Vaginal Cancer
What is Vaginal Cancer
Vaginal cancer is a rare type of cancer that originates in the tissues of the vagina (birth canal). Most cases are secondary (spread from cervix, uterus, or vulva), while primary vaginal cancers are less common.
Types
1. Squamous Cell Carcinoma (SCC):
- Most common type (~85%).
- Arises from the epithelial lining of the vagina.
- Usually occurs in older women.
2.Adenocarcinoma:
- Includes clear cell adenocarcinoma, seen in women exposed to DES (diethylstilbestrol) in utero.
- Tends to occur in younger women.
3. Melanoma:
- Rare, usually in the lower vagina.
4. Sarcoma (e.g., Rhabdomyosarcoma):
- Rare, more common in children and adolescents.
Risk Factors
- Persistent HPV infection (especially types 16 and 18).
- Previous cervical or vulvar cancer.
- History of cervical precancer (CIN).
- DES exposure in utero (risk for clear cell carcinoma).
Smoking.
- Older age (esp. postmenopausal women).
Symptoms
Often asymptomatic in early stages.
- Abnormal vaginal bleeding (postcoital, intermenstrual, postmenopausal).
- Watery or foul-smelling vaginal discharge.
- Pelvic pain or mass.
- Painful urination (dysuria) or difficulty passing stool in advanced cases.
- Vaginal lump or ulcer.
Diagnosis
- Pelvic examination and speculum exam.
- Pap smear / vaginal cytology (may detect abnormal cells).
- Biopsy → confirms diagnosis.
- Colposcopy for visualizing lesions.
Imaging:
- MRI / CT scan → for staging and spread.
- PET scan → metastasis evaluation.
Staging (FIGO)
- Stage I: Limited to vaginal wall.
- Stage II: Involves subvaginal tissue, not extending to pelvic wall.
- Stage III: Extends to pelvic wall.
- Stage IV: Invades bladder, rectum, or distant metastasis.
Treatment
Depends on stage, size, and histology.
Early stage (I, II):
- Surgery: Wide local excision or partial vaginectomy.
- Radiotherapy: Often preferred, especially brachytherapy.
- Advanced stages (III, IV):
- Radiotherapy + Chemotherapy (cisplatin-based).
- Pelvic exenteration (removal of bladder, uterus, rectum, and vagina) in selected cases.
Recurrent disease:
- Palliative chemotherapy or radiation.
Prognosis
- 5-year survival varies with stage:
- Stage I: ~70–80%.
- Stage IV: <20%.
Squamous cell carcinoma has a better prognosis than adenocarcinoma.
