VAGINAL CANCER

Vaginal cancer is a disease in which cancer or malignant cells form in the vagina.
The vagina is a 3.4inch (7 to 10cm) tube that goes from the cervix to open up at vulva. It is
also called the birth canal. The vagina is lined with a layer of flat cells called squamous cells.
This vaginal wall underneath the epithelium is made up of connective tissues, muscle tissue,
lymph vessels and nerves walls touching each other. The walls open and expand during
sexual intercourse or the birth of a baby. Glands near the opening of the vaginal secret mucus
to keep the vaginal living moist.
Cancer starts when cells in the body begins to grow out of control. Cells in nearly any part at
the body can become cancer and can spread to other areas at the body.
When vaginal cancer is detected early, it can often be cured.

STAGES
Staging is the way of describing where the cancer is located, if or where it has spread and
also whether it is affecting other parts of the body. Diagnostic tests are used to determine the
stage of the cancer. Staging may therefore not be complete until all the tests are completed.
Staging helps doctors to decide the kind of treatment to give and can also help to predict a
patients prognosis. There are different stage descriptions for different types of cancers.
Most vaginal cancers are staged using the International Federation of Gynaecology and
Obstetrics (FIGO) system of staging combined with the American Joint Committee on Cancer
(AJCC) TNM system. TNM is an abbreviation for Tumour (T), Node (N) and Metastasis (M).
The system clarifies the diseases in Stages 0 through IV depending on the extent of the
tumour (T), whether the cancer has spread to lymph nodes (N) and whether it has spread to
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distant sites, metastasis (M). The results are combined to determine the stage of cancer for
each person
Vaginal cancer is staged clinically, which means staging does not take into account what is
found during surgery.
The details on each part of the TNM system for vaginal cancer is;

Tumour (T)
Using the TNM system, the T plus a number or letter (0 4) is used to
describe the size and location of the tumour. Some stages are divided into
smaller groups that help describe the tumour stage.
1. TX
The primary tumour cannot be evaluated
2. T0
There is no evidence of cancer in the vagina
3. Tis
The tumour is carcinoma in situ, an early cancer found
only in one layer of cells that has not spread to nearby
4. T1

tissue
The tumour is in the vagina and has not spread through

5. T2

the vaginal wall or to other parts of the body

The tumour has spread through the vaginal wall and

surrounding tissue but not to the walls of the pelvis

The tumour has spread to the pelvic wall
The tumour has spread to the bladder, rectum or other

6. T3
7. T4

areas of the body

Node (N), Lymph nodes

Lymph nodes near the pelvis and groin are called regional lymph nodes.
Depending on the exact location of the tumour, (upper third, middle third or
lower third of the vagina), the lymph nodes near the hips or upper thighs may

also be involved. Lymph nodes in other parts of the body are distant lymph
nodes.
1. NX
2. N0
3. N1

The lymph nodes cannot be evaluated

cancer has not spread to the regional lymph nodes
Cancer has spread to the regional lymph nodes.

Metastasis (M)
This indicates whether the cancer has spread to other parts of the body.
1. MX
Metastasis cannot be evaluated
2. M0
The cancer has not spread to other parts of the body
3. M1
The cancer has spread to another part of the body

Doctors describe this type of cancer by its grade (G), which describe how much cancer cells
look like healthy cells when viewed under a microscope. The cancerous tissue is compared
with healthy tissues. Healthy tissues usually contain many different types of cells grouped
together. If the cancer looks similar to the healthy tissues and contain different cell groupings,
it is called differentiated or a low-grade tumour. If the cancerous tissue looks very different
from healthy tissue, it is called poorly differentiated or a high-grade tumour. The cancers
grade can help the doctor predict how quickly the cancer will spread. In general, the lower the
tumours grade, the better the prognosis.

1. GX
2. G1

The tumour grade cannot be evaluated

The tumour cells are well differentiated (contain many healthy-

3. G2

looking cells)
The tumour cells are moderately differentiated (more cells

4. G3

appear abnormal than healthy)

The tumour cells are poorly differentiated (most of the cells

5. G4

appear abnormal)
The tumour cells are undifferentiated (the cells barely resemble
healthy cells)

Vaginal caner stage grouping

Once the T, N and M categories have been assigned, this information is combined to assign
and overall stage in a process called Stage grouping. The stages identify tumours that have a
similar outlook and are treated in a similar way.

