What is vaginal cancer?

Vaginal cancer is a rare type of cancer that starts in the vagina, the passage that leads from the vulva (the external genitals) to the cervix at the bottom of the womb. It is more common in women aged 60 and over, and the outlook is usually good when vaginal cancer is found early. In this post I explain how it develops, the symptoms to look out for, and how it is diagnosed and treated.

How does vaginal cancer develop?

The surface of the vaginal walls is made of thin, flat skin cells called squamous cells. Beneath them lie layers of muscle, connective tissue, lymph vessels and nerves, along with glands that keep the vagina moist and elastic.

Healthy cells grow and divide at a steady rate, then die when they are no longer needed. Cancer cells, by contrast, keep growing and do not die, so they build up into a mass called a tumour. Vaginal cancer happens when this occurs in the cells of the vagina.

Some cancers start elsewhere and spread to the vagina, such as cervical cancer or vulval cancer. When that happens, the cancer is named after the place where it began, not the vagina.

Symptoms of vaginal cancer

Always make an appointment with your GP or gynaecologist if you notice anything unusual, including:

• vaginal bleeding that is not part of your period, including bleeding after the menopause
• unusual vaginal discharge
• a lump or mass in the vagina (see vulval and vaginal lumps)
• pain during sex, or pelvic pain
• difficulty or pain passing urine, or constipation
• pain in the back of the legs, or swelling in the legs

These symptoms are much more likely to have a less serious cause. Even so, they should always be checked.

What causes vaginal cancer?

The exact cause of vaginal cancer is not yet known. However, several factors are known to increase the risk:

• Age: women over 60 are most at risk.
• HPV infection: human papillomavirus raises the risk of vaginal cancer, as it does for cervical cancer.
• A history of cervical cancer, or previous radiotherapy to the pelvis.
• A previous hysterectomy: women who have had one are statistically more likely to develop vaginal cancer.
• Long-term use of a vaginal pessary, for example to support a prolapse.
• Vaginal intraepithelial neoplasia (VAIN): cells that are abnormal but not yet cancer. They are considered precancerous because they can sometimes develop into cancer.

Many HPV-related cancers, including vaginal and cervical cancer, begin with precancerous changes. These can often be picked up early, which is one more reason to attend your smear test.

How is vaginal cancer diagnosed?

Your doctor will ask about your symptoms and medical history, then carry out a pelvic examination to look and feel for anything unusual. You may also have a cervical smear. If the smear is abnormal, or anything looks suspicious, you may be offered a colposcopy, a closer look at the cervix and vagina with a magnifying instrument.

A biopsy is needed to confirm vaginal cancer. During a biopsy, small samples of tissue are taken under local anaesthetic and examined under a microscope. Biopsies are commonly taken during a colposcopy. Cancer Research UK explains how vaginal cancer is diagnosed in more detail.

How is vaginal cancer treated?

Treatment depends on the size and position of the cancer and whether it has spread. The main options are radiotherapy and chemotherapy, and some small, early cancers may be removed with surgery. Before any treatment begins, you should understand what to expect, the possible side effects, and the risks and benefits of each option. Your specialist will take time to explain them.

You can read more on our vaginal cancer page, and Cancer Research UK sets out the treatment options for vaginal cancer. If you are worried about any symptoms, you can book an appointment with Mr Jafaru Abu at The Park Hospital, Nottingham.