Signs & Symptoms
Unfortunately, vaginal cancer in its early stages is asymptomatic. Symptoms occur when the cancer is already advanced. Some of the most common signs of vaginal cancer include:
Unusual bleeding or abnormal vaginal discharge not related to the period.
Difficulties or pain during urination.
Pain during sexual intercourse.
Constipation.
Pain within the pelvic area.
Pain in the back or legs.
Edema (swelling in the legs).
The presence of a lump inside the vagina.
However, these can be symptoms or signs of other medical conditions, and is recommended to consult a specialist when the above signs occur. Only a doctor can establish a cancer diagnosis.
Treatment Options
The treatment plan varies from patient to patient, and depends on a number of factors such as: (1) the patient age and general overall health state, (2) the tumor location and size, (3) and the need to maintain the function of the vagina. The course of treatment is often a group decision between the patient and the specialist team (gynecologic oncologist, surgeon, and radiation oncologist).
SurgerySurgery is one of the most common treatment for patients with vaginal cancer, and is mainly used as a primary treatment. According to the tumor size and cancer stage, there are five type of surgeries performed to treat vaginal cancer:
1. Laser surgery: This is a type of surgery that uses a laser beam (a narrow beam of intense light) to remove the tumor. The laser beam is used as a knife, only that the cut is bloodless or leaves no bleeding. The laser removes the tumor by burning off the tissue. This type of surgery is usually used for patients with early stages of cancer, where the tumor together with additional tissue are removed to reduce the risk of a relapse.
2. Wide local excision: This is a surgical procedure where the cancer is removed together with the tissue around it. In some cases, the patient needs reconstructive surgery to rebuild the vagina. This is done with the help of skin grafts removed from other parts of the body (usually buttock or thigh).
3. Vaginectomy: This is a surgical procedure where parts of the entire vagina are removed in some cases together with the lymph nodes (if they are also affected by the cancer), in a procedure called lymphadenectomy.
4. Radical (total) hysterectomy: This is a surgical procedure where the entire vagina is removed together with the surrounding organs or structures (such as the uterus, ovaries, fallopian tubes, or cervix). There are two type of radical hysterectomy:
Abdominal hysterectomy: During this procedure the vagina and adjacent organs are removed through a large incision in the abdomen.
Laparoscopic hysterectomy: During this procedure the vagina and adjacent organs are removed through small incision with the help of a special instrument called a laparoscope (slender endoscope inserted through an incision in the abdominal wall in order to examine the abdominal organs or to perform surgery).
5. Pelvic exenteration: This is a surgical procedure where the vagina is removed together with the rectum, colon, bladder, and/or part of the bowel (if the cancer invaded this organs or structures). This surgery is followed by a reconstructive operation where artificial openings, called stomas, are created. These stomas allow the stool and urine to collect into a special bag.
The surgery’s most common side effects include:
Intercourse discomfort.
Little or no natural lubrication of the vagina.
Body changes (the urine and stool might be flow out of the body through new ways).
Psychological problems (caused by the new body changes).
Radiation TherapyRadiation therapy or radiotherapy uses high-energy rays or particles (that focuses on a specific area) to destroy cancerous cells. This type of treatment can be administrated as: (1) a primary treatment, in the attempt to avoid the uncomfortable side effects of the surgery, or (2) an adjuvant treatment, in addition to the surgery to lower the risk of a cancer relapse, or in combination with chemotherapy for a better outcome.Vaginal cancer patients receive two types of radiation therapy:
I. External beam radiation therapy: This is the most common procedure to deliver the radiation beam through a device called a linear accelerator. The linear accelerator generates an external beam that is concentrated on the tumor area and breaks it up into smaller pieces. The treatment is administered for about 6 weeks (or more depending on the cancer type and size), 5 days a week. Unfortunately, this treatment does not only destroy the tumor, it also affects the healthy tissue causing a series of side effects, such as:
Skin burning sensations
Fatigue
Nausea
Diarrhea
Irritation of the intestines and rectum
Urethral stricture (the tube that carries out the urine from the bladder narrows)
Intestine perforations
Fistulas (abnormal connections) between the vagina and the bladder, rectum, or uterus.
The four last side effects occur only when the treatment uses high doses of radiation for patients with advanced stages of vaginal cancer.
II. Internal radiation therapy or brachytherapy: This is a type of treatment where the beam is received from inside the body close to the tumor location (inside the vagina). There are two types of brachytherapy used for patient with vaginal cancer:
1. Intracavitary radiation: This treatment uses low doses of radiation therapy, where the radioactive materials are placed within a cylindrical container inserted into the vagina. Usually, this type of treatment is administered for one or two days, and in most cases the patient has to stay in bed to keep the device inside the vagina. The doctor places gauze packing to assure that the radioactive device will not come out.
2. Interstitial radiation: This type of treatment uses needles (with radioactive material) placed directly into the tumor to administer the radiation beam.
In some cases, for a better outcome, the patient receives a combination of the two types of brachytherapy.
The most common side effects caused by the internal radiation therapy include:
Vaginal stenosis (the vagina shrinks or narrows).
Damages to the normal tissue inside the vagina.
Intercourse difficulties or problems.
Irritation of the intestines.
Diarrhea.
ChemotherapyChemotherapy is a type of treatment (affects cells throughout the entire body) that uses drugs either to stop the abnormal growth and dividing process of the cancerous cells, or to kill them. This treatment involves either a single drug, or a combination of several drugs, and it is usually administered in cycles where a treatment period is followed by a recovery period. Chemotherapy can be administrated intravenous in the vain or through a catheter, as pills, or direct into the tumor.
When the treatment is received through pills or intravenously, the chemotherapy is classified as a systemic type of therapy, because the drugs enters the bloodstream and circulates throughout the body to reach and destroy the cancer cells. Unfortunately, chemotherapy as a systemic therapy has not proven to be effective in treating vaginal cancer. However, it is mostly used in women with advanced stages of vaginal cancer.
The main side effects of this approach are:
Lower resistance to infections (caused by a reduced number of white blood cells).
Easy bruising and bleeding (caused by a reduced number of platelets which help the blood to clot).
Anemia (caused by a reduced number of red blood cells).
Nausea and vomiting.
Mouth sores.
Temporary hair loss.
Loss of appetite.
Fatigue.
Some of these side effects can be diminished and controlled with proper medication. The intensity of the side effects depend mainly on the drug dosage and the length of the treatment period.
When the treatment is administrated directly into the tumor, the chemotherapy is called regional chemotherapy. This type of treatment is used in women with early stages of vaginal cancer.
