Vaginal cancer is a rare cancer of the female reproductive system. Only three percent of gynecological cancers are vaginal. The vagina (birth canal) is the corridor through which menstrual fluid leaves the body and babies are born. It is connected to the cervix (the opening of the uterus or womb) and the vulva (folds of skin around its opening). The vaginal walls have a thin layer of cells called the epithelium, which contains a type of cells called squamous epithelial cells. The vaginal wall, underneath the epithelium, consists of connective and involuntary muscle tissue, lymph vessels, and nerves.

Usually, the vagina is in a collapsed position with its walls touching. The walls have many folds that allow the vagina to open and expand during sexual intercourse and childbirth. The vaginal lining is kept moist by mucus released by glands in the cervix.

Statistics

Vaginal cancer is rare. In the United States, approximately 2,160 new cases of vaginal cancer are expected to be diagnosed, and an estimated 790 women will die of the disease in 2004.

Cancer statistics should be interpreted with caution. These estimates are based on data from thousands of cases of this type of cancer in the United States and may not apply to a single person. It is not possible to tell a person how long she will live with vaginal cancer. Because the survival statistics are measured in five-year (or sometimes one-year) intervals, they may not represent advances made in the treatment or diagnosis of this cancer.

There are several types of vaginal cancers:

Squamous Carcinoma - Squamous cell cancer starts in the vagina’s epithelial lining, most often in the area closest to the cervix. Squamous cancers make up 85 to 90 percent of vaginal cancers. It develops slowly through pre-cancerous changes called vaginal intraepithelial neoplasia (VAIN).

Adenocarcinoma - This cancer may develop in tissues of vaginal glands. It accounts for 5 to 10 percent of vaginal cancers

Clear Cell Adenocarcinoma - This cancer occurs in young women whose mothers took the drug diethylstilbestrol (DES) during pregnancy between the late 1940’s and 1971. About one woman in 1,000 exposed to DES develops vaginal cancer.

Melanoma - Melanomas are the most serious type of skin cancer. They are usually found on skin exposed to the sun, but can begin on the skin of the vagina or other internal organs. Dark-colored tumors appear on the lower or outer parts of 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.

As we well know, there are many kinds of cancer; unfortunately they all come about because of the out-of-control growth of abnormal cells.