Vaginal Cancer

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Vaginal Cancer

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Overview
Vaginal cancer is a rare type of cancer most
common in women 60 and older.
Women are more likely to develop vaginal cancer if
they have the human papillomavirus (HPV) or if
your birth mother took diethylstilbestol (DES)
when she was pregnant.

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Overview
There are several types of vaginal cancer:
**Squamous cell carcinoma**


Overview
About 70 of every 100 cases of vaginal cancer are
squamous cell carcinomas. These cancers begin in
the squamous cells that make up the epithelial
lining of the vagina. These cancers are more
common in the upper area of the vagina near the
cervix. Squamous cell cancers of the vagina often
develop slowly. First, some of the normal cells of
the vagina get pre-cancerous changes. Then some
of the pre-cancer cells turn into cancer cells. This
process can take many years.

Overview
The medical term most often used for this pre-
cancerous condition is vaginal intraepithelial
neoplasia (VAIN). "Intraepithelial" means that the
abnormal cells are only found in the surface layer
of the vaginal skin (epithelium). There are 3 types
of VAIN: VAIN1, VAIN2, and VAIN3, with 3
indicating furthest progression toward a true
cancer. VAIN is more common in women who have
had their uterus removed (hysterectomy) and in
those who were previously treated for cervical
cancer or pre-cancer.

Overview
In the past, the term dysplasia was used instead of
VAIN. This term is used much less now. When
talking about dysplasia, there is also a range of
increasing progress toward cancer - first, mild
dysplasia; next, moderate dysplasia; and then
severe dysplasia.
**Adenocarcinoma**


Overview
Cancer that begins in gland cells is called
adenocarcinoma. About 15 of every 100 cases of
vaginal cancer are adenocarcinomas. The usual
type of vaginal adenocarcinoma typically develops
in women older than 50. One certain type, called
clear cell adenocarcinoma, occurs more often in
young women who were exposed to
diethylstilbestrol (DES) in utero (when they were in
their mother’s womb). (See the section called
"What are the risk factors for vaginal cancer?" for
more information on DES and cle

Overview
**Melanoma**
Melanomas develop from pigment-producing cells
that give skin its color. These cancers usually are
found on sun-exposed areas of the skin but can
form on the vagina or other internal organs. About
9 of every 100 cases of vaginal cancer are
melanomas. Melanoma tends to affect the lower
or outer portion of the vagina. The tumors vary
greatly in size, color, and growth pattern. More
information about melanoma can be found in our
document called Melanoma Skin Cancer.

Overview
**Sarcoma**
A sarcoma is a cancer that begins in the cells of
bones, muscles, or connective tissue. Up to 4 of
every 100 cases of vaginal cancer are sarcomas.
These cancers form deep in the wall of the vagina,
not on its surface. There are several types of
vaginal sarcomas. Rhabdomyosarcoma is the most
common type of vaginal sarcoma. It is most often
found in children and is rare in adults. A sarcoma
called leiomyosarcoma is seen more often in
adults. It tends to occur in women older than 50.

Symptoms
Vaginal cancer does not typically have early
symptoms. However, you should contact a medical
professional if you notice any of the
following symptoms:
-- bleeding at a time outside of your usual
menstrual cycle
-- a vaginal lump


Symptoms
-- abnormal vaginal discharge
-- bleeding during or after intercourse
-- pelvic pain
http://www.nlm.nih.gov/medlineplus/vaginalcanc
er.html


Diagnosis
There are several exams a doctor might perform to
test for vaginal cancer. These tests usually include a
pelvis exam with a Pap smear and a biopsy, if
needed.
Other imaging tests include the following:


Diagnosis
**Chest x-ray**
: If vaginal cancer is diagnosed, a plain x-ray of
your chest may be done to see if your cancer has
spread to your lungs. This is very unlikely unless
your cancer is far advanced. This x-ray can be done
in any outpatient setting.


Diagnosis
**Computed tomography (CT)**
: The CT scan is an x-ray procedure that produces
detailed cross-sectional images of your body.
Instead of taking one picture, as does a
conventional x-ray, a CT scanner takes many
pictures as it rotates around you. A computer then
combines these pictures into an image of a slice of
your body (think of a loaf of sliced bread). The
machine will take pictures of multiple slices of the
part of your body that is being studied.


