VAGINAL CANCER

What is the Vagina?

It is the female organ used for the discharge of menstrual flow, for copulation, and the
passageway through which babies are born. The vagina is the passageway leading to the
cervix. The vagina connects the cervix (the opening of the womb or uterus) and the vulva (the
folds of skin around the opening to the vagina). It is a muscular canal lined with mucous
membranes that extend from the outside of the body between the vulva and the anus to the
cervix of the uterus. In a woman's pelvis, the vagina and it's opening to the cervix is
sandwiched between the bladder in front and the rectum in back. The inner lining of the vagina
is made up of "squamous" cell, the same type of cell which is found in the mouth. This type of
cell is excellent at resisting abrasion, and healing quickly after an injury. This is in contrast with
the type of cells which are in the inner cervix and uterus, called "columnar" cells, which fold
into glands and produce mucous. In the vagina, the squamous lining cells do not produce any
mucous, but a moistening fluid does transverse to the surface of the vagina from glands deep
within it, located near the muscle layer of the vagina. This is important because squamous
cells give rise to different cancers than the glandular cells, and the cancers found in the vagina
are very similar to their counterparts in the mouth and anus. The vagina proper does not
include the clitoris, exit of the urination tube ("urethra") or the "vaginal lips" - these are
classified as part of the vulva and cancers in these areas are a different topic. The vagina has
a rich blood supply, becoming engorged with sexual stimulation. This blood supply can carry
cancer cells to other areas of the body. The vagina also has an elaborate system of bean-
sized filters to purify blood that runs through it, called "lymph glands." These lymph glands are
connected by lymph channels, which is another way that cancer or infections may spread
outward from the vagina. As a women ages, the lack of estrogen results in "dystrophic"
changes in the vagina, with subsequent drying out and inelasticity, this can in part be
prevented by estrogen pills or creams.

What is cancer of the Vagina?

Normally, vaginal cells grow quickly when girls are in the womb and again at puberty, but after
full adult growth they divide rarely. In the adult, vaginal cells (and most others) only divide to
replace those lost to injury or old age. The control of cells division is under tight regulation by
the genes - the genetic material within each cell. Amazingly, each cell in the body contains
within it's genes the total information necessary to make a whole new human body.
Sometimes an abnormal cell may arise which divides out of control. This will then form
a tumor . A tumor is simply a swelling, and does not necessarily mean cancer (obviously most
swellings are not cancerous). If a tumor only grows in it's local area, it is called "benign" and
is not cancer. If, however, it has the capability to spread to other areas of the body , then it is
called "malignant" and is cancer. Vaginal cancer starts in just one single cell, but this quickly
divides to form many similar cancer cells, which continue to divide. Eventually, if not cured,
these cells push the normal cells out of the way, grow a large tumor within the pelvis, spread
via the lymph channels to local lymph nodes, and then spread to other body areas. This
spread ultimately kills the patient though anemia, infection, general weakness, malnutrition
and debility.

What are the types of Vaginal Cancer?

The most common type of cancer in the vagina arises from the lining squamous cells, and is
thus called "squamous cell carcinoma" . These squamous cells often divide to heal injury,
and the more frequent their division, the greater the chance for a cancerous one to arise.
Squamous cell carcinoma accounts for for 85% of vaginal cancer cases in the UU.S.A. The
next most common type arises from glands, it is called "adenocarcinoma" and accounts for
10% of vaginal cancer in the U.S.A. The remaining 5% of cancers are a mixture of
vaginal melanomas(from pigment cells), sarcomas (from fat or muscle cells)
and lymphomas (from immune cells). The treatment for these rare cancers follows their
treatment in other body areas where they are more common. Squamous carcinoma is usually
found in women between the ages of 60 and 80. Adenocarcinoma is more often found in
women between the ages of 12 and 30, especially the "clear cell" type which is associate with
the patient's mother having used a drug called "Diethyl Stilbesterol" (DES) during pregnancy.

How common is Vagina Cancer?

There are about 2000 new cases of vagina cancer every year in the U.S.A. It accounts for
about 2% of the total cancers in the U.S.A. each year. Considered altogether, the average
patient is 70 years old.

What are the symptoms of Vaginal Cancer?

Early disease produces no symptoms, a tumor must grow to 1 billion cells (about 9
complete doublings) just to be 1/2" across. The first symptoms seen in commonly
painlessvaginal bleeding (80%) followed byvaginal discharge (50%) which may be foul
smelling.Itching ("pruritis") is also common (30%). The disease is often initially misdiagnosed
as an infection, and patients placed on antibiotics. If vaginal bleeding is seen in a woman after
her menopause, there is about a 30% chance of some cancer, with 98% of these cancers
being cervical or uterine. Only 2% of these cancers start in the vagina. A cancer from the
cervix can migrate down into the vagina as it grows; this should not be confused with "primary
vaginal cancer." As a vaginal cancer grows, it starts to press upon or invade nearby pelvic
organs - the bladder and rectum. This can cause blood in the urine or stool, or obstruction of
these systems. Lymph glands in the groin may swell up ("inguinal lymphadenopathy"), and
back pain may occur from spread to lymph nodes around the great aortic artery. Severe pain
in the pelvis usually means advanced disease, and that the cancer has invaded into nerves.
Distant spread may be noted by symptoms in the lungs, liver, bone or brain, and usually only
occurs once the local cancer has grown very large.