Stage 0 (Tis, N0, M0)

In this stage, the cancer cells are only in the top layer of the cells lining the
vagina, (epithelium) and have not grown into the deeper layers of the vagina.
Cancers of this stage cannot spread to other parts of the body. Stage 0 vaginal

cancer is also called carcinoma in situ (CIS) or vaginal neoplasis 3 (VAIN 3).
Stage I (T1, N0, M0)
The cancer has grown through the top layer of cells but it has not grown out of
the vagina and into nearby structures. It has not spread to nearby lymph nodes

or to distant sites.
Stage II (T2, N0, M0)
The cancer has spread to the connective tissues net to the vagina but has not
spread to the wall of the pelvis or to other organs nearby. It has not spread to
the nearby lymph nodes or to distant sites.

Stage III
Vaginal cancer is either of these conditions;
- T3, any N, M0
The cancer has spread to the wall of the pelvis. It may or may not
have spread to nearby lymph nodes but it has not spread to distant
sites.
-

T1 or T2, N1, M0
The cancer is in the vagina and it may have grown into the
connective tissue nearby. It has spread to lymph nodes nearby but
has not spread to distant sites.

Stage IVA (T4, any N, M0)

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The cancer has grown out of the vagina to organs nearby such as the bladder
or rectum. It may or may not have spread to lymph nodes but has not spread to
distant sites.

Stage IVB (any T, any N, M1)

The cancer has spread to distant organs such as the lungs.

TYPES OF VAGINAL CANCER

Vaginal cancer is of two main types.
1. Squamous cells carcinoma
This is the most common vaginal cancer found in women. About 70 of every 100 cases of
vaginal cancer are squamous cells carcinomas, (American Cancer Society).This cancer begins
in cells that make up the epithelia living of the vagina. This is more common in the upper
area of the vagina around the cervix. This type of vaginal cancer develops slowly. First, some
of the normal vaginal cells get pre-cancerous changes then later turn into cancer cells. This
process can take many years.
The medical term most often used for this pre-cancerous condition is Vaginal Intraepithelial
Neoplasia (VAIN). Intraepithelial means that the abnormal cells are only found in the surface
layer at the vaginal skin (epithelium). There are three types VAIN.
VAIN 1, VAIN 2, VAIN 3, with VAIN 3 indicating furthest progression toward true cancer.
VAIN is more common women who had their uterus removed (hysterectomy) and in those
who were previously treated for cervical cancer. In the past, the term dysplasia was used
instead of VAIN.
5

2. Adernocarinoma
This cancer begins in glandular cells. Glandular cells in the living of the vagina make and
release fluid such as mucus. About 15 of every 100 cases of vagina cancer are
adenocarcinomas. The usual type of vaginal adenocarcinoma typically develops in woman
older than 50 years. One type, called clear cell adenocarcinoma occurs more often in young
women who were exposed to diethylstilboestrol (DES) when they were in their mothers
womb.
Adenocarcinoma is more likely than squamous cell cancer to spread to the lungs and lymph
nodes.

3. Melanoma
Melanomas develop from pigment producing cells that give skin its colour. These cancer are
usually found on sun-exposed areas of the skin but can form in the vagina or other internal
organs. About nine of every 100 vaginal cases are melanomas. It tends to affect the lower or
outer particular of the vagina. The tumours vary greatly in size, colour and growth pattern.

4. Sarcomas
Sarcomas are cancers that begin in the cells of bones, muscles or connecting tissues. Up to
four of every 100 cases of vaginal cancer are sarcomas. They form deep in the wall of the
vagina but not on the surface. There are several types of vaginal sarcomas.
Rhabdomyosarcoma is the most common type of vaginal sarcoma and its mostly found in

children and rare in adults. Leiomyosarcoma is seen more in adults who are older than age of
50.

CAUSES
The cause of vaginal cancer is idiopathic.

PATHOPHYSIOLOGY
Pathophysiology deals with the study of the biological and physical manifestations of a
disease as they correlate with the underlying abnormalities and physiological disturbances. It
does not deal directly with the treatment of a disease. Rather, it explains the processes within
the body that result in signs and symptoms of the disease. In general, cancer begins when
healthy cells acquire a genetic mutation that turns normal cells into abnormal ones. Cancer
cells grow and multiply out of control and they dont die. The accumulation of the abnormal
cells form a tumour. Cancer cells invade tissues nearby and can break off from an initial
tumour to spread elsewhere in the body (metastasize).

