Vaginal cancer or vaginal carcinoma is a malignant tumor of the female vagina, which, however, occurs quite rarely. Several types are distinguished, with the so-called squamous cell carcinoma being the most common tumor, accounting for more than 90 percent of cases. In the remaining ten percent of cases, either black skin cancer or adenocarcinomas are triggers for vaginal cancer.
What is vaginal cancer?
Doctors also refer to vaginal cancer as vaginal carcinoma – this disease mainly affects women between the ages of 60 and 65. A distinction is made between primary and secondary vaginal cancer, with the latter occurring much more frequently. In this case, the tumors develop from other neighboring organs – very often vaginal cancer is preceded by cervical cancer. In primary vaginal cancer, on the other hand, it develops directly from the cells of the vagina. Vaginal cancer is quite a rare disease – only about one to two percent of all malignant tumors of the female reproductive organs are vaginal cancers.
Causes
The causes of the disease vaginal cancer are diverse and partly also still unexplored – but one of the known main causes is an infection with the so-called human papilloma viruses. These are the trigger for numerous sexually transmitted diseases. Diethylstilbestrol, also known as DES, is considered to be another cause of vaginal cancer. This was administered to women during pregnancy until it was banned in 1971 to prevent miscarriage. Women who have taken this artificial estrogen are much more likely to develop vaginal cancer because the effect of this drug is prolonged. Thus, vaginal cancer can break out even years or even decades after taking the hormone.
Symptoms, complaints and signs
Vaginal cancer initially progresses without clear signs of disease. In the early stages, nonspecific symptoms occur, such as increased vaginal discharge, heavy interstitial bleeding or an unusual feeling of pressure in the vaginal area. These abnormalities may indicate vaginal carcinoma, but they often have harmless causes. An advanced disease eventually causes increasingly heavy bleeding and pain. These occur mainly during sexual intercourse and urination and subside quickly. Larger carcinomas make urination and defecation difficult. Affected women also suffer from severe nerve pain, which can be localized on the back or legs. In parallel, sensory disturbances or paralysis in the limbs often occur. Untreated cancer progresses and eventually spreads to adjacent tissues and surrounding organs. The main organs affected are the cervix, urinary bladder, external vagina and rectum, but also lymph nodes, liver, lungs and bones. Very large carcinomas can cause circulatory problems, urinary retention and other complications. Consequential symptoms of this kind can be avoided by timely therapy. After removal of the carcinoma, the symptoms usually subside quickly as well. Externally, vaginal cancer is usually not recognizable.
Diagnosis and course
Vaginal cancer is usually not clearly recognizable based on individual symptoms. In some women, vaginal cancer can cause bleeding after sexual intercourse or even a discharge, but these symptoms are also conceivable in numerous other diseases. Only in the advanced stage of the disease, vaginal cancer causes abdominal pain or even disorders of the urinary bladder or bowel. Vaginal cancer is therefore usually detected by chance during preventive examinations at the gynecologist. During this examination, the gynecologist takes a tissue sample from the mucous membrane of the female vagina, the so-called cell smear. This is examined in the laboratory – during this examination, vaginal cancer can usually be clearly diagnosed. If vaginal cancer has been detected, it must now be determined how far it has already spread and whether it has metastasized to other organs. Frequently, the cervix, rectum and urinary bladder are affected; rather more rarely, the metastases radiate to the lungs, liver or bones.
Complications
In the worst case, disc cancer spreads to other parts of the body.Tumors can then grow into neighboring organs – i.e., the cervix, vulva, urinary bladder and rectum – or spread via the lymphatic channels. Rarely, metastases settle in the liver, lungs and bones. Extension to the pelvis can cause other organs to be cut off from blood supply. If the ureters are affected, urine may drain poorly or not at all. Urine stasis and severe kidney damage are the result. In general, malignant tumors also result in physical deterioration, which reduces the quality of life and affects the mental state. During surgical removal of tumors, adjacent organs or anatomical structures may be injured. As a result, bleeding and rebleeding may occur. Injuries to the nerves result in loss of function of the urinary bladder, among other things. Due to the bacterial colonization of the vagina, inflammations also occur relatively frequently, which in turn can develop into inflammatory connecting channels (fistulas) between the urethra and the urinary bladder. Loss of function and allergic reactions cannot be ruled out either. Vaginal cancer also tends to recur months or years after treatment is completed.