Diagnosis
Before any pictures are taken, you may be asked to
drink 1 to 2 pints of a liquid called oral contrast.
This helps outline the intestine so that certain
areas are not mistaken for tumors. You may also
receive an IV (intravenous) line through which a
different kind of contrast dye (IV contrast) is
injected. This helps better outline structures in
your body.


Diagnosis
The injection can cause some flushing (redness and
warm feeling that may last hours to days). A few
people are allergic to the dye and get hives. Rarely,
more serious reactions like trouble breathing and
low blood pressure can occur. Medicine can be
given to prevent and treat allergic reactions. Be
sure to tell the doctor if you have ever had a
reaction to any contrast material used for x-rays.


Diagnosis
CT scans take longer than regular x-rays and you
will need to lie still on a table while they are being
done. Also, you might feel a bit confined by the
ring-like equipment you’re in when the pictures
are being taken.


Diagnosis
A CT scan can provide information about the size,
shape, and position of a tumor, and can be helpful
to see if the cancer has spread to other organs. It
can also help find enlarged lymph nodes that might
have cancer cells.


Diagnosis
CT scans can also be used to precisely guide a
biopsy needle into a suspected area of cancer
spread. For this procedure, called a CT-guided
needle biopsy, you remain on the CT scanning
table while a doctor moves a biopsy needle toward
the mass. CT scans are repeated until the doctor is
sure that the needle is inside the mass. A fine
needle biopsy sample (tiny fragment of tissue) or a
core needle biopsy sample (a thin cylinder of tissue
about ½ inch long and less than 1/8 inch in
diameter) is re

Diagnosis
**Magnetic resonance imaging (MRI): **
MRI scans use radio waves and strong magnets
instead of x-rays. The energy from the radio waves
is absorbed and then released in a pattern formed
by the type of tissue and by certain diseases. A
computer translates the pattern of radio waves
given off by the tissues into a very detailed image
of parts of the body. Not only does this produce
cross sectional slices of the body like a CT scanner,
it can also produce slices that are parallel with the
length of your body.

Diagnosis
Sometimes a contrast material is injected into a
vein to help better see some structures in the
body. The contrast used for MRI is different than
the one used for CT, so being allergic to one does
not mean that you are allergic to the other. MRI
scans are a little more uncomfortable than CT
scans. First, they take longer -- often up to an hour.
Also, you have to be placed inside a tube, which is
confining and can upset people with
claustrophobia (a fear of close spaces). Newer,
“open MRI” ma

Diagnosis
MRI images are particularly useful in examining
pelvic tumors. They may often detect enlarged
lymph nodes in the groin. They are also helpful in
detecting cancer that has spread to the brain or
spinal cord. This rarely occurs in vaginal cancer.
**Positron emission tomography: **


Diagnosis
Positron emission tomography (PET) uses glucose
(a form of sugar) that contains a radioactive atom.
Because cancers use glucose at a higher rate than
normal tissues, the radioactivity tends to
concentrate in the cancer. A special camera is used
to detect the radioactivity. This test can be helpful
for spotting collections of cancer cells, and can be
useful to see if the cancer has spread to lymph
nodes. PET scans are also useful when your doctor
thinks the cancer has spread, but doesn’t know w

Treatment
After the diagnostic tests are done, your cancer
care team will recommend a treatment plan. Don't
feel rushed about considering your options.The
choice of treatment depends on the type of cancer
and stage of the disease when it is diagnosed.


Treatment
Other factors might play a part in choosing the
best treatment plan. These could include your age,
your overall state of health, whether you plan to
have more children, and other personal
considerations. Be sure you understand all the risks
and side effects of the various therapies before
making a decision about treatment.


Treatment
You may want to get a second opinion. This can
provide more information and help you feel
confident about the treatment plan you choose.
Some insurance companies require a second
opinion before they will pay for treatments.


Treatment
Invasive vaginal cancer is treated mainly with
radiation therapy and surgery.Chemotherapy in
combination with radiation may be used to treat
advanced disease. Some other treatments are
available to treat pre-cancers of the vagina (vaginal
epithelial neoplasia, VAIN).


Treatment
Whenever possible, treatment is given with the
goal of completely removing or destroying the
cancer. If a cure is not possible, removing or
destroying much of the cancer in order to prevent
the tumor from growing, spreading, or returning
for as long as possible is important. If the cancer
has spread widely, the main goal of treatment is
palliation (relieving pain, blockage of the urinary or
intestinal system, or other symptoms).


