Vulvar and Vaginal Cancer: Symptoms, Diagnosis, and Treatment

Vaginal and vulvar cancers are rare cancers. Vaginal cancerusually develops in cells lining the vagina, also called the birth canal. Cancer developing in the external vaginal region is called vulvar cancer .

Early detection is crucial for vaginal and vulvar cancers and greatly improves treatment success. Knowing their symptoms is therefore useful.

Symptoms of Vaginal Cancer

Early vaginal cancer may cause no symptoms. Later, symptoms may include:

• Unexplained vaginal bleeding, such as after intercourse or menopause
• Watery vaginal discharge
• A lump or mass in the vagina
• Pain when urinating
• Frequent urination
• Constipation
• Pelvic or groin pain

Vulvar Cancer Symptoms

• Asymmetry: one half of the external vaginal area looking different from the other
• Changes in shape
• Color changes, including different shades of tan, brown, or black and sometimes red, blue, or white patches
• Pain
• Persistent itching
• Bleeding outside menstruation

These symptoms do not always indicate vaginal or vulvar cancer. However, unexplained problems such as excessive discharge or bleeding require an examination and appropriate tests.

Causes of Vaginal and Vulvar Cancers

• Older age—over 60
• HPV infection increases risk.
• Women who have undergone hysterectomy have a higher risk of vaginal cancer.
• A history of cervical cancer is a risk factor for vaginal cancer.
• Previous radiotherapy may increase vaginal cancer risk.
• Use of a vaginal medicine
• Vaginal precancerous changes (VAIN)

Many cancers caused by HPV, including vaginal and cervical cancer, are associated with precancerous lesions. These develop before cancer and can be tested with a Pap smear .

The exact causes of these cancers are not clearly known. Most patients are over 60, and some cases are thought to be caused by HPV. However, the relationship between HPV and vaginal/vulvar cancer is weaker than that between HPV and cervical cancer . Cancer generally begins when healthy cells mutate into abnormal cells. Healthy cells grow and multiply at a set rate and are programmed to die at a certain time. Cancer cells grow and multiply uncontrollably without dying. Abnormal cells accumulate into a mass (tumor). Cancer cells may eventually invade other tissues and spread to distant body areas, which we call metastasis .

What Are the Types of Vaginal Cancer?

• Vaginal Squamous Cell Carcinoma: The most common type, beginning in thin, flat (squamous) cells lining the vagina.
• Vaginal Adenocarcinoma: A type beginning in glandular (secretory) cells on the vaginal surface.
• Vaginal Melanoma: Develops in pigment-producing cells (melanocytes) in vaginal skin.
• Vaginal Sarcoma: Develops in connective tissue or muscle cells in the vaginal walls.

Types of Vulvar Cancer

The cell type in which vulvar cancer starts helps the doctor plan the most effective treatment. Its most common types are:

• Vulvar Squamous Cell Carcinoma. Most vulvar cancers are squamous cell carcinomas.
• Vulvar Melanoma. This cancer begins in pigment-producing cells in vulvar skin.

Vaginal Precancerous Changes / Precancerous Lesions

Before cancer develops, some cells appear abnormal. These changes are not yet cancer and are called vaginal intraepithelial neoplasia (VAIN), but may become cancerous over time. VAIN, or cellular changes, occurs only in the vagina’s inner surface layer (lining). It is more common in women treated for cervical cancer who have had their uterus removed (hysterectomy).

There are 3 VAIN types: VAIN1, VAIN2, and VAIN3. VAIN3 is closest to cancer. Low-grade VAIN (VAIN1) sometimes disappears on its own, but untreated VAIN may sometimes lead to cancer. High-grade VAIN (VAIN2 or VAIN3) is generally treated immediately when detected.

Treatment of Vaginal and Vulvar Cancers

Vaginal cancers can be treated in several ways, including surgery, radiotherapy, and chemotherapy. Surgery is naturally preferred first in early-stage disease. In advanced disease, cell type and extent of spread chiefly guide treatment. Before treatment, patients should understand what to expect, possible side effects, and treatment risks and benefits. The more a person knows about cancer treatment, the better they can communicate with the medical team and participate in decisions.

How Can the Risk of Vaginal and Vulvar Cancers Be Reduced?

There is no certain way to prevent these cancers. However, you can reduce your risk:

• Have regular pelvic/gynecological examinations and Pap tests.
• To prevent HPV infection, you can receive a vaccine .
• Do not smoke.
• Avoid sexual relationships with multiple partners.
• Avoid sexual contact with anyone who has multiple partners.

Researchers continue to investigate the causes of vaginal and vulvar cancers and how to prevent them. Although no method completely prevents these diseases, following the advice above may minimize risk.