The vagina is a muscular tube like organ that runs from the womb’s opening (cervix) to the folds of tissue between a female’s legs (vulva).
It is the passageway via which infants are born and allows blood from periods (menstruation) to move out of the body.
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What is Cancer of the vagina?
Cancers of the vaginal area are uncommon. Each year, less than 300 women in the United Kingdom are diagnosed with this kind of cancer.
There are two types of vaginal cancer: those that start in the vagina and spread to other parts of the body (primary vaginal cancer) and those spread in the vagina from another parts of the body (secondary vaginal cancer).
Primary vaginal cancer
Primary vaginal cancers are divided into two categories, each called after the cells that give rise to them:
- Squamous cell carcinoma Squamous cell carcinoma is the most frequent type of vaginal cancer. This mainly affects women between the ages of 50 and 70 and is discovered in the upper region of the vagina.
- Adenocarcinoma This kind of vaginal cancer is most common in women under the age of 20, but it can also develop in women of various ages.
- Melanoma, small cell carcinoma, sarcoma, and lymphoma are all exceedingly rare kinds of vaginal cancer
Secondary vaginal cancer
Secondary vaginal cancers are more common than initial vaginal cancers, and they usually arise from the womb’s neck (cervix), endometrium (lining of womb), or adjacent organs like the bladder or intestine.
What Causes Virginal Cancer?
The actual cause of most vaginal cancers is unknown, as it is with many malignancies, but research is in progress. Although vaginal cancer is not contagious, it cannot be passed on to others.
Vaginal cancer is somewhat more likely in women who have had genital warts caused by the human papillomavirus (HPV). Women who received pelvic radiation treatment (radiotherapy) are also at a slightly elevated risk, but cancer development is extremely rare, and women who received this treatment still have a very low risk of likelihood of having verginal cancer.
Diethylstilbestrol (DES), a hormone medication, has been linked to a kind of vaginal adenocarcinoma. Between 1940 and 1970, pregnant women were given DES to try to avoid miscarriages.
The mother of Female children who had used DES during pregnancy had a higher chance of getting clear cell adenocarcinoma, a form of vaginal cancer (CCA). Although DES as well as other female hormones (oestrogens) can be used to treat a variety of medical issues, it is no longer recommended for usage during pregnancy.
What are the signs and symptoms of Virginal Cancer?
The most common symptoms of vaginal cancer are a
- Blood-stained vaginal discharge,
- bleeding during sexual intercourse,
- discomfort are the most typical signs of vaginal cancer,
- Urinary problems, such as blood in the urine,
- the need to pass pee often, and
- the urge to pass urine at night, are also possible.
- Back pain (rectum) is a common occurrence.
How Virginal cancer is diagnosed?
Typically, you’ll start by seeing your primary care physician, who will recommend you to a specialist for testing, as well as professional advice and treatment.
The following tests are commonly used to diagnose vaginal cancers:
An internal vaginal examination is performed. A comprehensive pelvic examination will be performed in the hospital by a qualified doctor. Examining the interior of your vaginal canal for lumps or swellings is part of this procedure.Â
Your doctor will also examine your groyne and pelvic area for any enlarged glands, as well as your back passage (rectum). Smear of the cervix to discover if there are any abnormalities in the cells of the cervix, you may undergo a smear or a liquid-based cytology test.
The person doing the smear should explain the technique to you, and you should feel free to ask any questions you have. Once you’re comfortable on the sofa, the doctor or nurse will gently put a speculum into your vaginal opening to hold it open while the smear is taken.
After that, a little disposable spatula or brush is used to collect a sample of cells from the cervix. The cells are then placed on a glass slide or placed in a liquid and transported to the laboratory to be examined under a microscope.
Colposcopy A colposcope, a tiny low-powered microscope, is used to examine the vagina more closely. The colposcope works as a magnifying glass, allowing the doctor or specialist nurse to examine the whole vaginal area in more detail.
To hold the vagina open, the doctor will use a speculum similar to that used for a smear test. The vaginal wall may then be painted with a liquid to highlight clearly any abnormalities.
Colposcopy is commonly done in the outpatient section of a hospital and takes around 10–15 minutes. It is normally not painful, although it can be irritating.
Biopsy Any suspicious locations will have a tiny sample of tissue extracted. A microscope will be used to examine this material.
What is VAIN?
Early cell alterations in the vaginal lining, described as vaginal intraepithelial neoplasia, or VAIN, may be detected by the aforementioned tests. Carcinoma-in-situ is a term used to describe this condition. Because VAIN is not cancer, its therapy differs from that of cancer.
