Cancer of the vagina, a rare kind of cancer in women, is a disease in which cancer (malignant) cells are found in the tissues of the vagina. The vagina is the passageway through which fluid passes out of the body during menstrual periods and through which a woman has babies. It is also called the "birth canal." The vagina connects the cervix (the opening of the womb or uterus) and the vulva (the folds of skin around the opening to the vagina).

There are two types of cancer of the vagina: squamous cell cancer (squamous carcinoma) and adenocarcinoma. Squamous carcinoma is usually found in women between the ages of 60 and 80. Adenocarcinoma is more often found in women between the ages of 12 and 30.

Young women whose mothers took DES (diethylstilbestrol) are at risk of getting tumours in their vaginas. Some of them get a rare form of cancer called clear cell adenocarcinoma. The drug DES was given to pregnant women between 1945 and 1970 to keep them from losing their babies (miscarriage).

A doctor should be seen if there are any of the following:

• Bleeding or discharge not related to menstrual periods.
• Difficult or painful urination.
• Pain during intercourse or in the pelvic area.
• Also, there is still a chance of developing vaginal cancer in women who have had a hysterectomy.

A doctor may use several tests to see if there is cancer. The doctor will usually begin by giving the patient an internal (pelvic) examination. The doctor will feel for lumps and will then do a Pap smear. Using a piece of cotton, a brush, or a small wooden stick, the doctor will gently scrape the outside of the cervix and vagina in order to pick up cells. Some pressure may be felt, but usually with no pain.

If cells that are not normal are found, the doctor will need to cut a small sample of tissue (called a biopsy) out of the vagina and look at it under a microscope to see if there are any cancer cells. The doctor should look not only at the vagina, but also at the other organs in the pelvis to see where the cancer started and where it may have spread. The doctor may take an x-ray of the chest to make sure the cancer has not spread to the lungs.

The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in the vagina or has spread to other places) and the patient's general state of health.

Stages of cancer of the vagina

Once cancer of the vagina has been found (diagnosed), more tests will be done to find out if the cancer has spread from the vagina to other parts of the body (staging). A doctor needs to know the stage of the disease to plan treatment. The following stages are used for cancer of the vagina:

Stage 0 or carcinoma in situ

Stage 0 cancer of the vagina is a very early cancer. The cancer is found inside the vagina only and is in only a few layers of cells.

Stage I

Cancer is found in the vagina, but has not spread outside of it.

Stage II

Cancer has spread to the tissues just outside the vagina, but has not gone to the bones of the pelvis.

Stage III

Cancer has spread to the bones of the pelvis. Cancer cells may also have spread to other organs and the lymph nodes in the pelvis. (Lymph nodes are small bean-shaped structures that are found throughout the body. They produce and store cells that fight infection.)

Stage IVA

Cancer has spread into the bladder or rectum.

Stage IVB

Cancer has spread to other parts of the body, such as the lungs.

Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the vagina or in another place.

How cancer of the vagina is treated

Treatments are available for all patients with cancer of the vagina. There are three kinds of treatment:

• Surgery (taking out the cancer in an operation).
• Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells and shrink tumours).
• Chemotherapy (using drugs to kill cancer cells).

Surgery is the most common treatment of all stages of cancer of the vagina. A doctor may take out the cancer using one of the following:

• Laser surgery uses a narrow beam of light to kill cancer cells and is useful for stage 0 cancer.
   
• Wide local excision takes out the cancer and some of the tissue around it. A patient may need to have skin taken from another part of the body (grafted) to repair the vagina after the cancer has been taken out.
   
• An operation in which the vagina is removed (vaginectomy) is sometimes done. When the cancer has spread outside the vagina, vaginectomy may be combined with surgery to take out the uterus, ovaries, and fallopian tubes (radical hysterectomy). During these operations, lymph nodes in the pelvis may also be removed (lymph node dissection).
   
• If the cancer has spread outside the vagina and the other female organs, the doctor may take out the lower colon, rectum, or bladder (depending on where the cancer has spread) along with the cervix, uterus, and vagina (exenteration).
   
• A patient may need skin grafts and plastic surgery to make an artificial vagina after these operations.

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumours. Radiation may come from a machine outside the body (external radiation) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes into the area where the cancer cells are found (internal radiation). Radiation may be used alone or after surgery.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells outside the vagina. In treating vaginal cancer, chemotherapy may also be put directly into the vagina itself, which is called intra-vaginal chemotherapy.

Stage 0 Vaginal Cancer

Treatment may be one of the following:

1. Surgery to remove all or part of the vagina (vaginectomy). This may be followed by skin grafting to repair damage done to the vagina.
2. Internal radiation therapy.
3. Laser surgery.
4. Intravaginal chemotherapy

Stage I Vaginal Cancer

Treatment of stage I cancer of the vagina depends on whether a patient has squamous cell cancer or adenocarcinoma.

If squamous cancer is found, treatment may be one of the following:

1. Internal radiation therapy with or without external beam radiation therapy.
2. Wide local excision. This may be followed by the rebuilding of the vagina. Radiation therapy following surgery may also be performed in some cases.
3. Surgery to remove the vagina with or without lymph nodes in the pelvic area (vaginectomy and lymph node dissection).

If adenocarcinoma is found, treatment may be one of the following:

1. Surgery to remove the vagina (vaginectomy) and the uterus, ovaries, and fallopian tubes (hysterectomy). The lymph nodes in the pelvis are also removed (lymph node dissection). This may be followed by the rebuilding of the vagina. Radiation therapy following surgery may also be performed in some cases.
2. Internal radiation therapy with or without external beam radiation therapy.
3. In selected patients, wide local excision and removal of some of the lymph nodes in the pelvis followed by internal radiation

Stage II Vaginal Cancer

Treatment of stage II cancer of the vagina is the same whether a patient has squamous cell cancer or adenocarcinoma.

Treatment may be one of the following:

1. Combined internal and external radiation therapy.
2. Surgery, which may be followed by radiation therapy.

Stage III Vaginal Cancer

Treatment of stage III cancer of the vagina is the same whether a patient has squamous cell cancer or adenocarcinoma.

Treatment may be one of the following:

1. Combined internal and external radiation therapy.
2. Surgery may sometimes be combined with radiation therapy.

Stage IVA Vaginal Cancer

Treatment of stage IVA cancer of the vagina is the same whether a patient has squamous cell cancer or adenocarcinoma.

Treatment may be one of the following:

1. Combined internal and external radiation therapy.
2. Surgery may sometimes be combined with radiation therapy

Stage IVB Vaginal Cancer

If stage IVB cancer of the vagina is found, treatment may be radiation to relieve symptoms such as pain, nausea, vomiting, or abnormal bowel function. Chemotherapy may also be performed. A patient may also choose to participate in a clinical trial.

Recurrent Vaginal Cancer

If the cancer has come back (recurred) and spread past the female organs, a doctor may take out the cervix, uterus, lower colon, rectum, or bladder (exenteration), depending on where the cancer has spread. The doctor may give the patient radiation therapy or chemotherapy.

A patient may also choose to participate in a clinical trial of chemotherapy or radiation therapy.

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