Vaginal cancer

Vaginal cancer is one of the rarest gynaecological cancers, accounting for around two per cent of cases. Women aged over 50 years are most commonly affected.

The vagina is part of the female reproductive system. This muscular canal is around 7.5 cm long and extends from the neck of the uterus (the cervix) to the external genitals (the vulva).

Generally, vaginal cancer tends to be a secondary cancer, which means cancer cells have migrated to the vagina from somewhere else in the body, such as the cervix or vulva. About 95 per cent of cancers that start in the vagina are squamous cell carcinomas, which means the cancer originated from skin cells.

Another group of women prone to vaginal cancers are those who were exposed to the drug diethylstilbestrol (DES) while in utero (in their mother’s womb). This drug was prescribed to pregnant woman between 1938 and 1971 in the mistaken belief that it helped prevent miscarriage.

Symptoms of vaginal cancer

Some vaginal cancers have no symptoms in the early stages, and only cause symptoms once they have invaded other parts of the body. They may be suspected following an abnormal cervical screening test.

Some of the symptoms of vaginal cancer include:

• painless vaginal bleeding that’s not associated with menstruation
• bleeding after sexual intercourse
• smelly vaginal discharge
• pain when urinating or passing bowel motions
• constant pelvic pain.

Risk factors for vaginal cancer

The risk factors for vaginal cancer include:

• advancing age – most women with vaginal cancer are aged over 50 years
• prior history of gynaecological cancer, such as cancer of the cervix or vulva
• previous treatment for dysplasia (abnormal cells on the cervix, vagina and vulva)
• genital warts (human papillomavirus infection)
• cigarette smoking
• prenatal exposure to the synthetic hormone DES which can cause vaginal adenosis. (This has not been prescribed since 1971)
• vaginal adenosis, whereby cells that should be confined to the internal cervix lining (endocervix) are also found on the vaginal walls.

Some research suggests that using a pessary to treat a prolapsed uterus may, over time, irritate the vagina and potentially cause vaginal cell changes.

DES-related vaginal cancer

Between 1938 and 1971, the synthetic hormone DES was commonly prescribed for pregnant women in the mistaken belief that it helped prevent miscarriage. We now know that DES exposure can cause health problems for both the women who took the drug and their children in later life.

A DES daughter’s reproductive system can change after her exposure to DES. This may include alteration of the shape of the uterus and cervix. Many DES daughters have vaginal adenosis, which is a risk factor for clear-cell cancer (adenocarcinoma), the rare vaginal cancer associated with DES daughters.

Unlike other cases of vaginal cancer, DES daughters who develop vaginal cancer are typically diagnosed at a young age, between 14 and 33 years.

Spread of vaginal cancer

Vaginal cancer, as it grows, usually spreads locally first into nearby body parts such as the bladder and bowel. In advanced cases it spreads via the lymphatic or blood system to other organs such as the lungs and liver.

Diagnosis of vaginal cancer

Vaginal cancer is diagnosed using a number of investigations, including:

• medical history
• physical examination, including a pelvic examination using an instrument called a colposcope
• biopsy of the affected tissue, which may need to be performed under anaesthetic.

Treatment of vaginal cancer

Treatment depends on a number of different factors including your general health, the size and stage of the cancer, and whether it has spread to other parts of your body.

Treatment options can include surgery, if the cancer is small, and radiation therapy or extensive surgery after radiation therapy when the cancer is very large or has recurred:

• surgery – the vagina and surrounding tissues may need to be removed. The surgeons can create an artificial vagina using tissue from elsewhere in the body, such as the thigh, so that you can still have sexual intercourse. A radical hysterectomy may also be needed (the uterus, cervix, ovaries and fallopian tubes are removed, along with associated lymph nodes and the top end of the vagina). If the cancer has spread to other pelvic organs, such as the bladder or rectum, surgery will be required to remove the diseased tissues or organs
• radiation therapy – is the use of precisely targeted x-rays to kill cancer cells
• internal radiation therapy (brachytherapy) – radioactive material is surgically implanted into the tumour or nearby.

When a cure for vaginal cancer isn't possible

If vaginal cancer has been diagnosed in its later stages, the cancer may have spread to the point where a cure is no longer possible. Treatment then focuses on improving quality of life by relieving the symptoms. This is called palliative treatment.

Where to get help

• Your specialist or nurse care coordinator at your treatment centre
• Cancer Council Victoria Tel. 13 11 20
• Your GP (doctor)
• Women’s health clinic
• Sexual Health Victoria (SHV). To book an appointment call SHV Melbourne CBD Clinic: (03) 9660 4700 or call SHV Box Hill Clinic: (03) 9257 0100 or (free call): 1800 013 952. These services are youth friendly.
• Counterpart - Women supporting women with cancer.