Grades, Stages and Prognosis of Vaginal Cancer

Primary cancer of the vagina is very rare and because of this, as well as due to the absence of early symptoms, diagnosis is often delayed. Symptoms, when present, are often non-specific and by the time the cancer is diagnosed, it may have spread to adjacent structures or metastasized to distant sites. Read more on vaginal cancer symptoms.

Metastasis of Vaginal Cancer

Vaginal cancer may invade adjacent organs such as the bladder and rectum by direct spread. In more advanced stages, the cancer spreads to distant areas of the body, usually through the lymphatic and blood vessels. This is known as metastasis. In vaginal cancer, metastasis is common in the liver, lungs, bones, and lymph nodes.

Grading of Vaginal Cancer

Grading of a tumor is based on the appearance of the cells under the microscope and how it differs from the adjacent normal cells. Grading indicates how rapidly the tumor is likely to grow and spread, and treatment options will vary according to the grade of the tumor.

Grading is done by taking a biopsy of the abnormal tissue and examining it under the microscope.

• Grade 1 (low grade) – the cancer cells look very similar to normal cells (well differentiated). It is slow growing and less likely to spread than higher grades.
• Grade 2 (moderate grade) – the cancer cells appear slightly abnormal. It grows at a faster rate than grade 1 tumors.
• Grade 3 (high grade) – the cancer cells look very abnormal (poorly differentiated). It grows rapidly and is more likely to spread than lower grades.

Staging of Vaginal Cancer

Staging of vaginal cancer is done to determine the spread of the disease. Staging helps to decide on the type of treatment to be undertaken. Staging may be done with the help of the following procedures

• Biopsy.
• Chest x-ray.
• Cystoscopy.
• Ureteroscopy.
• Proctoscopy.
• CT scan.
• MRI.
• Lymphangiogram.

The stages of vaginal cancer are :

Stage 0 – Precancerous Stage

Vaginal intra-epithelial neoplasia (VAIN) is a pre-cancerous condition where abnormal cells may be detected on the surface of the vagina. VAIN does not usually cause any symptoms. It may resolve on its own or in some women it may develop into vaginal cancer after many years.

VAIN may occur in only one area of the vagina (usually the upper third of the vagina) or in many areas. Infection with human papillomavirus (HPV) is considered as one of the risk factors for VAIN. It is more common in women following a hysterectomy for cervical cancer, or in those who have been treated with radiation therapy to the pelvic area following a cancerous or pre-cancerous lesion of the vagina or cervix. VAIN is usually diagnosed by a cervical smear test or a smear taken from the vaginal vault following a hysterectomy.

VAIN may be divided into grades based on how deeply the abnormal cells are embedded into the surface layer of the vagina.

• VAIN 1 (low grade VAIN) – one third of the thickness of the surface layer of the vagina is involved.
• VAIN 2 (moderate grade VAIN) – two thirds of the thickness of the surface layer of the vagina is involved.
• VAIN 3 (high grade VAIN) – the full thickness of the surface layer of the vagina is involved. Also known as carcinoma in situ.

Stage 1

The cancer has grown into the wall of the vagina.

Stage 2

The cancer has grown outside the wall of the vagina but not into the pelvis.

Stage 3

The cancer has spread beyond the vagina and into the pelvis. Nearby lymph nodes may be affected as well.

Stage 4 – Advanced Vaginal Cancer

The cancer has spread beyond the pelvis or involves the mucosa of the bladder or rectum.
This stage is divided into Stage 4A and Stage 4B.

Stage 4A

The cancer may have spread to the lymph nodes in the pelvis. It may also have spread to the mucosa of the bladder or rectum and/or has directly extended beyond the pelvis.

Stage 4B

The cancer has spread to other distant organs in the body, such as the lungs. Distant lymph node spread is also a possibility.

Prognosis (Outlook) of Vaginal Cancer

The prognosis depends upon the type of vaginal cancer, how early it is detected, the age and health condition of the patient, whether symptomatic at the time of diagnosis, and the stage and grade of the cancer.

Squamous cell carcinoma and clear cell adenocarcinoma have a good prognosis if detected while the cancer is still confined to the vagina. The 5-year survival rate for early stage vaginal cancer is very good.

The outlook for melanoma type of vaginal cancer is poor since it is more aggressive and tends to spread rapidly.
Recurrent vaginal cancer has a poor prognosis.