RISK FACTORS
A risk factor is anything that can increase the chances of someone developing a disease.
Different cancers have different risk factors. Having one or more risk factors does not imply
that one will definitely acquire vaginal cancer. There are some people that have one or more
risk factors but do not contract the disease.

Age

The risk of women getting vaginal cancer increases as they grow older. That is to say,
vaginal cancer is more common in older women. Almost 40 out of every 100 cases of
vaginal cancer occur in women aged 75 and over but very rare in women below the
age

of 40 years.

Being exposed to Diethylstilboestrol (DES)

DES is a drug the doctors sometime administer to pregnant women in the past to stop
them from miscarriage. The female children of such mothers who took DES during
pregnancy, especially in the first trimester, are more likely to develop vaginal cancer.
The type of the vaginal cancer they can develop is Clear cell adenocarcinoma.
The female children of women who took DES while pregnant are most likely to
acquire

vaginal cancer in their late teens or twenties but cases have also shown that

women in

their 40,s can also acquire the disease. Colposcopy is indicated for all women

exposed

to this medication in utero. If colposcopic examination discloses adenosis or a

signicant cervical lesion, follow-up is essential.

-

Human papilloma virus (HPV) infection

This is a common infection which is passed from one person to another through
sexual contact. For some people, the virus is harmless and can go away without any medical
treatment. HPV is present in almost three quarters of women who have vaginal cancer.
HPV causes vaginal intraepithelial neoplasia (VAIN). Women with VAIN have an
8

increased risk of vaginal cancer. In women with VAIN, cells in the vagina appear
different from normal cells but not different enough to be considered cancer. A small
number of women with VAIN will eventually develop vaginal cancer.
HPV can also cause cervical cancer, vulvar cancer among others. Vaccines that
prevent some types of HPV are now available.
-

History of cervical cancer

Women who have had cervical cancer or precancerous changes in their cervical cells
have an increased risk of developing vaginal cancer.
-

HIV infection

Women with HIV infection or AIDS may have an increased risk of vaginal cancer.
This

may be due to the HIV or AIDS ability to lower or weaken the bodys immune

system,

making the body less able to overcome HPV infection.

Other risk factors include

Smoking
Having multiple sexual partners
Early age at first intercourse

SIGNS AND SYMPTOMS

Precancerous conditions such as VAIN and early-stage vaginal cancer do not often cause
symptoms in the early stages, but cancer in advanced stages can cause symptoms. However,

many cases of VAIN and early vaginal cancer can be found through regular gynaecologic
examinations or pap tests.
Women with vaginal cancer may experience the following signs and symptoms.

Abnormal vaginal bleeding

Abnormal vaginal discharge
Difficulty or pain when urinating
Pain during sexual intercourse
Pain in the pelvic area
Swelling in the legs or leg oedema
Lump or mass in the vagina

DIAGNOSTIC INVESTIGATION
Doctors use many tests to diagnose the cancer and find out if it has spread to other parts of
the body. Some tests may also determine which treatments may be the most effective. For
most types of cancer, a biopsy is the only way to make a definitive diagnosis. If a biopsy is
not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests
may also be used to find out whether the cancer has spread. The following factors may be
considered when choosing a diagnostic test.
-

Age and medical condition

Type of cancer suspected

Signs and symptoms

Previous test results

In addition to physical examination, the following test may be used to diagnose vaginal
cancer.

Pelvic examination

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The doctor feels the uterus, vagina, ovaries, fallopian tubes, bladder and rectum to
check for unusual changes.
The doctor or nurse inserts one or two lubricated, gloved fingers of one hand into
the vagina and places the other hand over the lower abdomen to feel the size,
shape, and position of the uterus and ovaries. A speculum is also inserted into the
vagina and the doctor or nurse looks at the vagina and cervix for signs of disease.
The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel
for lumps or abnormal areas.

Pap test

The doctor gently scraps the outside of the cervix and vagina and takes a sample of
cells

for testing.

Colposcopy

The doctor may do a colposcopy to check the vagina and cervix for any abnormalities.
A colposcopy is a special instrument that magnifies the cells of the cervix and vagina,
similar to a microscope. The colposcopy gives the doctor a lighted, magnified view of
the tissues of the vagina and cervix. The colposcopy is not inserted into the womans
body and the examination is not painful.

