Vaginal Cancer

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Vaginal cancer is a disease in which malignant (cancer) cells form in the vagina. The vagina is the canal leading from the cervix (the opening of uterus) to the outside of the body. At birth, a baby passes out of the body through the vagina (also called the birth canal).
Anatomy of the female reproductive system. The organs in the female reproductive system include the uterus, ovaries, fallopian tubes, cervix, and vagina. The uterus has a muscular outer layer called the myometrium and an inner lining called the endometrium.
Vaginal cancer is not common. When found in early stages, it can often be cured. There are two main types of vaginal cancer:

• Squamous cell carcinoma:
Cancer that forms in squamous cells, the thin, flat cells lining the vagina. Squamous cell vaginal cancer spreads slowly and usually stays near the vagina, but may spread to the lungs and liver. This is the most common type of vaginal cancer. It is found most often in women aged 60 or older.

• Adenocarcinoma:
Cancer that begins in glandular cells. Glandular cells in the lining of the vagina make and release fluids such as mucus. Adenocarcinoma is more likely than squamous cell cancer to spread to the lungs and lymph nodes. It is found most often in women aged 30 or younger.

Symptoms

Early vaginal cancer may not cause any signs and symptoms. As it progresses, vaginal cancer may cause signs and symptoms such as:
• Unusual vaginal bleeding, for example, after intercourse or after menopause
• Watery vaginal discharge
• A lump or mass in your vagina
• Painful urination
• Frequent urination
• Constipation
• Pelvic pain

When to see a doctor

See your doctor if you have any signs and symptoms related to vaginal cancer, such as abnormal vaginal bleeding. Since vaginal cancer doesn't always cause signs and symptoms, follow your doctor's recommendations about when you should have routine pelvic exams.

What screening is

Screening means testing seemingly healthy people, who have no symptoms, for early stage cancer. Before they can screen for any type of cancer, doctors must have an accurate test to use . The test must be reliable in picking up cancers that are there. And it must not give false positive results.



A false positive result means that a test makes it look as though a cancer could be present when it isn't. We usually only screen for illnesses that affect large numbers of people. Or screening may sometimes be used for groups of people who are known to be at high risk of getting a particular disease or condition.

Why we don't screen for vaginal cancer There is no screening programme for vaginal cancer because it is a very rare condition . But when you have a cervical screening test, the doctor or nurse does a routine examination of your vagina at the same time. They can pick up precancerous conditions such as vaginal intraepithelial neoplasia (VAIN) during this examination. If you have treatment for VAIN, this prevents vaginal cancer from developing. Some doctors recommend that you look at the entrance to your own vagina regularly to check for any changes to the skin.

Checks like this may help women to pick up cancer at an early stage. By using a mirror, you can look for areas that are red, irritated, white or darkly coloured. You should be able to see any growths, nodules, bumps or sores (ulcers). If you do notice any changes like this, you need to see your GP. You can read more about the cervical screening test, and about vaginal intraepithelial neoplasia (VAIN) at these links.

Vaginal Cancer Test

Tests that examine the vagina and other organs in the pelvis are used to detect (find) and diagnose vaginal cancer. The following tests and procedures may be used:

• Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.

• Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. The doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. A speculum is also inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test or Pap smear of the cervix is usually done. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.

Pelvic exam
A doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and presses on the lower abdomen with the other hand. This is done to feel the size, shape, and position of the uterus and ovaries. The vagina, cervix, fallopian tubes, and rectum are also checked.

• Pap test: A procedure to collect cells from the surface of the cervix and vagina. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the cervix and vagina. The cells are viewed under a microscope to find out if they are abnormal. This procedure is also called a Pap smear.

Pap test:
A speculum is inserted into the vagina to widen it. Then, a brush is inserted into the vagina to collect cells from the cervix. The cells are checked under a microscope for signs of disease.

• Colposcopy : A procedure in which a colposcope (a lighted, magnifying instrument) is used to check the vagina and cervix for abnormal areas. Tissue samples may be taken using a curette (spoon-shaped instrument) and checked under a microscope for signs of disease.

• Biopsy : The removal of cells or tissues from the vagina and cervix so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a Pap test shows abnormal cells in the vagina, a biopsy may be done during a colposcopy.

What a risk factor is

A risk factor is anything that can increase your chance of developing a disease. Different cancers have different risk factors. There are some factors that may increase your risk of vaginal cancer. Remember that having one or more risk factors does not mean that you will definitely get vaginal cancer. Many people with one or more risk factors never get it. And sometimes people with none of these risk factors develop vaginal cancer. Risk factors are only a guide to what may increase risk.

