Article: Vaginal Cancer Treatment

Description

What is cancer of the vagina?

Cancer of the vagina, a rare kind of cancer in women, is a disease in which cancer (malignant) cells are found in the tissues of the vagina. The vagina is the passageway through which fluid passes out of the body during menstrual periods and through which a woman has babies. It is also called the "birth canal." The vagina connects the cervix (the opening of the womb or uterus) and the vulva (the folds of skin around the opening to the vagina).

There are two types of cancer of the vagina: squamous cell cancer (squamous carcinoma) and adenocarcinoma. Squamous carcinoma is usually found in women between the ages of 60 and 80. Adenocarcinoma is more often found in women between the ages of 12 and 30.

Young women whose mothers took DES (diethylstilbestrol) are at risk for getting tumors in their vaginas. Some of them get a rare form of cancer called clear cell adenocarcinoma. The drug DES was given to pregnant women between 1945 and 1970 to keep them from losing their babies (miscarriage).

A doctor should be seen if there are any of the following:

• Bleeding or discharge not related to menstrual periods.
• Difficult or painful urination.
• Pain during intercourse or in the pelvic area.
• Also, there is still a chance of developing vaginal cancer in women who have had a hysterectomy.

A doctor may use several tests to see if there is cancer. The doctor will usually begin by giving the patient an internal (pelvic) examination. The doctor will feel for lumps and will then do a Pap smear. Using a piece of cotton, a brush, or a small wooden stick, the doctor will gently scrape the outside of the cervix and vagina in order to pick up cells. Some pressure may be felt, but usually with no pain.

If cells that are not normal are found, the doctor will need to cut a small sample of tissue (called a biopsy) out of the vagina and look at it under a microscope to see if there are any cancer cells. The doctor should look not only at the vagina, but also at the other organs in the pelvis to see where the cancer started and where it may have spread. The doctor may take an x-ray of the chest to make sure the cancer has not spread to the lungs.

The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in the vagina or has spread to other places) and the patient's general state of health.

Stage Explanation

Stages of cancer of the vagina

Once cancer of the vagina has been found (diagnosed), more tests will be done to find out if the cancer has spread from the vagina to other parts of the body (staging). A doctor needs to know the stage of the disease to plan treatment. The following stages are used for cancer of the vagina:

Stage 0 or carcinoma in situ

Stage 0 cancer of the vagina is a very early cancer. The cancer is found inside the vagina only and is in only a few layers of cells.

Stage I

Cancer is found in the vagina, but has not spread outside of it.

Stage II

Cancer has spread to the tissues just outside the vagina, but has not gone to the bones of the pelvis.

Stage III

Cancer has spread to the bones of the pelvis. Cancer cells may also have spread to other organs and the lymph nodes in the pelvis. (Lymph nodes are small bean-shaped structures that are found throughout the body. They produce and store cells that fight infection.)

Stage IVA

Cancer has spread into the bladder or rectum.

Stage IVB

Cancer has spread to other parts of the body, such as the lungs.

Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the vagina or in another place.

Treatment Option Overview

How cancer of the vagina is treated

Treatments are available for all patients with cancer of the vagina. There are three kinds of treatment:

• Surgery (taking out the cancer in an operation).
• Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells and shrink tumors).
• Chemotherapy (using drugs to kill cancer cells).

Surgery is the most common treatment of all stages of cancer of the vagina. A doctor may take out the cancer using one of the following:

• Laser surgery uses a narrow beam of light to kill cancer cells and is useful for stage 0 cancer.



• Wide local excision takes out the cancer and some of the tissue around it. A patient may need to have skin taken from another part of the body (grafted) to repair the vagina after the cancer has been taken out.



• An operation in which the vagina is removed (vaginectomy) is sometimes done. When the cancer has spread outside the vagina, vaginectomy may be combined with surgery to take out the uterus, ovaries, and fallopian tubes (radical hysterectomy). During these operations, lymph nodes in the pelvis may also be removed (lymph node dissection).