Biopsy

A biopsy is the removal of a small amount of tissue for examination under a

microscope. Other test can suggest that cancer is present but only a biopsy can make a
definite diagnosis. The sample removed during the biopsy is analysed by a

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pathologist.

The type of biopsy performed will depend on the location of the tissue been

biopsied.

X ray

An X ray is a way to create a picture of the structures inside the body using a small
amount of radiation. If vaginal cancer is diagnosed, a plain x ray of the chest may be
done to see if the cancer has spread to the lungs. This is unlikely unless the cancer is
far advanced.

Endoscopy

This test allows the doctor to see inside the body with a thin, lighted, flexible tube
called an endoscope. The person may be sedated as the tube is inserted through the mouth,
anus, vagina, urethra or a small surgical opening.

Computed Tomography (CT) scan

A CT scan creates a three-dimensional picture of the inside of the body with an x

ray

machine. A computer then combines these images into a detailed cross-sectional view
that shows any abnormalities or tumour. A CT scan can also be used to measure the
size of the tumour. Sometimes a special dye called a contrast medium is given before
the scan to provide better detail on the image. This dye can be injected into a patients
vein or given as a pill to swallow.

Magnetic Resonance Imaging (MRI)

MRI scans use radio waves and strong magnets instead of x rays to make images of
the body. The energy from the radio waves is absorbed by the body and then released
in a specific pattern formed by the type of tissue and by certain diseases. A computer
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translates the pattern into a detailed image of parts of the body. Like CT scanner, this
produces cross-sectional slices of the body. An MRI can also produce slices that are
parallel with the length of the body. MRI scans are more uncomfortable than CT scans
in that, they take longer time. A patient is placed inside a tube-like equipment. This is
confining and can upset people with claustrophobia (a fear of closed spaces).
Sometimes medicine can be given just before the scan to reduce anxiety. MRI images
are useful in examining pelvic tumours. They may show enlarged lymph nodes in the
groin. They are also helpful in finding cancer that has spread to the brain or spinal
cord.

Position Emission Tomography (PET)

Position Emission Tomography uses glucose that contains a low-level radioactive

atom. Because cancer cells use glucose at a high rate than normal cells, they absorb more of
the radioactive sugar. The areas of radioactivity are detected with this test.
A patient is injected with a special glucose and then about an hour later, moved onto a
table in the PET scanner. The scanner has a camera which creates a picture of areas of
radioactivity in the body. The picture is not finely detailed like a CT or MRI scan.
The test is helpful in spotting collections of cancer cells and seeing if the cancer has
spread.

Cystoscopy

It is procedure that looks at the inside of the bladder. It is done to check for spread of
vaginal cancer to the bladder. A patient may be given an intravenous drug to make her
drowsy. A thin tube with a les and light is inserted into the bladder through the
urethra.

If suspicious areas or growths are seen, a biopsy will be done. A cystoscopy is

13

recommended if a vaginal cancer is large and/or located in the front wall of the
vagina,

near the bladder.

INCIDENCE
Before 1970, vaginal cancer occurred primarily in postmenopausal women. In the 1970s, it
was shown that maternal ingestion of DES affected female offspring who were exposed in
utero. Benign genital tract abnormalities have occurred in some of these young women.
Vaginal adenosis (abnormal tissue growth) may also occur. The risk for clear cell tumour
related to DES exposure is 0.14 to 1.4 in 1,000 women.
.
MEDICAL AND SURGICAL MANAGEMENT
Treatment of early lesions may be local excision or administration of a chemotherapeutic
cream (ie, 5-uorouracil applied with a tampon or a diaphragm). Cotton balls placed at the
introitus lessen spillage, which otherwise can result in perinea irritation.
If a patient is having a combination of radiotherapy and chemotherapy together for early
stage cancer, she is likely to be given cisplatin as a single drug. For advanced cancer, it is
most common to have two or more chemotherapy drugs together. The treatment is usually
once every three or four weeks with a break afterwards. Some examples of drugs for vaginal
cancer include;
-

fluorouracil

Cisplatin

Carboplatin

Paclitaxel (taxol)

Topotecan

14

Gemcitabine

Bleomycin

Ifosfamide

Etoposide

Surgery is usually used for small stage I tumours and for caners that were not cured by
radiation. Surgery is not often used to treat squamous cell cancers of the vagina but it is used
for sarcomas and melanomas.
The extent of the surgery depends on the size and stage of the cancer.

