Looking closely at vaginal cancer

The vagina is a muscular tube, which can stretch to great lengths.  Yes, childbirth.  It’s lined by a thick membrane, which is also covered by squamous epithelium.

Primary cancer of the vagina accounts for only about 2% of gynae cancers, although the vagina is more commonly involved with secondary cancer spread from the cervix or vulva.  Most women with vaginal cancer are postmenopausal and 95% of vaginal cancers are squamous cell carcinomas.  Many of these cancers are caused by HPV infection and about 30% of women with vaginal cancer will have a prior history of cervical precancer (CIN) or cancer.

A woman with early vaginal cancer may have no symptoms and the cancer may only be detected by Pap testing.  As the cancer grows, it’ll cause abnormal vaginal bleeding and discharge.  This may include bleeding after intercourse (post-coital bleeding).  If it continues to grow, it may spread into the bladder or rectum and cause pain or urgency when urinating, or pain when passing a bowel motion.  It may also spread to lymph nodes in the pelvis or groin and cause pain.

Diagnosis requires a biopsy, which can usually be done in the clinic under local anaesthesia but may need to be performed under anaesthesia (Examination under Anaesthesia or EUA).  An EUA will also allow an assessment of the extent of the cancer, including looking into the bladder (cystoscopy) and into the rectum (proctoscopy).  Imaging will usually include a CT or MRI scan.