Vagina is one of the sex organs of a woman. Cancer of the vagina is not a very common cancer.
What are the risk factors for vaginal cancers?
• Age: Like other cancers, the risk of cancer of vagina increases with age. It is rare before the age of 60.
• HPV infections: History of human papilloma virus infection increases the risk of cancer of vagina.
What may be the symptoms of cancer of vagina?
There may not be any symptoms in the early stage of cancer. Symptoms may include:
• A lump or swelling in the vagina
• Itching that does not go away
• Bleeding between periods or after menopause
• Bleeding or pain during sexual intercourse
• Unusual vaginal discharge
• Pain or soreness or tenderness in the vagina
If the cancer has spread to pelvis and other surrounding structures, symptoms like constipation, swelling in the legs, pain in the pelvic area, and pain on passing urine may be present.
Diagnosis of cancer of vagina
The diagnosis is based on the history, physical examination and tests.
Physical examination: The doctor will examine the vagina and also will do a pelvic examination. He/she will look for any abnormal areas, lumps or any discharge or bleeding.
The doctor may take a sample of tissue from abnormal areas in the vagina (biopsy). This is usually done under local anaesthesia but sometimes the doctor may want to do under general anaesthesia. The tissues will be sent to laboratory where a pathologist looks for cancer cells. This is the sure way of diagnosing the cancer.
Other scans like Chest X-ray, CT and MRI may also be done.
How is cancer of vagina treated?
In majority of cancer cases, the general practitioner or the family physician coordinates the diagnosis and treatment of vaginal cancers and refers patients to appropriate professionals as required.
Treatment of vaginal cancer depends on the stage of the cancer, how far it has spread, age and general health and fitness of the patient. The main treatment for vaginal cancer is surgery and radiotherapy.
Surgery is the main treatment for vaginal cancer. Depending on the stage of the cancer, different types of operations are done. The goal of surgery both for the patient and the surgeon is to remove all the cancer but at the same time preserve as much as possible the sexual functions of the patient. The surgery may be:
• Local excision where the cancer is removed along with some of the healthy tissues around it.
• The whole or part of the vagina is removed called vaginectomy.
• Hysterectomy where the cervix, uterus, upper part of vagina and the surrounding tissues are removed. The lymph nodes may be removed as well.
If the cancer is in advanced stage and has spread to pelvic areas, the patient may need a bigger operation. The surgeon will remove the cervix, vagina, uterus, ovaries, the nearby lymph nodes, bladder, rectum and colon. If colon and rectum are removed, the patient will need colostomy bag to collect stool and urine bag to collect urine.
If the vagina is removed during the operation, the surgeon may perform a surgical reconstruction of the vagina. This may involve skin grafting as well. The gynaecologic surgeon may refer the patient to a plastic surgeon for reconstruction. It is therefore very important for the patient to discuss in detail with the gynaecologic surgeon regarding any operation on vagina as soon as the diagnosis of cancer is confirmed.
Radiotherapy may be given:
• Before surgery to shrink the cancer
• For cancer that wasn’t completely removed with surgery
• To stop the cancer from coming back after surgery
• When the patient cannot have surgery
• To control symptoms of advanced cancer
What next after cancer treatment?
The patient needs to see the doctors for follow up visits. This will help the doctor monitor the general health of the patient, problems associated with treatment, and to check for the signs of the cancer coming back. Initially the check up may be every 4- 6 weeks, then every 3-6 months and less often after that. If the patient does not have any symptom, she may not have to do any tests.
The prognosis for early stage vaginal cancer is good.
There is no proven strategy to prevent cancers of vagina and no routine screening test for detecting cancer of vagina early.
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