The vaginal cancer (vaginal carcinoma) is a rare, malignant tumor, which occurs mainly in women of old age. In early stages, a vaginal cancer causes no symptoms, so it is often discovered late. It usually develops from cancer precursors, which can still be treated well. Here you will read, among other things, how to recognize vagina cancer as early as possible and how to treat it.
Sheath cancer: description
The vaginal cancer is a malignant tumor in the female sex organ. The vagina belongs together with the uterus, the fallopian tubes and the ovaries to the inner, the labia, the pubic mound and the clitoris (clitoris) to the external sexual organs of the woman.
A malignant sheath tumor is referred to in the jargon as vaginal carcinoma when the malignant cells emanate from the vagina. The malignant tumor in the area of the external genitalia, such as the labia, on the other hand, is called vulvar carcinoma.
There are several types of vaginal cancer. The differences exist in the type of cell from which the vaginal cancer develops. In more than 95 percent of malignant cancers develops from the uppermost layer of mucus, the squamous epithelium. If the vaginal cancer forms from glandular tissue, it is called an adenocarcinoma. If it originates from the muscle cells, it is a rhabdomyosarcoma. Even a black skin cancer (malignant melanoma) can form in the vagina.
Precursors and stages of vaginal cancer
A possible precursor of vaginal cancer is vaginal intraepithelial neoplasia (VAIN). This is a mucosal lesion (dysplasia) that, if left untreated, can develop into a vaginal cancer. There are three degrees of VAIN degeneration: low, moderate, and severe dysplasia.
If there is already a vaginal carcinoma, the so-called FIGO classification is used to classify the stadiums. It also includes four disease states. It is taken into account in which tissue layers the vaginal tumor grows, whether it has penetrated neighboring organs or has already spread to the lymph nodes or distant organs.
Most of the time a vaginal carcinoma grows in the posterior vaginal wall or in the upper third of the vagina. At an early stage, it can spread to the neighboring organs and spread via the lymph channels into the inguinal and pelvic lymph nodes.
Vaginal carcinoma is a rare cancer. In Germany, only about 0.3 percent of all malignant neoplasms of the female reproductive organs are diagnosed as having vaginal cancer. On average, about one in every 100,000 women suffer from it. Most sufferers are between 62 and 74 years old.
Sheath cancer: symptoms
In most cases, vaginal cancer causes symptoms only in the advanced stage of the disease. The cancer precursors VAIN I, II and III usually cause no symptoms.
The first signs of vaginal cancer are an increased vaginal discharge or unusual bleeding. Such bleeding can be harmless but may also indicate a vaginal carcinoma. They should therefore be clarified by the doctor.
Often, bleeding occurs during or after the sexual act. If the vagina cancer reaches a certain size, urination or defecation can be difficult. Also on the spinal cord the so-called nerve roots, can be compressed, which can cause back pain and emotional disorders or leg pain.
Sheath cancer: causes and risk factors
Why vaginal cancer develops is not fully understood. However, medical professionals now believe that infection with the HPV virus (HPV = Human Papillomavirus) promotes vaginal cancer – especially if a tumor occurs in a younger woman. HP viruses are usually transmitted through sexual intercourse. Women also have a higher risk of having a vagina, whose uterus was removed. With them, precancerous lesions (VAIN) often form on the stump of the vagina.
Vaginal cancer: examinations and diagnosis
Because vaginal cancer causes late symptoms, it is more likely to be discovered by a gynecologist during a routine check-up. Before the examination, this will ask you to ask for new complaints.
He may also ask you the following questions:
- Do you have (still) menstrual bleeding? Do these occur regularly?
- Have your bleeding changed?
- Have you had any recent bleeding or bleeding after intercourse?
- Have you noticed an unfamiliar discharge from the vagina?
- Do you have problems urinating or defecating?
Physical examination includes the rectum and the lymph nodes in the groin in addition to the genital organs. Swelling or tumors, the doctor can already palpate here with his hands. With the so-called colposcope he can look at the vagina to the cervix and with the help of a cotton swab remove a cell sample from the vaginal mucosa. He will then use a cotton swab to brush against the vaginal mucosa for a smear. If a mucosal area is noticeably altered with the naked eye, it will use a small biopsy forceps to take a tissue sample, which must be examined in a tissue-like manner in the laboratory.
