Vaginal Cancer Symptoms

Vaginal cancer is a rare type of cancer that forms in the vaginal tissue of women. In the early stages, vaginal cancer does not usually cause any noticeable symptoms. As the disease progresses, vaginal cancer symptoms begin to appear. These symptoms are not exclusive to vaginal cancer; in fact, they are also symptoms of other, less serious conditions.

Vaginal Cancer Symptoms

Vaginal cancer is a gynecologic cancer that affects about 2000 women in the United States each year. Its rarity and the vagueness of its symptoms can make it difficult to diagnose. Diagnosis delays are not uncommon in some women with vaginal cancer. A small number of women do not experience any symptoms prior to diagnosis; a routine Pap smear leads to the detection.

Vaginal cancer symptoms include:

Abnormal Vaginal Bleeding: In reference to vaginal cancer, abnormal vaginal bleeding presents itself after sexual intercourse and/or in women who have completed menopause. It is the most common symptom of vaginal cancer and is often one of the first symptoms experienced. Postmenopausal and post-coital bleeding are vague symptoms that are also commonly present in many other gynecologic diseases and conditions.

Vaginal Discharge: Although vaginal discharge is common in many women and often not a concern, abnormal or unusual vaginal discharge -- with or without a blood-tinge or odor -- can be symptoms of vaginal cancer. This is incredibly rare, and much more likely to be due to something much less worrisome, but it should be evaluated by your doctor.

Changes in Urination: If you find that you may be urinating more frequently, it is important to determine the cause of it. This may be related to an increase in fluid intake, the consumption of caffeinated beverages, or presence of a urinary tract infection, but this can also be caused by more serious conditions. Changes in urination can also include pain during urination and blood in the urine. Though the presence of blood may not always be able to be detected by the naked eye, some women may notice pink tinges/streaks in their panties or when wiping with toilet tissue.

Pelvic Pain: Pelvic pain generally occurs when vaginal cancer has begun to spread. Pelvic pain can be described as pain or pressure felt anywhere in the abdomen below the navel. It may be intermittent or constant. Many women describe pelvic pain as a dull ache that may include sharp pains.

Vaginal Mass: A vaginal mass that can be felt either by you or your physician can be a symptom of vaginal cancer. There can be several causes of vaginal masses, including vaginal cysts. A biopsy may be necessary to determine if the mass is cancerous or not.

Changes in Bowel Movements: Changes in bowel function can indicate many conditions, including vaginal cancer. As vaginal cancer progresses, women may experience chronic constipation, black/tarry stools, and a feeling as if the bowels have not been completely emptied after having a bowel movement.

Screening healthy women for vaginal cancer
Vaginal cancer is sometimes found during a routine pelvic exam before signs and symptoms become evident. During a pelvic exam, your doctor carefully inspects the outer exposed part of your vagina, and then inserts two fingers of one hand into your vagina and simultaneously presses the other hand on your abdomen to feel your uterus and ovaries. He or she also inserts a device called a speculum into your vagina. The speculum widens your vagina so that your doctor can check your vagina and cervix for abnormalities.

Your doctor may also do a Pap test. Pap tests are usually used to screen for cervical cancer, but sometimes vaginal cancer cells can be detected on a Pap test. Pap tests and pelvic exams are generally recommended every two to three years. How often you undergo these screenings depends on your risk factors for cancer and whether you've had abnormal Pap tests in the past. Talk to your doctor about how often you should have these health screenings.

Tests to diagnose vaginal cancer
Your doctor may conduct a pelvic exam and Pap test to check for abnormalities that may indicate vaginal cancer. Based on those findings, your doctor may conduct other procedures to determine whether you have vaginal cancer, such as:

Inspecting the vagina with a microscope. Colposcopy is an examination of your vagina with a special lighted microscope called a colposcope. Colposcopy allows your doctor to magnify the surface of your vagina to see any areas of abnormal cells.
Removing a sample of vaginal tissue for testing. Biopsy is a procedure to remove a sample of suspicious tissue to test for cancer cells. Your doctor may take a biopsy of tissue during a colposcopy exam. Your doctor sends the tissue sample to a laboratory for testing.

Staging
Once your doctor diagnoses vaginal cancer, steps will be taken to determine the extent of the cancer — a process called staging. The stage of your cancer helps your doctor decide what treatments are appropriate for you. In order to determine the stage of your cancer, your doctor may use:

Imaging tests. Your doctor may order imaging tests to determine whether cancer has spread. Imaging tests may include X-rays, computerized tomography (CT) scans, magnetic resonance imaging (MRI) or positron emission tomography (PET).
Tiny cameras to see inside your body. Procedures that use tiny cameras to see inside your body may help your doctor determine if cancer has spread to certain areas. Cameras help your doctor see inside your bladder (cystoscopy) and your rectum (proctoscopy).

Once your doctor determines the extent of your cancer, it is assigned a stage. The stages of vaginal cancer are:

Stage I. Cancer is limited to the vaginal wall.
Stage II. Cancer has spread to tissue next to your vagina.
Stage III. Cancer has spread to nearby lymph nodes or into the pelvis or both.
Stage IVA. Cancer has spread to nearby lymph nodes and has also spread to your bladder, rectum or pelvis.
Stage IVB. Cancer has spread to areas away from your vagina, such as your lungs.

Treatment options by stage and type of vaginal cancer

The type of treatment your cancer care team will recommend depends on the type of vaginal cancer you have and how far the cancer has spread. This section summarizes the choices available according to the stage of your cancer.