Further tests
If the foregoing tests reveal that you have vaginal cancer, more testing may be required to determine whether the cancer cells have spread or if spread the extant of spreading. Cancer can expand throughout the body via the blood circulatory system or the lymphatic system. The lymphatic system prevents our body from diseases and ill health.Â
The lymphatic system consists of a network of lymph glands (lymph nodes) connected by small ducts that carry lymph fluid. The findings of these tests will aid the specialist in determining the best treatment option for you.
X-rays of the chest and blood tests are required to examine your overall health and to determine whether the malignancy has progressed to your lungs.
CT scan (computerized tomography) A three-dimensional image of the inside of the body is created by a sequence of x-rays. It might be used to determine whether cancer has spread to other places of the body. You will be given an injection of a chemical that will aid in the clarity of the images before the scan.
An MRI (magnetic resonance imaging) scan is a type of imaging that uses radio waves to produce images. Instead of using x-rays, magnetism is used to create a sequence of cross-sectional images of the inside of the body. You will be requested to lie quite motionless on a sofa inside a metal cylinder for the scan.Â
It may take up to an hour for the test to complete and is absolutely painless. If you are claustrophobic, you may find the machine uncomfortable.
What is the Staging and grading of Virginal Cancer?
- Staging
Cancer’s stage refers to the size of the tumor and whether or not it has migrated beyond its initial location. Knowing what sort of cancer you have and at what stage it is might help physicians choose the best treatment for you.
- Stage 1: The cancer is limited to the vaginal area and has not started to spread.
- Stage 2: Cancer has gradually started to migrate from the vaginal wall but still hasn’t gone to the pelvic bones.
- Stage 3: Cancer has gone to the pelvis and may have migrated to the lymph nodes near the vaginal opening.
- Stage 4: Cancer has spread to other regions of the body, such as the lungs, or to the bladder or colon.
If cancer reoccurs after some time or after initial treatment, this is known as recurrent cancer.
- Grading
Grading describes how cancer cells appear under a microscope and provides an estimate of how rapidly the disease will progress or speed of cell will replicate with. Low-grade cancer cells resemble normal cells, develop slowly, and are less likely to spread than high-grade cancer cells. The cells in high-grade tumors have an unusual appearance, are more likely to develop fast, and are more capable of spreading.
What is the Treatment for Virginal Cancer?
Vaginal cancer therapy is determined by a variety of criteria, namely this includes your age, general health, and the stage, grade, and kind of cancer.
Vaginal cancer can be treated with radiotherapy, surgery, and chemotherapy. You may get one or more of these therapies.
You should be given the opportunity to ask your cancer expert any questions you have about the treatments being discussed before beginning treatment.Â
If there is anything you don’t understand, it’s crucial to ask the professional to explain it again, no matter how little it may appear.
- Radiotherapy
Radiotherapy is the best treatment option for many females with vaginal cancer. Radiotherapy may be coupled with chemotherapy in certain younger women, a treatment often recognized as chemoradiotherapy.
Radiotherapy is a type of cancer treatment that uses high-energy radiation to kill cancer cells while causing as little harm as possible to healthy cells. It is administered in the hospital’s radiotherapy department.
A doctor who specializes in radiation treatment will design your treatment (a clinical oncologist or radiotherapist). They will be able to talk to you about your treatment options and answer any questions you might have. A radiographer will administer the therapy.
Because the dose required depends on the kind of cancer and whether it has spread to surrounding tissue, you may find that your radiation treatment differs from that of other women you meet at the hospital. Some women are treated with both external and internal radiation.
- External irradiation This includes externally directed radiation beams being focused at the tumour, similar to an x-ray. You will be required to visit the radiation department for diagnosis every weekday for four to six weeks while receiving external radiotherapy. Each treatment lasts a few minutes and is completely painless.
- Radiotherapy on the inside This includes inserting a tampon-like applicator carrying a radioactive material into your vaginal canal. The therapy might last anywhere from a few hours to a few days. If your cancer doctor advises internal radiation, you might want to ask the radiotherapy department personnel to outline what will happen and show you the devices before you start.
Tiny radioactive needles may be inserted into the region surrounding the vaginal opening in addition to the applicator. If they are required, they are implanted under general anesthesia and removed when the treatment is completed.
Side effects of radiotherapy
Short- and long-term adverse effects are possible with radiotherapy for vaginal cancer. The majority of side effects occur during or shortly after therapy. The side effects occur because, in addition to killing cancer cells, radiation can harm healthy cells nearby.
Consequences in the short term After the radiation treatment, little bleeding or discharge from the vaginal area is not uncommon. It’s crucial to tell your doctor or nurse if it lasts more than a few weeks or becomes too heavy.
Tiredness, diarrhoea, and a burning feeling when passing urine are all possible adverse effects of pelvic radiotherapy (cystitis). Depending on the strength of the radiation dose and the length of your treatment, these side effects might be minor or severe. Your oncologist will be able to provide you further information on what to expect.
