July 6, 2022 Author : João Casanova Vaginal cancer is a rare gynecological cancer (1 case in every 100 000 women), mainly in women under 40 years of age. The average age at diagnosis is 60 years; More than half of vaginal cancers occur in women infected with the human papilloma virus (HPV). Vaginal cancer can be a primary cancer, that is it originates from cells in the vagina; Metastases from cancers in other organs can also have metastasis in the vagina, most often tumors in the uterus, ovaries, breast, rectum and kidney. Different types of primary vaginal cancer exist: Vaginal squamous cell carcinoma , which originates in the squamous cells that line the internal vaginal surface and is the most frequent; Vaginal adenocarcinoma , which originates from vaginal gland cells; Vaginal melanoma , which originates from melanin-producing cells (melanocytes) in the vagina; Vaginal sarcoma , which originates from connective tissue or muscle cells in the vaginal walls. Risk factors for vaginal cancer The risk of vaginal cancer increases with age. Most diagnosed cases are in women over 60 years old Human papilloma virus ( HPV ) infection. More than half of vaginal cancer cases are related to this sexually transmitted infection; Presence of precancerous cells in the uterus or vagina; Previous cervical cancer; Being daughters of mothers exposed to diethylstilbestrol (DES) during pregnancy; Multiple sexual partners; Beginning of sexual life at a young age; Tobacco consumption; Lupus; Human immunodeficiency virus infection. Among gynecological cancers, vaginal cancer and cervical cancer are the most related to human papilloma virus (HPV) infection, so they share risk factors. Vaginal cancer symptoms Many vaginal cancers do not have symptoms and are detected accidentally in routine consultations or exams , for example when a gynecological physical examination is performed, or samples are collected for a cytology for cervical cancer screening. In other cases, vaginal cancer has symptoms. The most important of these are vaginal bleeding either after sexual intercourse, between menstruation or in women in menopause. Other possible symptoms of vaginal cancer are: Unusual vaginal discharge, with or without traces of blood or unpleasant odor; Urinary symptoms such as painful urination, blood in the urine or need to urinate more often than usual; Sensation of a foreign body or vaginal mass; Lesions of the vaginal mucosa, such as masses, plaques or ulcers; Changes in bowel habits, such as constipation; Vaginal itching that does not disappear; Pain during sexual intercourse; Pelvic pain. These symptoms are not specific to vaginal cancer , they can be related to many other health problems. Whenever they are present, medical care should be sought so that its causes are correctly identified. Diagnosis and treatment of vaginal cancer The results of a detailed gynecological and pelvic physical examination and additional diagnostic tests , for example, a colposcopy with biopsy for cells study, contribute to the initial diagnosis. If this evaluation confirms a vaginal cancer, then other tests are usually needed for vaginal cancer staging . Staging depends on: Identification, size and extent of the primary tumor in the vagina and other nearby organs (bladder and rectum); Presence of lymph node metastases; Presence of distant metastases. Vaginal cancer can metastasize mainly to the lungs, liver and bone. Tests required for cancer staging may be: Blood tests; Chest X-ray; Computed tomography (CAT), magnetic resonance, positron emission tomography (PET). Once all the results are available, the best treatment approach is decided by a multidisciplinary team of specialists from different areas. Treatment may be: Surgery: from just removing a part of the vagina (when the disease is diagnosed in an early stage) to the removal of all reproductive organs (vagina, uterus and ovaries), bladder, rectum and intestines, in advanced cases and when there are no other possibilities for treatment; External or internal radiotherapy (brachytherapy); Chemotherapy, which is not usually used as sole treatment for vaginal cancer. Vaginal cancer in women of childbearing age does not preclude future pregnancy unless a hysterectomy is performed. However, 10%-15% of women develop treatment-related complications that may interfere with a successful subsequent pregnancy. Radiation therapy for vaginal cancer in women of childbearing age can also induce an early menopause. Prevention There are no specific preventive measures of vaginal cancer, but the following have an important contribution: Maintain regular gynecological follow-up and carry out the recommended exams and screenings; HPV prevention – vaccination and condom use – help to prevent vaginal cancer. The HPV vaccine is part of the Portuguese national vaccination program, both for girls (since 2008) and boys (since 2020); Not smoking . Meet the gynecology clinical team from Hospital da Luz network and book your consultation The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
