A vaginal tumor is an abnormal growth of tissue in the vagina, one of the female reproductive organs.
The vulva is the outer part of the female genitals. The vulva includes the opening of the vagina, the clitoris, and the labia majora and labia minora, which are the two sets of skin folds protecting the opening of the vagina. Vulvar cancer most often affects the inner edges of the labia majora or the labia minora. Rarely, the cancer can occur on the clitoris or small glands found just inside the opening of the vagina, called the Bartholin glands.
Causes of Vaginal Cancer
Most cancerous vaginal tumors occur when another cancer, such as cervical or endometrial cancer, spreads. This is called secondary vaginal cancer. Primary vaginal cancer, which starts growing in the vagina, is very rare.
Women whose mothers took diethylstilbestrol (DES) during the first three months of pregnancy are at increased risk for developing adenocarcinoma (a type of cancer that begins growing in glandular tissue).
Causes of Vulvar Cancer
Vulvar cancer most often develops in one of two ways:
- In many women with vulvar cancer, human papilloma virus (HPV) is a cause. This kind of vulvar cancer tends to strike women who are younger and are often smokers.
- The other way vulvar cancer can develop does not involve HPV and is connected to genetics. DNA tests from vulvar cancers in older women show a mutation of a certain gene. This gene normally prevents cells from becoming cancerous; when it is mutated, it allows for cells to become cancerous. This type of vulvar cancer affects women age 55 and older.
Risk Factors for Vaginal and Vulvar Cancer
There are certain risk factors for vulvar cancer. However, keep in mind that many women with these risk factors will never develop vulvar cancer, and there are women with none of these risk factors who will develop the cancer. Risk factors include:
- Age - The risk increases as a woman ages
- Human Papilloma Virus (HPV) - HPV infection is thought to cause up to half of vulvar cancers
- Human Immunodeficiency Virus (HIV) - The virus that causes acquired immunodeficiency virus (AIDS)
- Vulvar Intraepithelial Neoplasia (VIN) - A precancerous condition
- Lichen Sclerosus - A disorder which causes the vulvar skin to become very thin and itchy
- Other genital cancers
- Melanoma or atypical moles - Having these moles on other parts of the body leads to an increased risk of developing one on the vulva
Symptoms of Vaginal Cancer
- Bleeding after sexual intercourse
- Painless vaginal bleeding and discharge
- Pain in the pelvis or vagina
About five to 10 percent of patients have no symptoms.
Symptoms of Vulvar Cancer
- Itching that does not go away or get better
- A burning sensation
- Painful urination
- Bleeding and discharge not associated with your normal menstrual period
You may also notice certain abnormal growths on your vagina, such as:
- A growth that appears red, pink, or a white bump (or bumps) with a raw surface; it may also appear white and feel rough
- An open sore that does not go away after a month
- Cauliflower-like growths similar to genital warts
- A dark, pigmented growth
- A distinct lump on either side of the opening to the vagina
- Soreness and a red, scaly area.
If you notice any pain or abnormality, you should immediately make an appointment with your doctor. However, don't wait until you notice something-make sure you go for regular Pap tests and pelvic examinations.
Diagnosis of Vaginal and Vulvar Cancer
First, your doctor will take your complete medical history and perform a comprehensive physical examination. Your doctor will examine your uterus, ovaries, cervix and vagina for any abnormalities. He or she will also take a Pap smear.
In patients with no symptoms, the cancer may be found during a routine pelvic examination and Pap smear. If a Pap smear is abnormal, but the health care provider cannot see problems with the vagina during a pelvic exam, a colposcopy may be done. A colposcopy is a painless procedure in which your doctor uses a lighted microscope to view your cervix.
Further tests may include:
- Biopsy - The symptoms you are experiencing may be caused by vulvar cancer, or possibly by another, non-cancerous condition. The only way to be sure is to do a biopsy. Your doctor will remove a small piece of the affected tissue and examine it under a microscope. This way, your doctor can tell you if it is cancer, as well as the type of cancer.
- Further examinations - If your doctor confirms that the mass is cancerous, you will need more tests to find out how far the cancer has spread. A gynecologic oncologist may perform:
- Cystoscopy - Using a lighted tube to check the inside surface of the bladder
- Proctoscopy - Visual inspection of the rectum using a lighted tube
- Pelvic examination using anesthesia - A more thorough exam which can better see how the cancer has spread
- Imaging Tests -your doctor may also order imaging tests, including:
- Chest X-ray
- Computed Tomography (CT) Scan - An X-ray procedure that produces a more detailed view of your body
- Magnetic Resonance Imaging (MRI) - A procedure that uses radio waves and magnets to produce a detailed image of your body
- Positron Emission Tomography (PET) - Injects a small amount of radioactive sugar into your blood. Cancer cells absorb a large amount of the sugar, making it easier to spot tumors.
Treatment of Vaginal and Vulvar Cancer
Your doctor will first figure out the stage of your cancer, as the treatment options largely depend on the stage of the cancer at the time of diagnosis. The doctor will also take into account your age, general health and preferences.
There are many treatment options, including:
- Surgery - Your doctor will balance surgery and removal of the cancer with trying to retain sexual function.
- Radiation Therapy - Using high-energy rays to kill cancer cells. For treating vulvar cancers, external beam radiation therapy is used. During the treatment, radiation is delivered from outside the body, and may be used along with chemotherapy. If the tumor is cervical cancer that has spread to the vagina, then both radiation and chemotherapy are used.
- Chemotherapy - Anti-cancer drugs used to kill the cancer. The medicine can be given through an intravenous (IV) drip directly into your vein, can be taken by mouth, or can be applied to the skin as an ointment.
- Topical Therapy - The drug is applied directly to the cancer site. This is sometimes used to treat vulvar intraepithelial neoplasia (VIN; a precancerous condition), but it is not used to treat invasive vaginal cancer.