Vaginal cancer is cancer that grows and develops in the vagina. Primary vaginal cancer is a type of cancer that starts in the vagina, not in other organs, such as the cervix, uterus, or ovaries. Vaginal cancer is a rare cancer and often does not cause symptoms in the early stages.
The vagina is a canal that connects the cervix (neck of the womb) with the outside of the body. The vagina is also a way out for the baby during a normal delivery. Advanced vaginal cancer usually causes itching and lumps in the vagina, pelvic pain, and pain when urinating.
Causes of Vaginal Cancer
The cause of vaginal cancer is still not known with certainty. Cancer arises when some of the body's cells change (mutate), then grow uncontrollably, and attack or damage healthy cells around them. Furthermore, cancer cells spread and attack other body tissues (metastasize).
Types of vaginal cancer
Vaginal cancer can be divided into several types based on the type of cell where the cancer begins, namely:
- Squamous cell carcinoma, which is cancer that begins in the thin, flat cells that line the surface of the vagina. Squamous cell carcinoma is the most common type of vaginal cancer.
- Adenocarcinoma, which is vaginal cancer that begins in the gland cells of the vaginal surface.
- Melanoma, which is cancer that develops in the pigment-producing cells (melanocytes) in the vagina.
- Vaginal sarcoma, which is cancer that develops in the connective tissue cells or muscle cells in the vaginal wall.
Vaginal cancer risk factors
Some factors that are thought to be at risk of triggering normal cells in the vagina to mutate and become cancerous are:
- Over 60 years old
- Multiple sexual partners
- Using synthetic estrogen hormone diethylstilbestrol (DES)
- Having sex at an early age
- Suffering from HPV infection (human papillomavirus)
- Suffering from HIV infection
- Suffering from pre-cancerous disorders, such as vaginal intraepithelial neoplasia (VAIN)
- Have a smoking habit
- Have had a uterus removed (hysterectomy)
Vaginal Cancer Symptoms
At first, vaginal cancer does not cause any specific symptoms or signs. However, over time vaginal cancer will cause the following signs and symptoms:
- Abnormal bleeding from the vagina, for example during or after sexual intercourse, outside of menstruation, or after menopause
- Itching or lump in the vagina that doesn't go away
- Vaginal discharge that is watery, smells, or contains blood
- Pain when urinating
- Frequent urination
- Pain in the pelvis
When to go to the doctor
Do an examination to the doctor if the complaints and symptoms mentioned above appear. Get regular pelvic exams if your doctor recommends that you do them. This is because vaginal cancer is sometimes asymptomatic.
Early examination can determine the cause of the complaints you are experiencing. If the symptoms experienced are caused by cancer, treatment can be done immediately.
Vaginal Cancer Diagnosis
Vaginal cancer is sometimes found when the patient performs an examination of the female area before any symptoms or complaints develop. To diagnose vaginal cancer, initially the doctor will ask the patient's complaints or symptoms.
After that, the doctor will examine the outside and inside of the patient's vagina to see any abnormalities. Internal examination is carried out with a plug vaginal examination and examination with a speculum to open the vaginal canal.
After conducting the examination, the doctor may ask the patient to undergo several supporting examinations, such as:
- Pap smear, to take a sample from the vagina
- Colposcopy, to see the condition of the vagina and cervix in more detail
- Biopsy by taking a sample of abnormal tissue, to confirm the growth of abnormal cells and tissues
- Scanning with X-rays, CT scans, MRI, PET scans, cystoscopy and proctoscopy (rectal endoscopy), to determine the presence and size of the cancer, and how far the cancer has spread
Vaginal Cancer Stage
Based on the TNM classification (tumor, nodule, and metastases), vaginal cancer can be divided into 4 stages, namely:
- Stage 1At this stage, the spread of cancer is limited to the vaginal wall
- Stage 2At this stage, the cancer in the vaginal wall has spread, but has not yet reached the pelvic wall
- Stage 3
At this stage, the cancer has spread to the pelvic cavity and has blocked the flow of urine, causing hydronephrosis
- Stage 4AAt this stage, the cancer has spread to other organs, such as the anus or bladder, but has not yet reached the lymph nodes in the pelvis or groin.
- Stage 4B
At this stage, the cancer has spread to other organs that are far from the vagina, such as the lungs, liver, or bones
Vaginal Cancer Treatment
Vaginal cancer treatment aims to eliminate cancer. However, the treatment method used can be different for each patient, depending on the type of cancer and the stage of vaginal cancer. Here is the explanation:
Radiotherapy is the mainstay of treatment for vaginal cancer. There are two types of radiotherapy, namely:
- External radiotherapy, which is radiotherapy with a machine to irradiate the vagina and pelvis to kill cancer cells
- Internal radiotherapy (brachytherapy), i.e. radiotherapy by implanting radioactive material in the vagina or the surrounding area to treat early-stage vaginal cancer or follow-up treatment after external radiotherapy
There are 4 types of surgery to treat vaginal cancer, namely:
- Tumor removal surgery, to remove the tumor and some of the healthy vaginal tissue around it
- Partial vaginectomy, to remove cancer and part of the vagina
- Radical Vaginectomy, to lift the whole vagina
- Radical vaginectomy and hysterectomy, to remove the entire vagina, uterus, ovaries, fallopian tubes, and lymph nodes in the pelvis
- Pelvic exenteration, to remove tissue from the vagina, rectum, ovaries, uterus, bladder, and lower colon
If radiotherapy and surgery cannot control or eliminate the cancer, your doctor may suggest chemotherapy. Chemotherapy is done with the use of drugs to kill cancer cells and is usually combined with radiotherapy.
In addition to the above treatment methods, doctors can also recommend patients undergo palliative therapy. Palliative therapy is useful for relieving pain and symptoms suffered, as well as giving patients encouragement and enthusiasm to improve the quality of life.
Vaginal Cancer Complications
Vaginal cancer that is not treated immediately can enlarge and spread to the tissues around the vagina. In fact, vaginal cancer can also spread to distant organs, such as the lungs, liver, and bones.
Vaginal Cancer Prevention
There is no specific way that can really prevent the onset of vaginal cancer. However, there are several things that can be done to reduce the risk of developing vaginal cancer, namely:
- Do not smoke
- Do not change sexual partners
- Carry out content checks and PAP smear routinely
- Getting vaccinated against HPV
- Not having sex at an early age
- Using a condom during sexual intercourse