Facts and figures about vaginal cancer
Vaginal cancer is very rare in the UK, accounting for only 0.2% of all new female cancer cases. Age related, incidence rises sharply from 45 years of age, 70% are diagnosed in women 60+ years and on average 35% arise in those over 75 years of age. 90% are carcinomas ( 80% of these are squamous cell carcinomas and 14% adenocarcinomas).
Risk factors include HPV exposure/infection, previous cervical cancer, possibly HIV infection and there are a small proportion of adenocarcinomas that are clear cell carcinomas and these are linked to women who were exposed to the drug diethylstiboestrol (DES) in utero, due to their mothers being prescribed this in pregnancy to reduce the risk of miscarriage. The highest incidence of these cases is in the late teen/early twenties age group.
Vaginal cancer symptoms
- There may be no symptoms, 20% are detected at a very early stage during routine cervical screening.
- Post-menopausal bleeding.
- Irregular bleeding in pre-menopausal women.
- Blood stained or foul smelling vaginal discharge.
- Bleeding after sexual intercourse (post-coital bleeding).
- Pain during sexual intercourse.
- Persistent irritation in the vagina.
- Lump or growth in the vagina that is sometimes detected during an internal pelvic examination.
More advanced symptoms may be:
- Swelling in the legs (oedema).
- Persistent pelvic pain or pain when passing urine.
- Urinary frequency and/or blood in the urine.
Many of these symptoms can be caused by other conditions such as infections.
Diagnosis of vaginal cancer
Investigations may include:
- Cervical screening.
- Physical examination (including internal and possibly rectal).
- Colposcopy and biopsy.
- Chest X-ray.
- Ultrasound scan.
- CT scan.
- PET-CT scan.
- MRI scan.
Vaginal cancer treatment
Depends on several factors:
- The type of tumour.
- The stage of cancer.
- Age and general health.
Surgery is frequently used to treat vaginal cancer; in cases of pre-cancerous vaginal intraepithelial neoplasia (VAIN), laser surgery is an effective treatment.
The extent of surgery depends on the stage of the disease, in early stage a wide local excision to remove the tumour and surrounding tissue will be performed.
In some cases part or all of the vagina will be removed (reconstruction may be possible) or if the disease has spread outside of the vagina, a radical hysterectomy may be advised.
Radiotherapy may be the main treatment, may be post-operative or may be given in combination with chemotherapy. It may be external or internal radiotherapy.
External radiotherapy will involve treating the pelvis with external radiation where internal radiotherapy can be interstitial or intracavity. Interstitial is the implantation of radioactive wires or seeds into the tumour for a few days, intracavity is where a radioactive source is placed in the vagina for a specifically calculated period of time.
Internal radiotherapy is sometimes given after a course of external radiotherapy to give an additional dose of radiation to the site of the primary tumour.
Radiotherapy is the treatment of choice if the patient is unfit for surgery and for some younger women. It is sometimes advised after surgery to reduce the risk of recurrence, particularly if malignant cells are found in the lymph nodes at surgery or if it was not possible to remove all the disease.
In advanced cases, palliative radiotherapy may be prescribed to help shrink the cancer and relieve symptoms.
Chemotherapy combined with radiotherapy (chemoradiation) is proving to be effective and it is thought that the chemotherapy makes the cancer cells more susceptible to radiation.
Cisplatin is usually given once weekly during the course of radiotherapy. It is rarely used on its own just very occasionally to try and shrink the tumour to slow the disease progression and relieve symptoms.