What causes Vagina Cancer?

Like any other cancer, the precise reason why one woman gets vagina cancer and another
does not is unknown. There are however "risk factors" that seem to predispose a woman to
the disease. There are different risk factors for different types of vaginal cancer. Many
pregnant women between 1945 and 1970 were given a drug called "diethylstilbestrol
" or DES . Young women whose mothers took DES are at risk for getting tumors in their
vaginas, at an average age of 20 years old. Some get a rare form of cancer called "clear cell
adenocarcinoma." The risk of an exposed fetus to develop clear cell carcinoma of the vagina
later in life is 1:1000. This type of cancer more commonly starts in the cervix than vagina. DES
may be a factor for the young.
For the more common patient with squamous cell cancer, risk factors include:
1. Being Female is obviously the biggest risk factor for vaginal cancer.
2. Lots of Male Sexual Partners and having children by different men, and
starting to have sex at a young age dramatically increases risk. In contrast,
vaginal cancer is extremely rare in women who never were pregnant
("nulliparous") and nuns. One-quarter of the American adult female population
have never had children.
3. Uncircumcised Sexual Partners - vaginal cancer is very rare in the wives of
circumcised Jewish men, as is cervical cancer.
4. Sexually Transmitted Viruses like the "Human Papilloma Virus" (HPV),
especially types 16, 18, and 33. These are found in about 50% of patients. They
cause genital warts and predispose to various cancers.
5. Low Social and Financial Status may reflect more sexual promiscuity
or inability to get proper screening and treatment for the disease.
6. Immune Deficiency Diseases like AIDS. In fact, the development of vaginal
cancer in a HIV positive patient is sufficient to reclassify them as full-blown AIDS.
Furthermore, getting immune-system suppressing drugs (to avoid rejecting a
newly transplanted organ) also increases the risk, especially in patients with
HPV.
7. Having had a hysterectomy could mean that you still have a chance of
developing vaginal cancer, or cancer of the remaining "cervical cuff"
****Alcohol and tobacco use is not linked to getting vaginal cancer!

What about Screening for Vaginal Cancer?

The Papaniculaou ("Pap") smear, done since 1940, is of proven value in the early detection
of vaginal cancer. It is also useful after treatment to help monitor the success of therapy. A
pap smear is done at the time of a pelvic examination, it involves taking a brush and a small
"spatula" (Ayer's) to get some cells from the "squamocolumnar junction" of the cervix and the
vagina, and also any abnormal areas. The scraping often causes slight bleeding. Too much
blood in the specimen can distort the Pap smear, so it is not advised during a menstrual
period. The American Cancer Society recommends a cancer "checkup" every three years for
women over age 20, or starting younger if she is sexually active. This includes a pelvic exam
with a Pap test every 3 years (after 2 initial "negative" tests one year apart). Those at higher
risk should get more frequent (i.e. annual) screening. The cells collected from the Pap test are
examined by a Pathologist (and often also checked by a computerized reading machine) to
look for abnormal changes. If cells are found that are not normal you will need to have a
sample taken called abiopsy. The Pathologist will look not only at cells of the vagina, but also
at the other cells taken from a scraping inside the cervix. If cancer is detected, he will state the
specific type.
The vagina is an amazing stretchable tube which functions to receive sperm and transmit it up
into the womb, helps in protecting a developing baby, and acts as the birth canal for delivery.
Common vaginal problems include irritation, mild infections and sexually transmitted diseases.
Rarely, cancer can develop in the vagina, making up just 2% of "female" cancers. While
cervix, uterus and ovarian cancer are much more common, great strides have still been made
in researching vaginal cancer.
If a person develops vaginal cancer, it is crucial to get prompt diagnosis and effective
treatment; this can literally make the difference between life and death. Understanding your
options will give you the peace-of-mind of knowing that youÕve done everything possible to
ensure a successful outcome for yourself or a loved one.
CancerAnswers's material explains, in plain English, the definition, types, risk factors,
frequency, symptoms, evaluation, historical and latest effective treatments for vaginal cancer.
We describe surgery, radiation and chemotherapy along with their expected side effects and
results. While we don't promise cure, we tell you everything you must know to help you make
the right choices today for a vaginal cancer problem.
This is just an excerpt of CancerAnswers's report on Vaginal Cancer. Much more,
including latest treatment, can be sent to you by mail when you order the complete
Vaginal Cancer transcript at a nominal cost. Thank you for using CancerAnswers as
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