Vaginal Cancer

Question 1

Risk Factors

Answer

Most vaginal cancers are caused by the human papilloma virus (HPV), a common infection that is transmitted sexually or through skin-to-skin contact. There are many different types of HPV. Two types, HPV 16 and HPV 18, are associated with an increased risk of developing cancers of the vagina, vulva and cervix.

HPV 16 and 18 can also cause a precancerous condition called vaginal intraepithelial neoplasia (VAIN). Women with VAIN have somewhat abnormal cells in the lining of the vagina. In some women, VAIN progresses into cancer.

Other factors that may raise the risk of vaginal cancer include:

A history of cervical cancer or precancerous cervical conditions
Being born to a mother who took diethylstilbestrol (DES), a hormone drug used from 1940 to 1971 to prevent miscarriage
Smoking cigarettes
Long-term irritation of the vagina, such as from use of a pessary (a device to keep the uterus in place)
Being age 50 and above

Question 2

Symptoms and Diagnosis

Answer

In the early stages, vaginal cancer may not cause any symptoms. As the cancer spreads, women may experience one or more of the following:

Painful sex
Abnormal bleeding or discharge from the vagina
A lump in the vagina
Pain in back, lower abdomen or pelvis
Leg swelling
Constipation
Pain when urinating

A pelvic exam and Pap test is often the first step in determining whether a woman has vaginal cancer. While Pap tests primarily screen for cervical cancer, they may also be used to identify abnormal vaginal cells. In addition, some women may get an HPV test as part of a Pap test to see if they carry the HPV virus. During the exam, the gynecologist will also look at vaginal tissue for any abnormalities. In certain situations, a colposcopy is performed at the same time. This is a procedure where acetic acid (vinegar) is placed along the vaginal tissue to see if there are any abnormalities that can be seen with a special lens.

If vaginal cancer or pre-cancer is suspected, the next step is typically a biopsy, or the removal of a small piece of suspicious tissue. Diagnostic accuracy is critical to proper treatment. Our experienced pathologists, who specialize in gynecologic cancers, use various laboratory tests to determine if the cells are cancerous and what subtype of vaginal cancer it is. There are four subtypes that are most common:

Squamous cell carcinomas: Ninety percent of vaginal cancer cases are squamous cell carcinomas. These cancers begin in the squamous cells in the lining of the vagina. They tend to grow slowly.
Adenocarcinomas: About 10 percent of vaginal cancers are adenocarcinomas. These start in gland cells.
Melanoma: While very rare, melanomas can affect the vagina. They grow in the pigment-producing cells of the vagina.
Sarcomas: These very rare vaginal cancers tend to form deep within the vagina.

When cancer is discovered, we may conduct various tests, such as MRIs and CT scans, to determine how far the cancer has spread and gain other critical information needed to guide treatment.

Question 3

Treatment: Radiation Therapy, Chemotherapy and Surgery

Answer

Early in the treatment process, we talk to our patients about what matters most to them. Then our team of experts — which primarily includes gynecologic oncologists and radiation oncologists— looks at each patient’s specific case to determine how to best treat the cancer while taking into account the woman’s preferences and values.

Depending on your specific cancer diagnosis, as well as your treatment preferences, your care plan may include some or all of the following:

Radiation Therapy

The goal of radiation therapy is to kill cancer cells. At UChicago Medicine, we also place a major emphasis on preventing or limiting damage to healthy cells and tissue during radiation. This helps reduce vaginal injury and other side effects from the treatments.

Prior to giving patients their first radiation treatment, we order imaging studies, such as MRI and PET scans, to help identify the tumor’s location. We also conduct a physical exam, typically under anesthesia, to locate and mark the tumor with tiny, safe non-radioactive seeds. These steps allow us to target the radiation very precisely at the tumor and not harm nearby healthy tissue.

Two types of radiation are used to treat vaginal cancer:

External beam radiation is delivered from outside the body. At UChicago Medicine, we use a radiation technique called volumetric modulated arc therapy (VMAT). This technology allows us to deliver radiation to the tumor as well as cancer cells that might be hiding nearby without harming nearby organs, such as the bladder.

Patients with vaginal cancer typically get external beam radiation five days a week for several weeks on an outpatient basis.

Internal radiation involves delivering radiation inside the vagina. After completing external beam radiation, patients will likely be advised to get internal radiation as standard of care.

Our radiation oncologists are highly experienced in an advanced internal radiation procedure called interstitial brachytherapy, which is considered a gold standard treatment for vaginal cancer if the tumor exceeds a certain thickness after the external radiation is complete. With this procedure we can attack the tumor with radiation up-close and very precisely.

Patients are typically hospitalized for this form of brachytherapy, which is given under anesthesia. Then very thin catheters are inserted to reach the tumor.

To reduce side effects from this procedure, physician-scientists at UChicago Medicine use advanced planning techniques and special materials to protect vaginal tissue before, during and after brachytherapy.

Chemotherapy and Other Drug Therapies

Patients with vaginal cancer may benefit from chemotherapy, or various cancer-fighting drugs, either alone or with radiation.

Some women, especially those with very rare subtypes of vaginal cancer, like melanoma and sarcomas, may also benefit from clinical trials being conducted at UChicago Medicine. Some of the new types of drugs that are being investigated include the following:

Immunotherapies, such as checkpoint inhibitors, can help the body’s own immune system fight the cancer.
Targeted drug therapies, such as monoclonal antibodies, block certain proteins in the body that help cancer cells grow.

Surgery

In general, surgery is recommended for small or early-stage vaginal cancers, although it may also be an option for more advanced cancers that do not respond to radiation or drug treatment.

Our gynecologic oncologists are highly experienced in operating on the delicate vaginal area and surrounding organs and tissues. Our primary goal is to remove the cancerous tumor, along with a small amount of tissue around it to prevent the cancer from coming back.

In cases where patients are worried about the look or function of their vagina after surgery, or in cases where the area that needs to be removed is very large, our gynecologic-oncologists partner with plastic and reconstructive surgeons at UChicago Medicine. These highly experienced surgeons are experts at restoring the vaginal area after tumors are removed.

Supportive Services

Our patients and their families also have access to our dedicated supportive oncology program, which provides a range of services, including mental health counseling, social work services and more.

Question 4

Fertility and Sexual Function

Answer

At UChicago Medicine, we begin thinking about how to prevent and treat any sexual or reproductive issues you may have due to your cancer or your cancer treatment from our first visit with you. In addition to taking steps to minimize vaginal pain and other treatment side effects, our cancer physicians work very closely with UChicago Medicine’s PRISM program, which is designed to address sexual health problems in female cancer patients and survivors. The PRISM team can help patients who might be struggling with sexual function-related issues after treatment, such as body image issues, physical pain with intercourse, and anxiety about sexual activity.

In addition, UChicago Medicine’s reproductive medicine and infertility specialists are available to discuss options with our patients of childbearing age who are concerned about their ability to conceive and give birth after cancer treatment.