VAGINAL CANCER

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Vaginal cancer develops when abnormal cells start to grow within the vagina, the birth canal of women that extends from the uterus opening to the external body. While various types of cancer can metastasize or spread to the vagina from other parts of the body, primary vaginal cancer is relatively rare, accounting for approximately 6,000 new cases annually in the United States.

The primary types of vaginal cancer include:

1. Squamous cell carcinoma: This type, the most prevalent, originates in the thin, flat cells lining the vaginal walls. It tends to progress slowly and predominantly remains localized, yet it can potentially spread to distant organs such as the liver, lungs, or bones. Typically, it affects older women, with nearly half of the new cases occurring in those aged 60 and above.
2. Adenocarcinoma: Arising from glandular cells in the vaginal lining responsible for producing mucus and other fluids, adenocarcinoma has a higher propensity to metastasize, particularly to the lungs and lymph nodes in the groin area.
3. Clear cell carcinoma: An uncommon subtype of adenocarcinoma, clear cell carcinoma often occurs in women whose mothers were administered diethylstilbestrol (DES) during early pregnancy to prevent miscarriage and other complications between 1938 and 1971.

Occasionally, vaginal cancer may also manifest in connective tissue or muscle cells (sarcoma) or melanocytes responsible for pigment production (melanoma).

Potential Causes and Risk Factors:

The causes and risk factors associated with vaginal cancer include:

• Age, with individuals aged 60 and above being at higher risk
• Exposure to diethylstilbestrol (DES)
• Alcohol consumption
• History of cervical cancer or precancerous lesions
• Human immunodeficiency virus (HIV) infection
• Smoking
• Presence of abnormal cells in the vagina known as vaginal intraepithelial neoplasia (VAIN)

Symptoms to Watch For:

Symptoms of vaginal cancer may not always be apparent, and it may be discovered during routine medical examinations or Pap tests. However, when symptoms do arise, they may include:

• Abnormal vaginal bleeding
• Unusual vaginal discharge, often with an unpleasant odor
• Pelvic pain
• Pain during sexual intercourse
• Painful urination
• Increased frequency of urination
• Constipation
• Presence of a vaginal lump

Experiencing any of these symptoms does not definitively indicate vaginal cancer but warrants prompt medical evaluation to rule out potential causes such as infection.

Diagnosis and Treatment:

Diagnosis of vaginal cancer typically involves a closer examination if a pelvic exam or Pap test indicates abnormalities. Your doctor may perform a colposcopy, using a colposcope, a magnifying tool with light, to inspect the vagina and cervix for any irregularities. Additionally, a biopsy may be conducted where a small tissue sample is taken for microscopic analysis by a specialist.

Once vaginal cancer is diagnosed, staging becomes crucial. Imaging tests and other examinations are performed to determine the extent of cancer spread, aiding in categorizing the cancer into stages:

• Stage I: Cancer confined to the vaginal wall.
• Stage II: Spread to surrounding vaginal tissue.
• Stage III: Involvement of the pelvic wall.
• Stage IVa: Extending to the lining of the bladder, rectum, or other pelvic areas.
• Stage IVb: Metastasis to distant organs such as the lungs or bones.

Treatment options depend on various factors:

The treatment decisions are made based on factors such as cancer proximity to neighboring organs, stage, prior pelvic radiation therapy, and history of hysterectomy. Treatment modalities may include:

• Surgery: Commonly utilized, involving the removal of tissue or growths using techniques like laser surgery or partial/complete vaginal removal (vaginectomy). Hysterectomy may also be recommended in some cases.
• Radiation therapy: Employing high-energy X-rays or radioactive substances to target and destroy cancer cells. Pelvic radiation may affect ovarian function, leading to menopausal symptoms and vaginal irritation.
• Chemotherapy: Administration of medications, either orally or intravenously, to halt cancer cell growth. Topical chemotherapy may also be utilized. Side effects may include changes in libido, nausea, hair loss, and weight fluctuations.

Prognosis and Prevention

Prognosis varies depending on factors such as cancer stage, age, overall health, and symptom presentation. Early-stage cancers often have higher cure rates, with a 5-year survival rate around 67% for stages I and II combined.

Prevention strategies focus on reducing HPV transmission, including vaccination with Gardasil 9, approved by the FDA for individuals aged 9 to 45. Lifestyle modifications such as delaying sexual debut, limiting sexual partners, consistent condom use, and regular Pap exams can also mitigate risk. Additionally, smoking cessation is advised to reduce overall cancer risk.

Sources:

• National Cancer Institute
• American Society of Clinical Oncology
• Centers for Disease Control and Prevention
• American Cancer Society
• Mayo Clinic
• U.S. Food and Drug Administration