Local excision

In this procedure, the surgeon removes the cancer along with a surrounding rim of
normal tissue. This is sometimes called a wide excision. For VAIN, a local excision
may be all that is needed.

Vaginectomy

Vaginectomy is surgery to remove the vagina. If only part of the vagina is removed, it
is called a partial vaginectomy but the removal of the entire vagina is total
vaginectomy. A radical vaginectomy is removal of the vagina along with the supporting
tissues around it.

Trachelectomy

Vaginal caner is most often found in the upper part of the vagina, so removing the
cancer also sometimes means removing the cervix. If only the cervix is removed, it is
called trachelectomy. This surgery is rarely used to treat vaginal cancer.

15

Hysterectomy

Sometimes to remove a vaginal cancer, the uterus and cervix must be removed as well
as all or part of the vagina. This is known as hysterectomy or Total hysterectomy
(TH). In operations done for cancer, the connective tissue that surrounds and supports the
uterus is often removed as well. In that case, the operation is a radical hysterectomy.
In

either case, there are two major ways of removing the uterus.
1. Removing the uterus through the vagina. (vaginal hysterectomy, VH)
2. Removing the uterus through an incision in the abdomen. (abdominal
hysterectomy or total abdominal; hysterectomy, TAH)
If a radical hysterectomy is done as part of your treatment, you may need to have a
catheter to drain the bladder for a time after surgery.

Vaginal reconstruction

If all or most of the vagina must be removed, it is possible to reconstruct the vagina
with tissue from another part of the body. This will allow a woman to still have sexual
intercourse. A new vagina can be surgically created out of skin, intestinal tissue or
myocutaneous (muscle and skin) grafts. A reconstructed vagina produces little or no
natural lubricant when a woman becomes sexually excited.

Lymphadenectomy

This is surgery done to remove lymph nodes. Sometimes it is called lymph node
dissection. For vaginal cancer, lymph nodes from the groin area or from inside the
pelvis near the vagina may be removed to check for cancer spread. Removing lymph
nodes in the groin or pelvis can result in poor fluid drainage from legs. The fluid
builds up leading to leg swelling that is severe and doesnt go down at night when

16

lying down. This is called lymphedema. This is more common if radiation is given
after surgery. Support stockings or special compression devices may help reduce
swelling. Women with lymphedema need to be very careful to avoid infection in the
affected leg or legs.

Pelvic exenterating

This is an extensive operation that includes vaginectomy and removing the pelvic
lymph nodes as well as one of one or more of the following structures; lower colon,
rectum, bladder, uterus and cervix. How much has to be removed depends on the
extent of spread of the cancer. If the bladder is removed, a new way to store and to get rid of
urine is needed. A short segment of intestine is usually used to function as a new
bladder. This may be connected to the abdominal wall so that urine is drained
periodically when he woman places a catheter into a small opening (urostomy). The
urine may also be drained continuously into a small plastic bag attached to the front of
the abdomen over the opening.
If the rectum and part of the colon are removed, the remaining intestine is attached to
the abdominal wall so that stool can pass through a small opening (colostomy) into a
small plastic bag worn on the front of the abdomen.

HOME CARE

Emotional support for mothers and daughters is essential. As such we encourage

relatives especially the partner to support the spouse.

For young women who have had vaginal reconstructive surgery, specic vagina-

dilating procedures may be initiated and taught.

Water-soluble lubricants are helpful in reducing painful intercourse (dyspareunia).
Some brands of the water soluble lubricants are, KY Jelly, maximus and wet.
17

NURSES DIAGNOSIS
Nursing diagnosis is the clinical judgement about an individual, family or community
experiences to actual or potential health problems. Nursing diagnosis provides the basis for
selection of nursing interventions to achieve outcomes for which the nurse has accountability.
It is important to perform a through head to toe assessment including related history to
establish a baseline of health and note any changes to prevent complications.
The following must be monitored or anticipated by the nurse.
-

vital signs

height and weight

family history

patient history

pap smear

pain

colposcopy (biopsy)

hysteroscopy

cervical conisation

Nursing diagnosis for vaginal cancer include

-

decisional conflict

chronic and acute pain

risk for impaired skin integrity

fear

anticipatory grieving

The expected outcomes of the diagnosis include;

18

to gain knowledge to make informed decisions about treatment options

to develop strategies for pain control

to maintain skin and tissue integrity during treatment

for the patient to express her feelings about the fear of cancer and death

to develop effective strategies for dealing with life-threatening illness and

pain.

