Vaginal cancer is a rare type of malignant tumor that develops within the vaginal canal. It often causes symptoms like bleeding after intercourse or after menopause, as well as watery, foul-smelling discharge or a noticeable lump.

This condition is most frequently diagnosed in women over the age of 60. Common risk factors include a history of HPV infection or precancerous conditions like vaginal intraepithelial neoplasia (VAIN).

Medical experts like gynecologists and oncologists typically manage treatment through a combination of specialized therapies. Depending on the stage, this may involve surgery to remove the tumor, radiation, or chemotherapy.

Main symptoms

The most common signs and symptoms associated with vaginal cancer include:

Vaginal bleeding after sexual intercourse or after menopause.
Watery vaginal discharge that may have a foul odor or contain traces of blood.
A palpable lump or swelling within the vagina.
Persistent vaginal itching that does not resolve with standard care.
Pain or discomfort during sexual intercourse.

In addition to these symptoms, some women may experience pain during urination, blood in the urine, a frequent urge to urinate, or chronic pelvic pain. Other signs can include constipation, a feeling of incomplete bowel movements, or swelling in the legs. In its earliest stages, vaginal cancer may not cause any symptoms at all, which is why regular screenings are vital.

How the diagnosis is made

A gynecologist diagnoses vaginal cancer by performing a physical exam and evaluating your medical history and current symptoms.

Tests for vaginal cancer

To accurately detect and stage vaginal cancer, doctors may use several different diagnostic tests:

Digital and rectovaginal exam: A manual exam to check for lumps or abnormalities in the vaginal wall and surrounding tissues.
Speculum exam: The use of a speculum to clearly view the vaginal canal and the cervix.
Lymph node evaluation: Checking for swollen or hard lymph nodes in the groin area.
Pap smear: Collecting cells to look for cancerous or precancerous changes under a microscope.
Colposcopy: Using a specialized magnifying instrument to closely examine the vaginal surface for abnormal cells.

During a colposcopy, a doctor may perform a biopsy, taking a small tissue sample, to confirm if cancer is present and determine its stage. Imaging tests like X-rays, MRIs, CT scans, or PET scans may also be used to see if the cancer has spread to other areas of the body.

Possible causes

Vaginal cancer occurs when the DNA in the cells lining the vagina undergoes specific mutations. These changes cause the cells to grow and multiply uncontrollably, eventually forming a tumor.

Who is at higher risk

Certain factors can increase the likelihood of developing vaginal cancer, including:

HPV infection: Specifically high-risk strains like HPV 16 and 18.
Age: Being over the age of 60.
History of VAIN: Having a history of vaginal intraepithelial neoplasia.
DES exposure: Having been exposed to diethylstilbestrol (DES) in the womb.
Smoking: A history of tobacco use.

These factors can lead to cellular changes in the vaginal canal, making it easier for cancer to develop over time.

Types of vaginal cancer

There are several distinct types of vaginal cancer based on the specific cells involved:

1. Vaginal squamous cell carcinoma

This is the most common form of vaginal cancer. It begins in the thin, flat squamous cells that line the surface of the vagina and is most often found in women over 60, usually near the cervix.

2. Vaginal adenocarcinoma

Adenocarcinoma is a rarer form that starts in the glandular cells of the vaginal lining. It is categorized into four subtypes: papillary, mucinous, adenosquamous, and clear cell adenocarcinoma. Clear cell adenocarcinoma is specifically linked to individuals whose mothers took the drug DES during pregnancy.

3. Vaginal sarcoma

This type develops deep within the vaginal walls in the connective tissue or muscle cells. Examples include leiomyosarcoma (more common in women over 50) and rhabdomyosarcoma (which primarily affects children).

4. Vaginal melanoma

This cancer originates in the melanocytes, the cells responsible for skin pigment. It can appear inside the vaginal canal or on the external vaginal area and is most common in women over 50.

5. Vaginal intraepithelial neoplasia (VAIN)

VAIN consists of precancerous cells that have the potential to turn into squamous cell carcinoma if left untreated.

How treatment is performed

Oncologists tailor treatment plans based on the tumor's size, type, and stage, as well as the patient's overall health. Options include:

1. Surgery

The primary goal is to remove the cancerous tissue and prevent it from spreading. Common procedures include:

Local excision: Removing the tumor along with a small margin of healthy tissue.
Vaginectomy: Partial or total removal of the vagina. In some cases, the uterus and ovaries may also be removed.
Pelvic exenteration: A major surgery involving the removal of the vagina and nearby organs like the bladder or rectum if the cancer is widespread.

2. Radiotherapy

Radiation uses high-energy beams to kill cancer cells or shrink the tumor. It can be delivered externally via a machine or internally.

3. Brachytherapy

This is a form of internal radiation where radioactive material is placed directly inside or very close to the tumor.

4. Chemotherapy

Chemotherapy involves using drugs (often delivered intravenously) to destroy cancer cells throughout the body. It may be used before surgery to shrink a tumor or as the primary treatment for advanced cases.

5. Immunotherapy

These medications help the body's own immune system recognize and attack cancer cells. Examples include pembrolizumab and nivolumab.

6. Targeted therapy

Targeted drugs attack specific weaknesses within cancer cells while causing less damage to healthy cells. Examples include bevacizumab or trastuzumab deruxtecan.

7. Topical therapy

For precancerous lesions (VAIN), doctors may prescribe medicated creams or gels containing fluorouracil (5-FU) or imiquimod to be applied directly to the affected area.