How common vaginal cancer is
We don’t know the exact causes of vaginal cancer. It is a rare cancer with just under 260 new cases diagnosed in the UK each year. Only around 1 in 100 cancers of the female sex organs (1%) are vaginal cancers. Cancer starting in another place in the body such as cancer of the cervix, womb cancer or bowel cancer can spread to the vagina. This is not the same as cancer starting in the vagina. Cancer starting in the vagina is known as primary vaginal cancer. Cancer that has spread from another place in the body is called secondary cancer.

Because vaginal cancer is such a rare type of cancer, it is very difficult to carry out research involving large enough numbers of women to give any reliable results. But researchers have managed to identify several risk factors.

Age
As women get older their risk of vaginal cancer increases. But because vaginal cancer is very rare, the increased risk is still very small. Cancer of the vagina is more common in older women. Almost 40 out of every 100 cases (40%) occur in women aged 75 and over. It is a very rare type of cancer in women younger than 40.

Changes in the cells lining the vagina
A condition called VAIN can mean you are more at risk of getting vaginal cancer. VAIN stands for vaginal intraepithelial neoplasia. It means there are changes to the cells in the inner lining of the vagina. These changes are not enough to make the cells cancerous. But they could become cancerous if not treated. There is information about vaginal intraepithelial neoplasia (VAIN) in this section.



Human papilloma virus infection
Human papilloma virus (HPV) is a common infection and is passed from one person to another by sexual contact. Around 80 out of 100 people (80%) in the UK are infected with the HPV virus at some time during their lifetime. For most people the virus causes no harm and goes away without treatment. It is only when the infection won't clear up that sometimes there is a problem. But most women infected with HPV don’t go on to develop vaginal cancer.

HPV is present in almost three quarters of women who have vaginal cancer (75%) and more than 90 out of 100 women who have precancerous changes in the vagina (VAIN) (90%). There are many different types of human papilloma virus (HPV).

HPV types 6 and 11 can infect the female and male genital organs and the anal area, causing visible genital warts. Women who have ever had genital warts have an increased risk of developing precancerous cell changes (VAIN) and some may develop vaginal cancer.

Women with HPV types 16, 18 and 31, as well as some others have a higher risk of developing genital and anal cancers. But the type of HPV most strongly linked to vaginal cancer is HPV 16. This type of HPV can cause changes in the cells covering the vagina. The changes make the cells more likely to become cancerous in time. But this can take years. Most women infected with this virus do not develop cancer of the vagina. So other factors must also be needed.

Although not designed to do so, having regular cervical screening tests may help to pick up vaginal cancer in its very early stages or in its precancerous stage (VAIN).

Also, girls who have the HPV vaccine before they are exposed to the HPV virus have a lower risk of developing VAIN. But the risk of high-grade VAIN is not reduced in girls who receive the HPV vaccine after they have been exposed to HPV.

CIN or cancer of the cervix
If you have had cervical cancer or precancerous changes in your cervical cells, you have an increased risk of developing vaginal cancer. Precancerous cervical cell changes are also called cervical dysplasia or CIN (which stands for cervical intraepithelial neoplasia).

HIV infection
Women with HIV or AIDS may have an increased risk of vaginal cancers, as well as other cancers in the genital or anal area. This may be because HIV and AIDS lower immunity so that the body is less able to overcome HPV infection. / But most women who have vaginal cancer do not have HIV or AIDS.

Weakened immune system
Systemic lupus erythematosus is a long term (chronic) illness which affects the immune system. In people with lupus the immune system starts to attack healthy cells, tissues and organs.

Women with systemic lupus erythematosus have an increased risk of vaginal cancer. This may be due to them being more at risk of HPV as their immune systems are not functioning properly. They may also be on immunosuppressant medication (drugs to dampen down the body's immune system).

A drug called diethylstilbestrol
Diethylstilbestrol is also called DES. It is a drug that doctors sometimes gave to pregnant women in the past, to stop them having a miscarriage. DES was only used between 1945 and 1970 and researchers are still gathering information about its effects. The daughters of women who took DES during their pregnancy (particularly during the first trimester) are more at risk of getting a type of vaginal cancer called clear cell adenocarcinoma.

It seems daughters of women who took DES are most likely to develop vaginal cancer in their late teens or twenties, but cases have also been reported in women in their early 40's.

Clear cell adenocarcinoma is a very rare type of cancer and only about 2 in 1,000 women with a mother who took DES will go on to develop vaginal or cervical cancer. DES hasn't been used for over 35 years now, so it is becoming less common as a risk factor.

Womb cancer treatment
A large American study has shown that women who have had womb cancer have a risk of vaginal cancer that is 3 times higher than women in the general population. In women who have had radiotherapy for their womb cancer the risk is higher compared to women who did not have radiotherapy.

Smoking
There may be a link between cancer of the vagina and smoking. But there have only been a small number of studies looking into this so there is not enough evidence to support this link yet.




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