Nursing interventions
-

during intracavitary radiation, check radioisotope applicator position every 8

hours and monitor amount of bleeding and drainage.

observe for signs and symptoms of radiation sickness such as nausea,

vomiting, fever, diahoroea, abdominal cramping.

monitor for complications of surgery bleeding and infection.

help the patient seek information on stage cancer and treatment options

provide emotional support during treatment

advise patient on discharge after surgical procedures and need to report

excessive, foul-smelling discharge or bleeding

explain the importance of life-long follow-up regardless of treatments to

determine the response to treatment and to detect spread of cancer

COMPLICATIONS
Complications of vaginal cancer can occur as side effects of treatment or as the result
of advanced vaginal cancer.

Pain

If the cancer spreads into the nerve endings, bones or muscles, it can often
cause severe pain. A number of effective painkilling medications can usually be used
19

to control the pain. Depending on the level of pain, they can range from
paracetamol and non-steroidal anti-inflammatory drugs (NSAIDSs) such as
ibuprofen to more powerful opiate-based painkillers, such as codeine and
morphine.

Kidney failure

The human kidney is responsible for the removal of waste materials from the
blood. The waste is passed out of the body in urine through tubes called
ureters.

Kidney function can be monitored by a simple blood test called serum

creatinine

level. In some cases of advanced vaginal cancer, the cancerous tumour

can press

against the ureters, blocking the flow of urine out of the kidneys. The

build-up

of urine inside the kidneys is known as hydronephrosis and can cause

the

kidneys to become swollen and stretched.

Severe cases of hydronephrosis can cause the kidneys to become scarred,

which can lead to loss of most or all of the kidneys functions. This condition is
known as kidney failure. Kidney failure can cause a wide range of symptoms,
including;
-

tiredness

swollen ankles, feet or hands, caused by water retention

shortness of breath

blood in urine (haematuria)

Treatment options for kidney failure associated with cervical cancer include
draining urine out of the kidneys using a tube inserted through the skin and
into

the kidney (percutaneous nephrostomy). Another option is to widen the ureters

by placing a small metal tube called a stent inside them.
20

Blood clots

As with other types of cancer, vaginal cancer can make the blood stickier and
more prone to forming clots. Bed rest after surgery and chemotherapy can also
increase the risk of developing a clot. Symptoms of blood clot in the legs
include;
-

pain, swelling and tenderness in one of the legs, usually the calf.

a heavy ache in the affected area.

warm skin in the area of the clot.

redness of the skin, particularly at the back of the leg below the knee.

A major concern in these areas is that the blood clot from the leg vein will
travel up the lungs and block the supply of blood. This condition is known as
pulmonary embolism and this can be fatal.
Blood clots in the legs are usually treated using a combination of blood
thinning

medication such as heparin or warfarin, and compression garments

designed to

help encourage the flow of blood through the limbs.

Bleeding

If the cancer spreads into the bowel or bladder, it can cause significant
damage,

resulting in bleeding. Bleeding can occur in the vagina or rectum or

may result

in blood-stained urine.

Minor bleeding can often be treated using tranexamic acid, which encourages
the blood to clot and stop the bleeding. Radiotherapy can also be highly
effective in controlling bleeding caused by the cancer. Major bleeding may be

21

treated temporarily by vaginal packing (using gauze to stem the bleeding) and
later by surgery, radiotherapy or by cutting off blood supply to the cervix.

Vaginal discharge

Another uncommon, but distressing complication of advanced vaginal cancer

is

an unpleasant-smelling discharge from the vagina. The discharge can occur for
a number of reasons, such as the breakdown of tissue, the leakage of bladder

or

bowel contents out of the vagina or a bacterial infection of the vagina.

Treatment options for vaginal discharge include an anti-bacterial gel called
metronidazole and wearing clothing that contains charcoal. Charcoal is a
chemical compound that is very effective in absorbing unpleasant smells.

Side effects
Early menopause
The ovaries are surgically removed or they are damaged during treatment with
radiotherapy, it will trigger an early menopause. Most women experience the
menopause in their early fifties. The menopause is caused when the ovaries stop
producing the hormones oestrogen and progesterone resulting in menopausal
symptoms.

Narrowing of the vagina

Radiotherapy treatment of vaginal cancer can cause the vagina to become narrower,
which can make sexual intercourse painful and difficult for women. There are two
main treatment options if the vagina becomes narrow.

