Vaginal cancer, or vaginal carcinoma, is one of the less common gynecological cancers. Secondary vaginal cancer (cancer that has spread from a different gynecological organ to the vagina) is more common than primary vaginal cancer (cancer that is first formed in the vagina). The symptoms of vaginal carcinoma often overlap with those of non-malignant gynecological conditions, and this makes early diagnosis challenging.
For early diagnosis, it is important for women to not ignore persistent gynecological symptoms and seek medical attention whenever necessary.
The vagina is a part of the female reproductive system. It is a muscular canal that connects the cervix and uterus with the vulva. Several types of cells are present in the vagina. These include parabasal cells, basal cells, intermediate cells, glandular cells, and superficial squamous flat cells. When one or more types of vaginal cells divide uncontrollably and form a tumor, it is referred to as vaginal cancer. Generally, vaginal carcinoma develops on the superficial vaginal lining. Women over 60 years of age or who are suffering from a human papillomavirus infection have a higher risk of developing this cancer.
Most cases of vaginal carcinoma are due to metastasis, i.e., cancer from another part of the body, especially from the reproductive organs, that spreads to the vagina. Primary vaginal cancer is rare. Vaginal carcinoma accounts for only 1% to 2% of all genital cancers found in women. The incidence rate of vaginal carcinoma in India is estimated to be 0.83/million population, while the mortality rate is estimated to be about 0.41/million population.
There are multiple vaginal cancer types depending on the type of cell and location from which they arise. The following are the different vaginal carcinoma types:
The following are more common vaginal cancer types are:
It is the most common vaginal cancer type, and 90% of the patients with primary vaginal carcinoma have squamous cell carcinoma. It begins in the flat, thin cells (the squamous cells) that are present in the lining of the vagina. Vaginal squamous cell carcinoma progresses slowly and is generally limited to the areas surrounding the vagina. However, in some cases, it may also spread to other organs, e.g., bones or lungs.
Glandular cells are present in the vagina that secrete mucus and lubricate the vagina. Adenocarcinoma of the vagina starts in these glandular cells. Vaginal adenocarcinoma is relatively more aggressive than squamous cell carcinoma and has a higher risk of spreading to lymph nodes and the lungs. It accounts for about 5–10% of vaginal cancers.
It is one of the vaginal cancer types, and it is often associated with prenatal exposure to diethylstilbestrol. However, certain studies have reported non-diethylstilbestrol clear cell carcinoma of the vagina as well. The most common site for occurrence is the anterior vaginal wall, although it may occur at any location in the vagina. Endometriosis of the peri-vaginal area and vagina may be considered a precursor for clear cell carcinoma in non-DES-exposed women.
Vaginal sarcoma occurs in the connective tissues and the muscles present in the vaginal wall. The most common vaginal sarcoma is rhabdomyosarcoma, which commonly occurs in children. Leiomyosarcoma generally occurs in women over the age of 50. In most cases, vaginal sarcoma is diagnosed in its advanced stages.
Melanoma of the vagina occurs in the melanocytes that give color to the skin. Patients with vaginal melanoma usually have a relatively poor prognosis. Symptoms of vaginal melanoma include abnormal vaginal bleeding, the presence of a palpable vaginal mass, and vaginal discharge. The average age for the diagnosis of vaginal melanoma is 55 years or older.
Some of the rare vaginal cancer types are:
It is extremely rare and has no established treatment. The treatment is often similar to small cell carcinoma of the lungs. It is a highly aggressive condition that has the potential to spread rapidly to other organs. Studies have reported that the survival rate for patients with small cell carcinoma is two years when the condition is treated in the early stages.
Undifferentiated carcinoma is usually diagnosed through biopsy. Undifferentiated carcinoma mostly comprises epithelial cells with scarce cytoplasm. Specific cellular differentiation is absent in the tumor cells. These tumors are rare but highly aggressive.
Vaginal cancer staging includes:
It refers to the earliest stage of vaginal carcinoma. It is also known as vaginal intraepithelial neoplasia, carcinoma-in-situ, or pre-cancer stage. In this stage, the cancerous lesions are present on the lining of the vagina and have not grown into the deeper vaginal tissues. Patients at this stage usually do not experience any symptoms.
In vaginal cancer stage 1, the tumor may spread to the deeper tissues of the vagina but has not spread outside the vagina.
In stage 2 vaginal cancer, the cancer spreads to the tissues surrounding the vagina but has not spread to the pelvic walls.
Stage 3 vaginal cancer is characterized by the spread of vaginal carcinoma to the nearby lymph nodes and/or walls of the pelvis.
Stage 4 vaginal cancer is divided into stages 4A and 4B.
In stage 4A, the disease has spread to one or more locations among the bladder lining, rectal lining, and beyond the pelvic area, comprising the uterus, ovaries, bladder, and cervix.
In stage 4B, the disease has spread to distant organs, such as bones or lungs.
Vaginal carcinoma is a cancer that occurs in the vagina. Primary vaginal carcinoma is rare, and most vaginal carcinomas are due to metastasis (spread from other organs). Vaginal cancer types include squamous cell carcinoma, adenocarcinoma, sarcoma, vaginal melanoma, vaginal small cell carcinoma, and undifferentiated carcinoma. Stages of vaginal cancer range from 0 to 4. Stage 0 is considered precancerous, while stage 4 is the most advanced stage of vaginal carcinoma.