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Vaginal Cancer: Symptoms, Treatment, Prognosis

by Josephine Andrews
Published: Last Updated on 355 views

Vaginal cancer ( vaginal carcinoma) is a rare, malignant tumor that occurs primarily in older women. In the early stages, vaginal cancer causes no symptoms, so it is often discovered late. It usually develops from precancerous stages that can still be treated well. Here you can read, among other things, how to detect vaginal cancer as early as possible and how to treat it.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

C52 C51

Vaginal cancer: description

Vaginal cancer is a malignant tumor in the female sex organ. The vagina, together with the uterus , the fallopian tubes and the ovaries belong to the internal, the labia , the pubic mound and the clitoris to the external sexual organs of the woman.

A malignant vaginal tumor is known in technical terms as a vaginal carcinoma if the malignant cells start from the vagina. The malignant tumor in the area of ​​​​the external sex organs such as the labia, on the other hand, is called vulvar carcinoma .

There are several types of vaginal cancer. The differences are in the type of cells from which vaginal cancer develops. In over 95 percent, a malignant vaginal cancer develops from the uppermost layer of the mucous membrane, the squamous epithelium. If the vaginal cancer forms from glandular tissue, it is called an adenocarcinoma. If it originates from the muscle cells, it is a rhabdomyosarcoma. Black skin cancer (malignant melanoma) can also develop in the vagina.

Precursors and stages of vaginal cancer

A possible precursor to vaginal cancer is vaginal intraepithelial neoplasia (VAIN). This is a change in the mucous membrane (dysplasia) which, if left untreated, can develop into vaginal cancer. There are three grades of VAIN: mild, moderate, and severe dysplasia.

If a vaginal carcinoma is already present, the so-called FIGO classification is used to classify the stages. It also includes four disease stages. The tissue layers into which the vaginal tumor is growing are taken into account, whether it has penetrated neighboring organs or has already spread to the lymph nodes or more distant organs.

A vaginal carcinoma usually grows in the back wall of the vagina or in the upper third of the vagina. Early on, it can spread to neighboring organs and spread through the lymphatic system to the inguinal and pelvic lymph nodes.

Vaginal carcinoma is a rare type of cancer. In Germany, only around 0.3 percent of all malignant neoplasms in the female genitalia are diagnosed as vaginal cancer. On average, about one in 100,000 women falls ill every year. Most of those affected are between 62 and 74 years old.

Vaginal Cancer: Symptoms

In most cases, vaginal cancer only causes symptoms in the advanced stage of the disease. The precancerous stages VAIN I, II and III usually do not cause any symptoms.

The first signs of vaginal cancer are increased vaginal discharge or unusual bleeding between periods. Such bleeding can have harmless causes, but also indicate a vaginal carcinoma. They should therefore be clarified by a doctor.

Bleeding often occurs during or after sex. If the vaginal cancer reaches a certain size, urination or bowel movements can become difficult. The so-called nerve roots on the spinal cord can also be compressed, which can cause back pain and sensory disturbances or pain in the legs.

Vaginal cancer: causes and risk factors

Why vaginal cancer develops is not fully understood. However, doctors now assume that an infection with the HP virus ( HPV = human papilloma virus) promotes vaginal cancer – especially if a tumor occurs in a younger woman. HP viruses are mostly transmitted through sexual intercourse. Women who have had their uterus removed also have a higher risk of vaginal cancer. They often develop precancerous lesions (VAIN) on the stump of the vagina.

Vaginal Cancer: Examinations and Diagnosis

Since vaginal cancer causes symptoms late, it is more likely to be discovered by accident during a routine examination by the gynecologist. Before the examination, he will ask you about any new complaints that have arisen.

He may also ask you the following questions:

  • Do you (still) have menstrual bleeding? Do these occur regularly?
  • Has your bleeding changed?
  • Have you recently had any bleeding between periods or after intercourse?
  • Have you noticed an unusual vaginal discharge ?
  • Do you have problems urinating or having a bowel movement?