22

The first is the application of hormonal cream to the vagina. This would increase the
moisture within the vagina and make having sex easier.
The second is the use of a vaginal dilator, which is a tampon-shaped device made of
plastic. It is inserted I to the vagina and is designed to help make it more supple. It is
usually recommended that the dilator is inserted for five (5) to ten (10) minutes at a
time on a regular basis during the over the course of six (6) to twelve (12) months.
Many women discussing the use of a vaginal dilator is embarrassing but it is a
standard and well-recognized treatment for narrowing of the vagina.

Lymphoedema
If the lymph nodes in the pelvis are removed, it can sometimes disrupt the normal
workings of the lymphatic system. One of the functions of the lymphatic system is to
drain away excess fluid from the bodys tissue. A disruption to this process can lead to
a build-up of fluid in the tissue. This is known as lymphoedema. This can cause
certain body parts to become swollen.
There are exercises and massage techniques that can reduce the swelling. Wearing
specially designed bandages and compression garments can also help.

TREATMENT
In cancer care, different types of doctors work together to create a patients overall treatment
plan that involves different types of treatments. This is called a multidisciplinary team.
Patients are also encouraged to consider clinical trials as an option. A clinical trial is a
research study to test a new approach to treatment to evaluate whether it is safe, effective and

23

possibly better than the standard treatment. Clinical trials may test such approaches as a new
drug, a new combination of standard treatments or new doses of current therapies.
Treatment options and recommendations depend on several factors, including the type and
stage of the cancer, possible side effects and the patients preferences and overall health.
Vaginal cancer is most often treated with one or a combination of treatments. This include;
surgery, radiation therapy and chemotherapy.
Surgery
Surgery is the primary treatment for vaginal cancer. The surgery removes the tumour ad
surrounding tissues and it depends on the stage of the cancer and other factors. Surgical
options include;
-

laser surgery

excision

vaginectomy

hysterectomy

pelvic exenteration

Trachelectomy

Vaginal reconstruction

Lymphadenectomy

Radiation therapy

It is the use of high-energy x rays or other particles to destroy cancer cells and it is
done by a radiation oncologist. Radiation therapy may be used alone or after surgery.
24

The most common type of radiation treatment is external-beam radiation therapy. It is

type of radiation given from a machine outside the body.
When radiation treatment is given using implants, it is called internal radiation
therapy

or brachytherapy. One method is intracavity radiation therapy in which tiny

tubes of a radioactive substance are placed in the vagina for one to two days. The woman
must

stay in bed during this time.

Another method is interstitial radiation therapy in which radioactive material in

injected

directly into the tumour.

Chemotherapy

It is the use of drugs to destroy cancer cells, usually by stopping the cancer cells
ability to grow and divide. Chemotherapy is given by a medical oncologist. The goal
of chemotherapy can be to destroy cancer remaining after surgery, slow growth
tumour or reduce side effects. A patient may receive one drug at a time or
combinations of different drugs at the same time.
Systematic chemotherapy is delivered through the blood stream to reach cancer cells
throughout the body. Although chemotherapy can be given orally, most drugs are
given intravenously (IV) for vaginal cancer. IV chemotherapy is either injected
directly into the vein or through a catheter. Intravaginal chemotherapy ( drugs that are
put directly into the vagina) may be used to treat early-stage vaginal cancer.

Treatment options by Stage

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 Stage 0
- Surgery to remove all or part of the vagina
- Internal radiation therapy
- Laser surgery
- Intravaginal chemotherapy
Stage I (squamous carcinoma)
- Internal radiation therapy
- Removal of the tumour with possible radiation therapy
- Removal of the vagina with or without lymph nodes
Stage I (adenocarcinoma)
- Radical hysterectomy with the removal of the lymph nodes and possible

radidiation therapy
- Internal radiation therapy with or without external-beam radiation therapy
- Removal of the tumour and lymph nodes followed by internal radiation therapy.
Stage II
- Combined internal radiation therapy and external-beam radiation therapy
- Surgery, followed by possible radiation therapy
Stage III
- Combined internal radiation therapy and external-beam radiation therapy
- Surgery, followed by possible radiation therapy
Stage IVA
- Combined internal radiation therapy and external-beam radiation therapy
- Surgery followed by possible radiation therapy
Stage IVB
- Radiation therapy
- Chemotherapy

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