The majority of these side effects may be managed with medication, and your oncologist can assist you. Once your treatment is over, any adverse effects should progressively fade away.
During your therapy, it is critical that you drink lots of water and consume a nutritious diet. Let your doctor know if your diarrhoea isn’t under control so that anti-diarrhoea medications can be provided. You may feel ill, although this is uncommon.
If you don’t feel like eating, you can substitute healthy high-calorie beverages, which can be purchased at most pharmacies or recommended by your doctor. A consultation with a dietician may be beneficial.
Unfortunately, radiation for vaginal cancer damages the ovaries, which causes menopause roughly three months after the treatment begins. Your periods will end, and you will experience menopausal symptoms such as hot flushes, dry skin, and potentially a lack of focus. As a result, you will become infertile. You can talk to your doctor about it further. Some women lose interest in intercourse and discover that their vaginal tissue has dried up. Radiotherapy can induce a narrowing of the vaginal canal, making sexual activity painful.
By using HRT (hormone replacement treatment)Â in the form of pills or skin patches, you can avoid menopausal symptoms. Your gynaecologist can begin these treatments during or shortly after your radiation treatment. They will select the appropriate hormone replacements and doses for you.
It’s critical to obtain as much rest as possible, especially if you have to travel a great distance each day for therapy.
Long-term adverse effects are a possibility. Radiotherapy to the pelvic region might have long-term consequences. However, advances in treatment planning and delivery have made these long-term consequences considerably less likely.
Radiotherapy may permanently harm the intestines or bladder in a small proportion of patients. Increased bowel movements and diarrhoea may occur, or you may require to pass urine more than then normal if this occurs.
After radiation, the blood vessels in the intestines and bladder might become weaker, causing blood to appear in urine or bowel movements. This might take few months or even years to happen. It’s critical to notify your doctor if you detect any bleeding so that tests may be performed and you can receive the proper treatment.
Radiotherapy can also impact lymph nodes in the pelvic region, causing leg oedema in certain persons. This is called lymphoedema, and it’s more common if you’ve had both surgery and radiation.
Surgery
In certain cases, the cancer must be surgically removed. The sort of surgery you’ll undergo is determined by the cancer’s size and location.
A procedure to remove the tumour as well as part of the surrounding normal tissue may be possible. Depending on how much tissue has been removed, the remaining vaginal tissue may be able to extend and allow you to have sexual relations.
Some women may require a more extensive procedure that involves the removal of the whole vaginal wall (vaginectomy). Using tissue from other regions of the body, it is sometimes feasible to create a new vagina (vaginal reconstruction). Your physicians and nurses will make sure you have all of the information and support you need regarding your operation.
The womb (uterus), cervix, ovaries, and fallopian tubes may also need to be removed. A radical hysterectomy is the name for this procedure. Some lymph nodes in the pelvis may also be removed during this procedure.
Chemotherapy
Chemotherapy is the treatment of cancer cells with anti-cancer (cytotoxic) medicines. They function by interfering with cell development and division. Chemotherapy is frequently administered through a vein (intravenously).
Chemotherapy is primarily used to treat advanced vaginal cancers or tumours that have reappeared after being treated before.
Will the treatment affect my sex life?
The therapy you receive will determine how your sex life is physically changed. It’s probable that you won’t be able to experience a vaginal orgasm if you have to have your cervix and uterus removed and vaginal reconstruction. However, because vaginal surgery does not damage the clitoris, orgasm can be achieved by oral sex and masturbation.
The adverse effects of radiation may make sexual intercourse both partners unpleasant and unappealing. You and your partner may continue to communicate your love for each other and be personal and close in other ways, such as snuggling, massaging, kissing, and stroking, even if you don’t feel like having sexual intercourse.
To avoid vaginal shortening and narrowing caused by radiotherapy, your doctor or gynaecology nurse will suggest you to use a dilator (a plastic or glass tube) every day during and for a period of time following the treatment. To maintain the vaginal opening open, the dilator is softly inserted.
Feelings and emotions:
It may be difficult to realise that you require such care. The idea of having therapy on their personal and private portions of their body usually shocks and upsets women.
You may feel a range of emotions, including anger, fear, and resentment, which are all natural. When these strong feelings are combined with the stress of surgery, as well as all of the other emotions that come with a cancer diagnosis, your relationship’s usual closeness may be disrupted. Sharing your feelings with your spouse may help you and your partner grow closer together.
When it comes to dealing with misfortune, everyone has their own way. Some people find it helpful to talk to friends or family about their problems, while others choose to seek support from those who are not directly engaged in their problems, such as a professional nurse or counsellor. Some people choose to hide their feelings. There is no right or wrong way to cope with it, but help is there if you need it. Giving yourself and your partner time to comprehend and recover from the emotions and feelings that cancer can generate is critical.