Vaginal cancer is one of the rarest of gynecologic diseases. Vaginal cancer is most common after age 40. Vaginal cancer and vulvar cancer originate in neighboring tissues and together makeup only about 5% of all the cancers that originate in the reproductive organs. Approximately 1 of every 150,000 women in the US will develop vaginal cancer. Pre-cancerous dysplasia of the vaginal skin surfaces are much more common than vaginal cancer. The true incidence of the dysplasia is uncertain because in the past a careful search for vaginal dysplasia was not routinely done while evaluating abnormal Pap smears, and not regularly reported in the way that cancer is reported. Vaginal cancer most often originates from changes within the vaginal skin cells. If untreated it can be life-threatening by invading neighboring tissues and eventually spreading through the body. Vaginal cancer is more common in patients who have a history of Pap smear abnormality and prior precancerous dysplasia of the cervix. The most common underlying cause is related to the family of viruses called HPV, and that explains how the same virus might cause problems in multiple parts of the anatomy including the cervix and vagina and vulva.
A woman who notices persistent vaginal drainage, abnormal bleeding, vaginal pressure or pain or difficulty voiding should have a careful vaginal exam. If unexplained blood has been found in urine sample, then a careful vaginal exam is crucial to help identify bleeding from either the vagina or the uterus. The precancerous dysplasia does not usually cause symptoms and would usually be found only while evaluating an abnormal Pap smear or other neighboring tissue dysplasia.
Vaginal cancer may be prevented by treatment of precancerous dysplasia. The precancerous phases can be found if a simple gynecologic exam reveals a visible vaginal lesion or while evaluating abnormal Pap smears. Dysplasia is confined to the vaginal skin but may progress to cancer. Treating the dysplasia stops the developing cancer. Vaginal dysplasia is often abbreviated as VAIN, which stands for Vaginal Intraepithelial Neoplasia. See our website about dysplasia and colposcopy. Dr. Martin can provide treatment if exam confirms a precancerous dysplasia. That treatment is all most often carried out with laser therapy as an outpatient surgery.
A simple office exam will easily identify more advanced cancerous lesions. Dr. Martin will often use a colposcopy exam to find the precancerous areas. The most common vaginal cancer is a squamous cancer. Other cancer types may originate from the vagina, however those other types require a search for cancer that may have started elsewhere in the body and later traveled to the vagina.
Treatment: Laser therapy is often used to treat the precancerous dysplasia, but surgical removal or radiation is required for cancer. Many patients have combinations of dysplasia and invasive cancer. Laser treatment may be used for some of the treatment and surgical removal for the area of invasive cancer. Laser treatment can remove the surface layers of the skin in a controlled fashion. Laser treatment can avoid unnecessary treatment of the deepest layers of the skin and that avoids scarring that is possible when surgical incisions are used for surgical removal. After the patient heals from the laser therapy there may be no visible evidence that a treatment was ever done.
When a vaginal cancer is detected it is common to surgically remove early stage tumors. More advanced cancers may require combinations of therapy including radiation or chemotherapy. Simple or radical procedures each have a place in treatment of this cancer. Radiation is more often used than radical surgery when treating advanced lesions, because the neighboring structures can be preserved using radiation. If the patient had previous radiation then surgery is an option but would require extensive surgery
Dr. Martin may recommend laser therapy as an outpatient procedure for dysplasia, and can evaluate and provide treatment for invasive cancer.