Prevention
The American Cancer Society suggests the
following tips to prevent vaginal cancer.


Prevention
**Avoid HPV exposure**
Infection with human papillomavirus (HPV) is a risk
factor for vaginal cancer. In women, HPV infections
occur mainly at younger ages and are less common
in women over 30. The reason for this is not clear.
Most of these infections in young women
disappear, but in some cases the HPV DNA remains
inside cells of a woman's cervix and vagina. This
can lead to pre-cancerous changes and even to
cancer many years later.


Prevention
Certain types of sexual behavior increase a
woman's risk of getting a genital HPV infection,
such as:
-- Having sex at an early age
-- Having many sex partners
-- Having a partner who has had many sex partners


Prevention
-- Having sex with uncircumcised males
Delaying sex until you are older can help you avoid
HPV. It also helps if you limit your number of sex
partners and avoid having sex with someone who
has had many other sex partners. Remember that
HPV can be present for years without causing any
symptoms. It does not always cause warts or any
other symptoms. Someone can have the virus and
pass it on without knowing it.


Prevention
Men who have not been circumcised are more
likely to be infected with HPV and pass it on to
their partners. The reasons for this are unclear, yet
circumcision does not completely protect against
HPV infection - men who are circumcised can still
get HPV and pass it on to their partners.The risk of
being infected with HPV is also strongly linked to
having many sexual partners (over a man's
lifetime).


Prevention
*Condoms can lower the HPV infection rate by
about 70%. Condoms cannot protect completely
because they don't cover every possible HPV-
infected area of the body, but they do provide
some protection against HPV, and also protect
against HIV and some other sexually transmitted
diseases. Condoms also seem to help genital HPV
infections clear faster in both women and men.
**Get vaccinated**


Prevention
A vaccine called Gardasil can help protect against
infection with HPV subtypes 16 and 18 (as well as 6
and 11). In studies, this vaccine was found to
prevent anal and genital warts caused by HPV
types 6 and 11 and to prevent anal, vulvar, vaginal,
and cervical cancers and pre-cancers caused by
types 16 and 18.


Prevention
This vaccine can only be used to prevent HPV
infection -- it does not help treat an existing
infection. To be most effective, the vaccine should
be given before a person becomes sexually active.


Prevention
Gardasil was originally only approved for use in
women to prevent cervical cancer, but it is now
also approved to prevent vulvar and vaginal
cancers and pre-cancers (in women) and to
prevent anal cancers and pre-cancers in both men
and women. It is also approved to prevent anal
and genital warts in both men and women.


Prevention
Cervarix, another HPV vaccine available in the US,
can also be used to prevent infection with HPV
types 16 and 18, but so far it has only been shown
to help prevent cervical cancers and pre-cancers
and not any of the other cancers linked to HPV
infection (such as vaginal cancer).
**Don't smoke**


Prevention
Not smoking is another way to lower vaginal
cancer risk. Women who don't smoke are also less
likely to develop a number of other cancers, such
as those of the
lungs, mouth, throat, bladder, kidneys, and several
other organs.
**Find and treat pre-cancerous conditions**


Prevention
Most vaginal squamous cell cancers are believed to
start out as pre-cancerous changes, called vaginal
intraepithelial neoplasia or VAIN. VAIN may be
present for years before turning into a true
(invasive) cancer. These pre-cancers can
sometimes be found during cervical cancer
screening. If a pre-cancer is found, it can be
treated, stopping cancer before it really starts.


Prevention
Still, since vaginal cancer and VAIN are rare,
doctors do not often do other tests to look for
them in women who do not have symptoms or a
history of pre-cancer or cancer of the cervix,
vagina, or vulva.
The American Cancer Society recommends these
guidelines for the early detection of cervical
cancer:


Prevention
-- All women should begin cervical cancer testing
(screening) at age 21. Women aged 21 to
29, should have a Pap test every 3 years. HPV
testing should not be used for screening in this age
group (although it may be used as a part of follow-
up for an abnormal Pap test).


Prevention
-- Beginning at age 30, the preferred way to screen
is with a Pap test combined with an HPV test every
5 years. This should continue until age 65. Another
reasonable option for women 30 to 65 is to get
tested every 3 years with just the Pap test.