With an ultrasound device can also detect changes below the mucous membrane. The ultrasound head can either be inserted directly into the vagina or placed on the lower abdomen from the outside.
If the investigations show that the cancer is vaginal, further staging examinations are necessary. They serve to determine whether and how far the tumor has already spread to surrounding tissue or whether it has spread through the lymphatics. The endoscope is used to examine the urinary tract and rectum. Computer tomography (CT) or magnetic resonance imaging (MRI) and bone scoring are also used in the staging examinations.
Sheath cancer: treatment
How a cancer of the vagina is treated depends on the stage of the disease and the location of the tumor. For some cancer precursors, a regular follow-up is sufficient. If a vaginal carcinoma has already formed, surgery, radiotherapy or chemotherapy are options for treatment.
Prevention of vaginal cancer
Today it is believed that vaginal cancer is favored by an infection with the HP virus. In the adult population, this virus is very common. Against some types of this virus protects the HPV vaccine. Also, condoms (“safe sex”) provide protection.
Treatment of vaginal cancer precursors
Young women with mild or moderate vaginal Intraepithelial Neoplasia (VAIN I or II) should be examined at regular intervals by the gynecologist, who will, among other things, make cell smears. In such cases, it is possible that the changes will regress themselves. If changes in the mucosal cells are still detectable after six months, they should be surgically removed. Alternatively, such an intervention can also take place with the aid of a laser. High grade VAIN stages should be completely removed. It is important that this is done with a sufficient distance to the tumor tissue.
Sheath cancer: surgery
If the cancer of the vagina is in the upper third of the vagina, the surgery usually also removes the uterus and some lymph nodes. If the tumor is located in the lower part of the vagina, usually only the lymph nodes of the groin are removed. A small vaginal carcinoma can be surgically removed without the patients being restricted. In such cases, however, it is often possible to restore the vagina with another operation (plastic-reconstructive surgery).
For larger tumors, the vagina can not be completely preserved. If the tumor has spread to the bladder, intestine or other organs of the pelvis, parts of these organs must also be removed.
Sheath cancer: radiotherapy
Radiation therapy is often used as the only treatment in the case of advanced stage III and IV vaginal cancer. The cancer cells can be irradiated either through the skin from the outside (percutaneous therapy) or from the inside (brachytherapy). In brachytherapy, a small, radiation-active tube is placed in the vagina. It is also possible to introduce small radioactive needles directly into the tumor.
Both types of radiation are repeated at certain intervals and combined with each other. Due to the radiation effect, the vagina can narrow or stick together. Mostly certain ointments or tamponades are used to prevent these consequences. Bleeding or itching can also occur. Irritation of the neighboring organs by radiotherapy are possible.
Sheath cancer: Chemotherapy
In the case of cancer of the vagina, chemotherapy is usually only carried out if the other treatments are inadequate or if the tumor is very advanced. This therapy is usually combined with radiation.
Sheath cancer: disease course and prognosis
If vaginal cancer is not treated, it can spread to surrounding tissue and adjacent organs. Especially the cervix, the outer vagina (vulva), the urinary bladder and the rectum are affected. Via the lymphatic system, tumor cells can also migrate to distant organs, where they form secondary tumors (metastases). Lymph nodes liver, lung or bone may be affected. If a vaginal carcinoma is very large, it can also restrict the ureters and cause a dangerous urinary retention in the kidneys.
In many cases, one-time surgical removal is sufficient to treat a VAIN. For every tenth to twentieth woman, tissue changes are formed again and must be removed. If the vagina has been removed or internal radiation therapy applied, cancer precursors reappear in less than one percent of cases. If, on the other hand, a vaginal carcinoma has already formed, the prognosis is considerably worse. It depends heavily on the stage at which the disease is detected. It is therefore important to have early signs of vaginal cancer to know.