 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
|
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 several types of vaginal cancer: About 85%-90% of vaginal cancers are squamous cell carcinomas that begin in the epithelial lining of the vagina. They tend to occur in the upper area of the vagina near the cervix. Verrucous carcinoma is a rare type of squamous cell carcinoma that tends to grow slowly. It grows mostly toward the inside of the vagina, and often appears as warty or cauliflower-like lumps. Compared with other squamous cell carcinomas, it is much less likely to invade deeply through the vaginal wall or metastasize (spread) to other organs and has a relatively good prognosis (outlook for cure). Vaginal squamous cell carcinomas do not appear suddenly, they develop over a period of many years from precancerous changes called vaginal intraepithelial neoplasia (often abbreviated as VAIN). About 5% to 10% of vaginal cancers are adenocarcinomas. The usual type of vaginal adenocarcinoma typically develops in women older than 50. One special type, called clear cell adenocarcinoma, occurs more often in young women who were exposed to diethylstilbestrol (DES) in utero (when they were in their mother’s womb). In the past some pregnant women were given DES to prevent miscarriage. The drug became available during the late 1940s and was banned in the USA in 1971. Malignant melanoma is a cancer that develops from pigment-producing cells called melanocytes. These cancers usually are found on sun-exposed areas of the skin but occasionally form on the vagina or other internal organs. They account for about 2% to 3% of all vaginal cancers. Melanoma tends to affect the lower or outer portion of the vagina. The tumors show considerable variation in size, color and growth pattern. About 2% to 3% of vaginal cancers are sarcomas. These cancers form deep in the wall of the vagina, not on its surface epithelium. There are several types of vaginal sarcomas. The most common, leiomyosarcoma, typically affects women older than 50. Leiomyosarcomas resemble the involuntary muscle cells of the vaginal wall. Rhabdomyosarcoma is a childhood cancer, usually found before the age of 3. Its cells resemble voluntary muscle cells - a tissue not normally found in the vaginal wall.
The median age at diagnosis is 60 years old. Vaginal intraepithelial neoplasia (VIN) is a precancerous condition and a possible precursor to vaginal cancer. The human papilloma virus (HPV) has been found to play a role in the pathogenesis of vaginal cancer in some patients. As many as 30% of patients with primary vaginal cancer have a previous history of preinvasive or invasive cervical cancer. 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 for getting tumors 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, and pain during intercourse or in the pelvic area. Some patients will have vaginal cancer diagnosed as the result of an abnormal Pap smear. 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.
Treatments are available for all patients with cancer of the vagina. There are three kinds of treatment:
Surgery may be appropriate for early stage disease. A doctor may take out the cancer using one of the following: treatment decisions depend on the size and location of the malignancy, maintenance or creation of a functioning vagina and preservation of ovarian function in premenopausal women are important factors to consider during treatment planning.
Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. 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. Radiation therapy often combined with chemotherapy is the initial therapy of choice for most patients with vaginal carcinoma. Brachytherapy (internal radiation) may be used alone for small lesions and is combined with teletherapy (external beam radiation therapy) to control or cure larger lesions. 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 intravaginal chemotherapy. Treatment by stage Treatment of cancer of the vagina depends on the stage of the disease, the type of disease, and the patient's age and overall condition. Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in most parts of the country for most stages of cancer of the vagina. 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. Loss of vaginal function is the most frequent adverse sequela of therapy for vaginal cancer. Although rare, rectovaginal and vesicovaginal fistulas are the most frequently reported serious complication of therapy for this disease. Sexual dysfunction is common. The risk of vaginal stenosis (narrowing) may be decreased by proper use of a vaginal dilator. All women should have intensive pre and postoperative therapy counseling to assist them in dealing with the potential lifelong consequences of therapy. Gynecologic oncologists are specifically trained to care for women with this disease. Gynecologic oncologists work closely with radiation therapists during the treatment of this disease.
|