Prevention
-- Women who are at high risk of cervical cancer
because of a suppressed immune system (for
example from HIV infection, organ transplant, or
long term steroid use) or because they were
exposed to DES in utero may need to be screened
more often. They should follow the
recommendations of their healthcare team.


Prevention
-- Women over 65 years of age who have had
regular screening in the previous 10 years should
stop cervical cancer screening as long as they
haven’t had any serious pre-cancers (like CIN2 or
CIN3) found in the last 20 years (CIN is discussed in
the section about cervical biopsies, in “How are
cervical cancers and pre-cancers diagnosed”).
Women with a history of CIN2 or CIN3 should
continue to have testing for at least 20 years after
the abnormality was found.

Prevention
-- Women who have had a total hysterectomy
(removal of the uterus and cervix) should stop
screening (such as Pap tests and HPV tests), unless
the hysterectomy was done as a treatment for
cervical pre-cancer (or cancer).
-- Women who have had a hysterectomy without
removal of the cervix (called a supra-cervical
hysterectomy) should continue cervical cancer
screening according to the guidelines above.


Prevention
-- Women of any age should NOT be screened
every year by any screening method.
-- Women who have been vaccinated against HPV
should still follow these guidelines
Although annual (every year) screening should not
be done, women who have abnormal screening
results may need to have a follow-up Pap test done
in 6 months or a year.


Risks
Scientists have found that certain risk factors make
a woman more likely to develop vaginal cancer.
Even if a woman with vaginal cancer has one or
more risk factors, it is impossible to know for sure
how much that risk factor contributed to causing
the cancer. And many women with vaginal cancer
do not have any apparent risk factors.


Risks
These risks include:
**Age**
Squamous cell cancer of the vagina occurs mainly
in older women. Only 15% of cases are found in
women younger than 40. Almost half of cases
occur in women who are 70 years old or older.


Risks
**Diethylstilbestrol (DES)**
DES is a hormonal drug that was given to some
women to prevent miscarriage between 1940 and
1971. Women whose mothers took DES (when
pregnant with them) develop clear-cell
adenocarcinoma of the vagina or cervix more often
than would normally be expected. There is about 1
case of this type of cancer in every 1,000
daughters of women who took DES during their
pregnancy. This means that about 99.9% of DES
daughters do not develop this cancer.

Risks
**Diethylstilbestrol (DES)**
DES-related clear cell adenocarcinoma is more
common in the vagina than the cervix. The risk
appears to be greatest in those whose mothers
took the drug during their first 16 weeks of
pregnancy. Their average age when they are
diagnosed is 19 years. Since the use of DES during
pregnancy was stopped by the FDA in 1971, even
the youngest DES daughters are older than 35 --
past the age of highest risk. But there is no age
when a woman is safe from DES-related cancer.
Doctors do not know exactly how

Risks
**Vaginal adenosis**
Normally, the vagina is lined by flat cells called
squamous cells. In about 40% of women who have
already started having periods, the vagina may
have one or more areas where it is lined instead by
glandular cells. These cells look like those found in
the glands of the cervix, the lining of the body of
the uterus (endometrium), and the lining of the
fallopian tubes. These areas of gland cells are
called adenosis. It occurs in nearly all women who
were exposed to DES during their mothers'
pregnanc

Risks
**Human papilloma virus**
Up to 90% of vaginal cancers and pre-cancers
(vaginal intraepithelial neoplasia -- VAIN) contain
the human papilloma virus (HPV). HPV is a group
of more than 100 related viruses. They are called
papilloma viruses because some of them cause a
type of growth called a papilloma. Papillomas --
more commonly known as warts -- are not cancers.
Different HPV types can cause different types of
warts in different parts of the body. Some types
cause common warts on the hands and feet. Other
types tend to

Risks
Certain HPV types can infect the outer female and
male genital organs and the anal area, causing
raised, bumpy warts. These warts may barely be
visible or they may be several inches across. The
medical term for genital warts is condyloma
acuminatum. 2 types of HPV, HPV 6 and HPV 11,
cause most cases of genital warts. These 2 types
are seldom linked to cancer, and so are called low-
risk types of HPV.