• If the cancer has spread outside the vagina and the other female organs, the doctor may take out the lower colon, rectum, or bladder (depending on where the cancer has spread) along with the cervix, uterus, and vagina (exenteration).



• A patient may need skin grafts and plastic surgery to make an artificial vagina after these operations.

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes into the area where the cancer cells are found (internal radiation). Radiation may be used alone or after surgery.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells outside the vagina. In treating vaginal cancer, chemotherapy may also be put directly into the vagina itself, which is called intravaginal chemotherapy.

Treatment by stage

Treatment of cancer of the vagina depends on the stage of the disease, the type of disease, and the patient's age and overall condition.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in most parts of the country for most stages of cancer of the vagina. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Stage 0 Vaginal Cancer

Treatment may be one of the following:

1. Surgery to remove all or part of the vagina (vaginectomy). This may be followed by skin grafting to repair damage done to the vagina.
2. Internal radiation therapy.
3. Laser surgery.
4. Intravaginal chemotherapy.

Stage I Vaginal Cancer

Treatment of stage I cancer of the vagina depends on whether a patient has squamous cell cancer or adenocarcinoma.

If squamous cancer is found, treatment may be one of the following:

1. Internal radiation therapy with or without external beam radiation therapy.
2. Wide local excision. This may be followed by the rebuilding of thevagina. Radiation therapy following surgery may also be performed in some cases.
3. Surgery to remove the vagina with or without lymph nodes in the pelvic area (vaginectomy and lymph node dissection).

If adenocarcinoma is found, treatment may be one of the following:

1. Surgery to remove the vagina (vaginectomy) and the uterus, ovaries, and fallopian tubes (hysterectomy). The lymph nodes in the pelvis are also removed (lymph node dissection). This may be followed by the rebuilding of the vagina. Radiation therapy following surgery may also be performed in some cases.
2. Internal radiation therapy with or without external beam radiation therapy.
3. In selected patients, wide local excision and removal of some of the lymph nodes in the pelvis followed by internal radiation.

Stage II Vaginal Cancer

Treatment of stage II cancer of the vagina is the same whether a patient has squamous cell cancer or adenocarcinoma.

Treatment may be one of the following:

1. Combined internal and external radiation therapy.
2. Surgery, which may be followed by radiation therapy.

Stage III Vaginal Cancer

Treatment of stage III cancer of the vagina is the same whether a patient has squamous cell cancer or adenocarcinoma.

Treatment may be one of the following:

1. Combined internal and external radiation therapy.
2. Surgery may sometimes be combined with radiation therapy.

Stage IVA Vaginal Cancer

Treatment of stage IVA cancer of the vagina is the same whether a patient has squamous cell cancer or adenocarcinoma.

Treatment may be one of the following:

1. Combined internal and external radiation therapy.
2. Surgery may sometimes be combined with radiation therapy.

Stage IVB Vaginal Cancer

If stage IVB cancer of the vagina is found, treatment may be radiation to relieve symptoms such as pain, nausea, vomiting, or abnormal bowel function. Chemotherapy may also be performed. A patient may also choose to participate in a clinical trial.

Recurrent Vaginal Cancer

If the cancer has come back (recurred) and spread past the female organs, a doctor may take out the cervix, uterus, lower colon, rectum, or bladder (exenteration), depending on where the cancer has spread. The doctor may give the patient radiation therapy or chemotherapy.

A patient may also choose to participate in a clinical trial of chemotherapy or radiation therapy.

To Learn More

Call

For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

Web sites and Organizations

The NCI's Cancer.gov Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.

Publications

The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

LiveHelp

The NCI's LiveHelp service, a program available on several of the Institute's Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 10:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

Write

For more information from the NCI, please write to this address:

NCI Public Inquiries Office

Suite 3036A

6116 Executive Boulevard, MSC8322

Bethesda, MD 20892-8322

About PDQ

PDQ is a comprehensive cancer database available on Cancer.gov.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at Cancer.gov, the NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."

Listings of clinical trials are included in PDQ and are available online at Cancer.gov. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Source: National Cancer Institute
Cache Date: December 10, 2004