General Information / Anatomy / Function / Statistics

• The vagina is the birth canal, extending from the vulva to the cervix
• Cancer of the vagina is extremely rare; occurs mainly in women over 50
• Five year survival rate is 55%, but if the cancer has spread to surrounding tissue the five year survival rate is 31%

Symptoms / Signs

• Vaginal discharge
• Spotting or bleeding between periods
• Bladder discomfort or irritation
• Lesion or lump
• Pain in the pelvis, back or legs

Etiology / Carcinogens / Risks

• Women with a history of cervical, vulvar or vaginal dysplasia (vaginal intraepithelial neoplasia - VAIN) and vaginal adenosis dysplasia (abnormality of development in size, alteration in size, shape and organization of adult cells)
• Adenosis - abnormal development of the vagina
• Causes of vaginal malignancies, other than DES, is unknown

Diethylstilbestrol (DES)

• In the province of British Columbia between the years of 1950 to 1954, the synthetic estrogen Diethylstilbestrol was used for pregnant women who were at a high risk of having a miscarriage.  In the late 1960's, it was discovered that the female offspring of women who had taken this drug had an increased risk of developing a rather rare carcinoma called clear cell adeno-carcinoma of the vagina or cervix.
• In this province, we have recommended in the past and still recommend that mothers, who believe they might have received DES during their pregnancy, should arrange for their daughters to visit a colposcopy clinic, after the daughter starts her menstrual cycle. There are colposcopy clinics situated around the province, so that one is within reach of most patients.
• Most of the cases of adenocarcinoma of the vagina in women, whose mothers took DES during pregnancy, have been in the late teens and early twenties at the time of diagnosis. In British Columbia the drug was virtually not used after 1954, so that those exposed would now be 45 years of age and should be well past the period of greatest risk. We are of course uncertain as to what their future will hold, but believe if they visit colposcopy centers annually there is no great risk.

Prevention

• Annual pelvis examination and Pap smear is recommended

Diagnosis / Staging / Grading / Types

• Pelvic examination
• Pap smear
• CT scan of the pelvis and abdomen
• Biopsy

Staging

• Stage 0  carcinoma in situ
• Stage I  limited to the vaginal wall
• Stage II  adjacent vaginal subvaginal tissue is involved but invasion has not extended into the pelvic wall
• Stage III  invasion has extended to the pelvic wall
• Stage IV  extended beyond the pelvis or has involved the mucosa of the bladder or rectum; or distant metastases

Types

• Squamous cell tumours -- account for 85% of vaginal cancers, usually occur in older women
• Adenocarcinomas -- account for 5%, usually occur in adolescence
• Melanomas -- account for 3%, usually occur in older women
• Sarcomas -- 3%
• Endodermal sinus tumours - account for 1%, usually occur in infants

Treatment

• Radiation and surgery both used as primary treatment of early lesions (clear cell cancers)
• Carcinoma in situ, a vaginectomy may be performed; or laser surgery
• Invasive lesions require either radiation therapy or radical surgery
• In advanced cancers, radiation may be used alone or in combination with chemotherapy to relieve symptoms

Revised April 2000