Risks
Certain types of HPV have been strongly linked
with vaginal cancers and pre-cancers. These types,
HPV types 16 and 18, are considered high-risk
types of HPV because they are strongly linked to
cancer. They can also cause cancers of the cervix
and vulva in women, cancer of the penis in men,
and anal and oral cancers (in men and women).


Risks
HPV is passed from one person to another during
skin-to-skin contact with an infected area of the
body. Although HPV can be spread during sex --
including vaginal intercourse, anal intercourse, and
oral sex - sex doesn't have to occur for the
infection to spread. All that is needed is skin-to-
skin contact with an area of the body infected with
HPV. Infection with HPV seems to be able to be
spread from one part of the body to another - for
example, infection may start in the cervix and then
sprea

Risks
The only way to completely prevent anal and
genital HPV infection is to never allow another
person to have contact with those areas of the
body.


Risks
Infection with HPV is common, and in most people
the body is able to clear the infection on its own. In
some, however, the infection does not go away
and becomes chronic. Chronic infection, especially
with high-risk HPV types, can eventually cause
certain cancers, including vaginal cancer.


Risks
In women, HPV infections occur mainly at younger
ages and are less common in women over 30. The
reason for this is not clear. A person can be
infected with HPV for years without any
symptoms, so the absence of visible warts cannot
be used to tell if someone has HPV. Even when
someone doesn't have warts (or any other
symptom), he (or she) can still be infected with
HPV and pass the virus to somebody else.


Risks
Vaccines have been developed to help prevent
infection with some types of HPV. Right now, 2
different HPV vaccines have been approved for use
in the United States by the Food and Drug
Administration (FDA): Gardasil® and Cervarix®.
These are discussed in more detail later in this
document.
**Cervical cancer**


Risks
Having cervical cancer or pre-cancer (cervical
intraepithelial neoplasia or cervical dysplasia)
increases a woman's risk of vaginal squamous cell
cancer. This is most likely because cervical and
vaginal cancers have similar risk factors, such as
HPV infection and smoking.


Risks
Some studies suggest that treating cervical cancer
with radiation therapy may increase the risk of
vaginal cancer, but this was not seen in other
studies, and the issue remains unresolved.
**Smoking**
Smoking cigarettes more than doubles a woman's
risk of getting vaginal cancer.


Risks
**Alcoho**
**l**


Risks
**Alcoho**
Drinking alcohol might affect the risk of vaginal
cancer. A study of alcoholic women found more
cases of vaginal cancer than was expected. But this
study was flawed because it didn't look at other
factors that can alter risk, such as smoking and
HPV infection. A more recent study that did take
these other risk factors into account found a
decreased risk of vaginal cancer in women who do
not drink alcohol at all.


Risks
**Human immunodeficiency virus**
Infection with HIV (human immunodeficiency
virus), the virus that causes AIDS, also increases
the risk of vaginal cancer.


Risks
**Vaginal irritation**
In some women, stretching of the pelvic ligaments
may cause the uterus to sag into the vagina or
even extend outside the vagina. This condition is
called uterine prolapse and can be treated by
surgery or by wearing a pessary, a device to keep
the uterus in place. Some studies suggest that
long-term (chronic) irritation of the vagina in
women using a pessary may slightly increase the
risk of squamous cell vaginal cancer. But this
association is extremely rare, and no studies have
conclusively pro

Risks
**Vaginal irritation**
http://www.cancer.org/Cancer/VaginalCancer/Det
ailedGuide/vaginal-cancer-risk-factors


Additional Resources
Visit the American
Ca Society ncer for downloadable information
about vaginal and other types of cancer.
In addition to the American Cancer Society, other
sources of patient information and support
include:


**Foundation for Women’s Cancer **
(formerly the Gynecologic Cancer Foundation)
Toll-free number: 1-800-444-4441
Telephone number: 1-312-578-1439
Web site: www.foundationforwomenscancer.org/


**National Cancer Institute**
Toll-free number: 1-800-422-6237 (1-800-4-
CANCER); TYY: 1-800-332-8615
Web site: www.cancer.gov


**National Coalition for Cancer Survivorship**
Toll free number: 1-888-650-9127
Web site: www.canceradvocacy.org


**Centers for Disease Control and Prevention (CDC)
Toll-free number:DES Update**
1-888-232-6789
Web site: http://www.cdc.gov/des


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