancer – squamous cell carcinoma (more common) and adenocarcinoma.
Abnormal vaginal bleeding and the other symptoms of vaginal cancer may also be indicative of other gynecological pathology such as uterine fibroids, uterine polyps or uterine cancer. Early diagnosis is the key to successful treatment. Depending upon the type and stage of the vaginal cancer, treatment will involve surgery and radiation therapy in most cases, while chemotherapy may be used where these forms of treatment have failed.
Most vaginal cancers occur in the upper third of the vagina. Vaginal cancer usually begins on the surface of the vaginal lining or epithelium. With time, it can invade the surrounding tissue. Due to its close proximity, the bladder and rectum are easily involved in direct spread of the cancer. If left untreated, it may spread to distant sites, such as the lungs, liver, bone, and skin through the blood and lymphatic vessels. It should be remembered that it is possible for vaginal cancer to develop in a woman who has had a hysterectomy (uterus removal surgery).
Types of Vaginal Cancer
- Squamous cell carcinoma
- More than 95% of vaginal cancers are squamous cell carcinomas.
- It is most common in women over the age of 60.
- This type of cancer originates in the squamous cells, the thin flat cells lining the vagina.
- It grows slowly but may eventually spread to distant organs in the body.
- Almost all other vaginal cancers which are not squamous cell carcinomas are adenocarcinomas.
- This type of cancer originates in the glandular or secretory cells lining the vagina which normally secrete mucus.
- It is more often seen in women below 30 years of age, the average age of diagnosis being 19.
- Adenocarcinomas may spread more rapidly than squamous cell carcinomas to distant sites.
- Clear cell carcinoma
- This is a rare form of vaginal cancer, seen almost exclusively in women who have been exposed to DES during fetal life.
- DES is a drug, now banned, which was used to prevent miscarriage in pregnant women.
- This is a rare type of vaginal cancer, which develops in the pigment-producing cells (melanocytes) of the vagina.
- It is more common in older women.
- This is another rare type of vaginal cancer, developing in the connective tissue cells or smooth muscle cells in the vaginal wall.
- Sarcoma botryoides is an extremely rare type of cancer, occurring mainly in infancy and early childhood.
Causes and Risk Factors of Vaginal Cancer
Genetic mutation causes uncontrolled growth of cells, resulting in a cancerous growth or tumor formation. The exact causes of the change in DNA structure of (genetic mutation) has not been definitively identified. However, the factors that may predispose a woman to developing vaginal cancer includes :
- Age – older women, especially those over 60, are more likely to develop vaginal cancer.
- Infection with human papillomavirus (HPV) – vaginal squamous cell carcinomas may be caused by HPV, the virus responsible for causing genital warts and cervical cancer. Thus, infection with HPV may be considered a risk factor for vaginal cancer.
- Previous history of cervical, vulvar or ovarian cancer may increase the risk of vaginal cancer.
- Exposure to DES.
- Radiation therapy to the pelvic area.
- Multiple sexual partners.
- HIV/AIDS infection.
- Immunosuppressive therapy.
- Long-term use of vaginal pessary.
- Chronic irritation of vaginal mucosa in women with procidentia (total uterine prolapse).