Vaginal Cancer - Diagnosis & Treatment

How is vaginal cancer diagnosed?

Vaginal cancer is a rare cancer usually caused by the human papilloma virus (HPV) and may sometimes be detected when the patient is being investigated for abnormal Pap smear or HPV test results.

Similar to cervical cancer, there is a pre-cancerous stage to vaginal cancer which can be treated with conservative surgery.

Symptoms of vaginal cancer include abnormal discharge and bleeding especially after intercourse and out of cycle.

If you do present symptoms, your doctor will also take your medical history and recommend a Pap smear to check for any abnormal cells in the vagina.

Other diagnostic procedures may include:

• Colposcopy. It is done using a special lighted magnifying instrument called a colposcope to detect abnormal cells on the vaginal walls and surface.
• Biopsy. It involves removing a sample of vaginal tissue to test for cancer cells. It may be done during a colposcopy exam.
• Imaging tests. Imaging tests such as X-rays, MRI, CT, or PET scans may be done after a diagnosis of vaginal cancer is confirmed to check if it has spread to other parts of the body.

Vaginal cancer staging

Based on the results of diagnostic tests, the doctor will decide the stage of cancer and the course of treatment:

• Stage I: The cancer is limited to the vaginal wall.
• Stage II: It has spread to the tissue surrounding the vagina.
• Stage III: It has spread to the wall of the pelvis.
• Stage IVa: It has spread to the lining of the bladder, the lining of the rectum, or another area of the pelvis.
• Stage IVb: It has spread to the lungs, bones or other parts of the body.

How is vaginal cancer treated?

Treatment of vaginal cancer depends on the type and stage of the cancer, as well as the overall health of the patient. Surgery, radiotherapy and chemotherapy are the main treatments for vaginal cancer.

Surgery

If there are small tumours limited to the surface of the vagina, they may be removed along with a small part of the surrounding normal tissue to ensure all the cancer cells have been resected.

• Vaginectomy. Sometimes partial or complete removal of the vagina is done to remove all cancer cells.
• Lymphadenectomy. If the cancer has spread to nearby lymph nodes, these may be removed at the time of vaginectomy.
• Hysterectomy. The uterus and ovaries are removed if the cancer has spread to these organs. Hysterectomy may be done at the time of vaginectomy.
• Pelvic exenteration. In cases where vaginal cancer has spread throughout the pelvic area or if it has recurred, the doctor may remove the majority of the pelvic organs including the ovaries, uterus, vagina, bladder, rectum and the lower part of the colon.

Radiation therapy

This utilises high-energy radiations such as X-rays to destroy cancer cells. It can be administered either externally or internally. External radiation is more commonly delivered to treat vaginal cancer. In case of early-stage vaginal cancer, only internal radiation may be required.

Radiation therapy may sometimes lead to side effects such as:

• Damage to ovaries
• Vaginal dryness
• Swollen, tender and sore vagina
• Menopause symptoms
• Pain while urinating
• Nausea and vomiting
• Fatigue
• Hair loss
• Discomfort during sex

Chemotherapy

It is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy is usually used in conjunction with radiotherapy to increase the effectiveness of radiation.