When should you see a doctor?
Vaginal cancer always needs to be treated by a doctor. In the worst case scenario, this can cause the cancer to spread to other areas of the body and lead to various medical conditions or complications. If the vaginal carcinoma is not treated, the life expectancy of the affected person may also be limited by the disease. A doctor should always be consulted if the affected person suffers from heavy intermittent bleeding. These occur relatively frequently and are usually very heavy. In some cases, there may also be pain during sexual intercourse, and the pain may also occur during urination. Vaginal carcinoma not infrequently also makes itself felt by disturbances in sensation, so that a doctor should be consulted. Frequently, there are also disturbances in blood circulation or even urinary retention. If these symptoms occur, a urologist or gynecologist must be consulted. Further treatment is usually performed surgically in a hospital. Early diagnosis has a positive effect on the further course of the disease.
Treatment and therapy
The success of treatment for vaginal cancer depends primarily on when the disease is detected and when treatment is started. Of course, the sooner treatment begins, the better the chances of complete cure. As a rule, an attempt is made to remove the tumor surgically. If it is still in the early stages, this is usually possible without major problems and the vagina can be preserved. Sometimes, however, complete removal of the vagina or other organs such as parts of the bladder or intestines is necessary. Another possible treatment method for vaginal cancer is radiation or a combination of both. In the case of radiation, doctors distinguish between two treatment methods – radiation from the inside and radiation from the outside. Chemotherapy, however, is rarely used, unlike other types of cancer.
Prevention
Direct prevention of the disease vaginal cancer is hardly possible. However, it is important, especially for women over the age of 50, to regularly perform all necessary preventive examinations at the gynecologist. Just as important as the preventive examinations, however, are the follow-up examinations after the disease has been overcome. In the early days, these are performed every three months, but later a six-monthly or annual rhythm is sufficient. In addition to a cell smear, an ultrasound examination of the vagina is also performed during this follow-up.
Follow-up care
After surgery or radiation treatment, patients should be examined by their gynecologist or in the clinic every three months for the first three years to detect any recurrence of vaginal carcinoma (recurrence) at an early stage. In a detailed consultation, the physician obtains a picture of the patient’s general condition and any complaints. During the subsequent gynecological examination, the vaginal mucosa is inspected with a special microscope and a sample (PAP smear) is taken. This is examined in the laboratory for cell changes that may indicate a recurrence. In addition, the doctor performs a vaginal ultrasound, which helps to assess the vagina, uterus, ovaries and urinary bladder.If the physician detects changes, he or she will order a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan to rule out metastases. Because recurrences of vaginal cancer are relatively common, keeping close follow-up appointments is extremely important. Even between the scheduled examinations, the patient should see a doctor immediately if she notices bleeding, discharge or other changes in the vaginal area. Aftercare also includes psychological support for those affected after cancer treatment. Cancer counseling centers, self-help groups and therapists in private practice can help the patient and her relatives to come to terms with the disease and overcome any problems that arise. In some cases, an inpatient stay at a health resort may be useful.
What you can do yourself
Self-help that enables the disease to be cured is not possible in the case of vaginal carcinoma. Therefore, it must rather be a matter of knowing possible symptoms of disc cancer, for one thing. The earlier it is detected that a carcinoma has formed, the more favorable the prognosis. Regular self-examination in everyday life therefore makes an active contribution to prevention. Even after treatment, all follow-up appointments should be attended regularly. This is the only way to be sure that no metastases have developed. Even if the disease cannot be cured primarily by self-help, affected women can improve their quality of life through their own efforts. In addition to general measures such as relaxation techniques, medication and ointments can also help to reduce physical pain. After the removal of a disc carcinoma, many women suffer from a dry vagina that can itch and burn in everyday life. In this case, moisturizing ointments can often have a very great effect, making the annoying but sometimes very agonizing side effects of the treatment bearable. Moisturizing creams for the vagina are now available over the counter in pharmacies. However, cancer patients should always discuss all ointments and medications used in the vagina with their attending physician.