Vaginal intraepithelial neoplasia (VAIN)

Many cases of low-grade VAIN (VAIN 1) will go away on their own, so some doctors will choose to watch them closely without starting treatment. This means getting repeat Pap tests -- often with colposcopy if needed. If the area of VAIN doesn't go away or gets worse, treatment is started. VAIN 2 is not likely to go away on its own, so treatment is usually started right away.

VAIN is treated using topical therapy (like 5-FU or imiquimod) or laser treatment. Less often, surgery is used to remove the lesion. Surgery may be chosen if other treatments fail or if the doctor wants to be sure that the area isn't invasive cancer. Surgery may involve a wide local excision, removing the abnormal area and a rim of surrounding normal tissue. A partial vaginectomy (removal of part of the vagina) is rarely needed to treat VAIN.

Stage 0 (VAIN 3 or CIS)

The usual treatment options are laser vaporization, removing the affected areas with surgery, and intracavitary radiation.

Topical chemotherapy with 5-FU cream is also an option, but this requires treatment at least weekly for 10 weeks. This treatment can severely irritate the vagina and vulva. Topical immunotherapy with imiquimod may also be used.

If the cancer comes back again after these treatments, surgery (partial vaginectomy) may be needed. The surgeon would remove the entire tumor and enough surrounding normal tissue to ensure that it doesn't come back.

Stage I

Squamous cell cancers: Radiation therapy is used for most stage I vaginal cancers. If the cancer is less than 5 mm thick (about 3/16 inch), intracavitary radiation is used. Interstitial radiation is an option for some tumors, but it is not often used. Intracavitary radiation may be combined with external beam radiation for larger tumors.

Removing part or the entire vagina is an option for some cancers (partial or radical vaginectomy). Reconstructive surgery to create a new vagina after treatment of the cancer is an option if a large portion of the vagina has been removed.

If the cancer is in the upper vagina, it may be treated by a radical hysterectomy, bilateral radical pelvic lymph node removal, and radical or partial vaginectomy.

Following a radical partial or complete vaginectomy, postoperative radiation (external beam) may be used to treat tiny deposits of cancer cells that have spread to lymph nodes in the pelvis.

Adenocarcinomas: For cancers in the upper part of the vagina, the treatment is surgery: a radical hysterectomy, partial or radical vaginectomy, and removal of pelvic lymph nodes. This can be followed by reconstructive surgery if needed or desired. Radiation therapy may be given as well.

For cancers lower down in the vagina, one choice is to give both either interstitial or intracavitary radiation therapy and external radiation beam therapy. The lymph nodes in the groin and/or pelvis are treated with external beam radiation therapy.

Stage II

The usual treatment is radiation, using a combination of brachytherapy and external beam radiation.

Radical surgery (radical vaginectomy or pelvic exenteration) is an option for some patients with stage II vaginal squamous cell cancer if it is small and in the upper vagina. It is also used to treat women who have already had radiation therapy for cervical cancer and who would not be able to tolerate additional radiation without severe damage to normal tissues.

Chemotherapy with radiation may also be used to treat stage II disease.

Giving chemotherapy to shrink the cancer before radical surgery has shown promising results.

Stage III or IVA

The usual treatment is radiation therapy, often with both brachytherapy and external beam radiation. Curative surgery is generally not attempted. Chemotherapy may be combined with radiation to help it work better.

Stage IVB

Since the cancer has spread to distant sites, it cannot be cured. Patients often receive radiation therapy to the vagina and pelvis to improve symptoms and reduce bleeding. . Chemotherapy may also be given, but it has not been shown to help patients live longer. Because there is no accepted treatment for this stage, often the best option is to enroll in a clinical trial.

Recurrent squamous cell cancer or adenocarcinoma of the vagina

If a cancer comes back after treatment it is called recurrent. If the cancer comes back in the same area as it was in the first place, it is called a local recurrence. If it comes back in another area (like the liver or lungs), it is called a distant recurrence.

A local recurrence of a stage I or stage II vaginal cancer may be treated with radical surgery (such as pelvic exenteration). If the cancer was originally treated with surgery, radiation therapy is an option. Surgery is the usual choice when the cancer has come back after radiation therapy.

Higher-stage cancers are difficult to treat when they recur. They usually cannot be cured by currently available treatments. Care focuses mostly on relieving symptoms, although participation in a clinical trial of new treatments may be helpful.

For a distant recurrence, the goal of treatment is to help the woman feel better. Surgery, radiation, or chemotherapy may be used. Again, a clinical trial is a good option.

Melanoma

Surgery is the main treatment for vaginal melanoma. Because vaginal melanoma is very rare, it hasn't been well studied. Doctors are still not certain about how much tissue needs to be removed to give the best chance of cure. One choice is to remove the cancer and a margin of the normal tissue around it. This is how a melanoma on the skin of an arm or leg would be treated. Another option is to remove the entire vagina and some tissue from nearby organs. Some (or all) of the lymph nodes that drain the area of the tumor are also removed and checked for cancer spread.

There are a few drugs that can be helpful in treating metastatic melanoma, but this disease rarely responds well to chemotherapy. Radiation therapy may also be used for melanoma that has spread. It is most often used for spread to the brain or spinal cord. A good option for women with metastatic vaginal melanoma is to receive treatment as a part of a clinical trial. For more information on melanoma, see our document called Melanoma Skin Cancer, which discusses the biology and treatment of melanoma and the role of lymph node surgery and treatment of advanced disease.

Source : http://www.cancer.org, http://cancer.about.com

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