In addition to the genitals, the physical examination includes the rectum and the lymph nodes in the groin. The doctor can already feel swellings or tumors with his hands. With the so-called colposcope, he can look at the vagina up to the cervix and take a cell sample from the vaginal mucosa with the help of a cotton swab. He will then use a cotton swab to rub the vaginal mucosa to take a swab. If an area of ​​​​the mucous membrane appears to be noticeably altered with the naked eye , a tissue sample will be taken with a small biopsy forceps, which then has to be analyzed in the laboratory.

An ultrasound device can also be used to detect changes underneath the mucous membrane. The ultrasound head can either be inserted directly into the vagina or placed on the lower abdomen from the outside.

If vaginal cancer is detected by the examinations, further so-called staging examinations are required. They are used to determine whether and how far the tumor has already spread to the surrounding tissue or whether it has spread via the lymphatic system. The urinary tract and rectum are examined with an endoscope. Computer tomography (CT) or magnetic resonance imaging (MRI) and bone scintigraphy are also used in the staging examinations.

Vaginal cancer: treatment

How vaginal cancer is treated depends on the stage of the disease and the location of the tumor. For some precancerous stages, regular follow-up is sufficient. If vaginal cancer has already formed, surgery, radiation therapy , or chemotherapy are options for treatment.

Prevention of vaginal cancer

It is now assumed that vaginal cancer is favored by an infection with the HP virus. This virus is very common in the adult population. The HPV vaccine protects against some types of this virus . Condoms (” Safer Sex “) also offer protection.

Treatment of vaginal cancer precursors

Young women with low or moderate vaginal intraepithelial neoplasia (VAIN I or II) should be examined at regular intervals by the gynecologist, who will take cell smears, among other things. In such cases, it is possible for the changes to be reversed on their own. However, if changes in the mucosal cells are still detectable after six months, these should be surgically removed. Alternatively, such an intervention can also be carried out with the help of a laser. High-grade VAIN stages should be removed completely. It is important that this is done at a sufficient distance from the tumor tissue.

Vaginal Cancer: Surgery

If the vaginal cancer is in the upper third of the vagina, the operation usually also removes the uterus and some lymph nodes. If the tumor is in the lower area of ​​​​the vagina, usually only the lymph nodes in the groin are removed. A small vaginal carcinoma can be surgically removed without affecting the patients. In such cases, however, it is often possible to restore the vagina with another operation (plastic-reconstructive operation).

With larger tumors, the vagina cannot be completely preserved. If the tumor has spread to the bladder , intestines or other organs in the pelvis, parts of these organs must also be removed.

Vaginal Cancer: Radiation Therapy

Radiation therapy is often used as the only treatment for vaginal cancer in advanced stages III and IV. The cancer cells can either be irradiated through the skin from the outside (percutaneous therapy) or from the inside (brachytherapy). In brachytherapy, a small, radiation-active tube is placed in the vagina. It is also possible to insert small radioactive needles directly into the tumor.

Both forms of irradiation are repeated at certain time intervals and combined with one another. Due to the radiation effect, the vagina can narrow or stick together. In most cases, certain ointments or tamponades are used to prevent these consequences. Bleeding or itching may also occur. Radiation therapy can irritate neighboring organs.

Vaginal cancer: chemotherapy

Chemotherapy is usually only used for vaginal cancer if the other treatments are not effective enough or the tumor is very advanced. This therapy is usually combined with radiation.

Vaginal cancer: disease course and prognosis

If vaginal cancer is not treated, it can spread to surrounding tissue and organs. The cervix , the outer vagina ( vulva ), the urinary bladder and the rectum are particularly affected. Tumor cells can also migrate to distant organs via the lymphatic system, where they form secondary tumors (metastases). Lymph nodes in the liver , lungs or bones can be affected. If a vaginal carcinoma is very large, it can also constrict the ureters and cause dangerous urinary retention in the kidneys.

In many cases, a single surgical removal is sufficient to treat a VAIN. Around every tenth to twenty-five woman develops new tissue changes that have to be removed. If the vagina has been removed or internal radiation therapy has been used, the precancerous lesions reappear in less than one percent of cases. If, on the other hand, a vaginal carcinoma has already formed, the prognosis is considerably worse. It depends heavily on the stage at which the disease is detected. It is therefore important to be aware of the early signs of vaginal cancer .

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