Cancer of the vagina or vulva

Vulvar or vaginal cancer affects a fairly small number of women, making it a rare type that needs to be treated by a specialized medical team.

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What is vaginal or vulvar cancer?

Cancer of the vulva or vagina originates in the cervix (lower part of the uterus) and spreads to the vulva (external female genitalia).

Structurally, the vagina is made up of folds that touch each other, which open and expand during childbirth and during sexual intercourse.

As it is made up of several types of tissues and cells, there is a lining of flat cells (squamous cells), also known as epithelium, where cancer mainly develops.

Below the epithelium, the vaginal wall is composed of nerves, muscle tissue, connective tissue, and lymphatic vessels.
Also, mucus in the vagina is produced by glands near the opening, which keeps the lining of the vagina lubricated.

Vulvar or vaginal cancer is a rare type of cancer, which according to statistics is prevalent in women over 60 years of age, who have had infection with human papillomavirus (HPV).

Causes of vaginal or vulvar cancer

The causes of vulvar cancer continue to be studied, as there is no certainty as to why some people develop a tumour and others do not.

However, there are a number of risk factors that increase the likelihood of vaginal cancer.
These include:

Being infected with the human papillomavirus (HPV).
Having had some other type of cancer (such as uterine cancer).
Suffering from an immunosuppressed disease such as HIV, which causes AIDS.
Having chronic burning in the vaginal area for a long period of time that has not been treated.
Frequent tobacco use.

Symptoms of vaginal or vulvar cancer

In its early stages, the symptoms of vaginal cancer they are practically non-existent.
However, as the disease has progressed, it is possible to detect discomforts such as:

Vaginal bleeding that is not normal or related to menstruation.
Recurrent pelvic pain.
Frequent need to go to the bathroom.
Change in color and odor in urine and stool.
Burning and itching in the vulva.
Change in skin color (redness or paleness in the area).
Appearance of warts or irritation.
Wounds on the vulva that do not heal (ulcers, lumps, or sores).
Discomfort during sexual intercourse.

Vaginal or vulvar cancer diagnosis process

Generally, the specialist starts with a pelvic exam and a Pap smear that allow him to detect any abnormality.

Based on this, it is likely that complementary tests will be requested that will help to specify a definitive diagnosis; as well as the corresponding approach and treatment strategies.

Thorough inspection

This procedure is carried out by inserting a special instrument into the vagina, made up of a beam of light and a magnifying glass called a colposcope.

With this, the specialist can observe the appearance of the surface of the vagina and detail any areas with abnormal cells.

During the pelvic exam, the specialist examines the external genitalia (vulva) in detail, then inserts two fingers of one hand into the vagina and in turn presses the abdomen with the other hand to be able to feel the ovaries and uterus.

Imaging studies

Firstly, by applying chest X-rays, it is possible to visualise whether cancer cells have spread to other organs such as the lungs or digestive tract.

On the other hand, CT and MRI can provide more accurate information about the inside of the body in the region of the pelvis and abdomen.

In particular, positron emission tomography is more focused on finding malignant tumor cells in the body.

To do this, the patient is given a small amount of radioactive glucose, so that it can be detected by the scanner that rotates around the body, to create an image that reflects the places that use glucose.

Consequently, malignant tumor cells look bright as they are activated by absorbing more glucose than normal cells.

Biopsy of the vagina or vulva

In this procedure, a sample of vaginal tissue is taken for testing.
This sample is mostly taken during a colposcopy.

Treatments for vaginal or vulvar cancer

There are several treatment options for vaginal or vulvar cancer, some more commonly used than others.

Surgery

Within this treatment, it is possible to apply various techniques, including:

Laser surgery: It allows part of the tumor to be removed, avoiding bleeding in the tissue or removing a superficial lesion.
Wide local excision: Removes the cancer and the normal tissue around it.
Vaginectomy: The entire vagina or a good part of it is removed.
Hysterectomy: The uterus and cervix are removed.
Lymph node dissection: This is the removal of lymph nodes, either those in the pelvis or groin.
Pelvic exenteration: This consists of the removal of the lower colon, rectum, cervix, vagina, ovaries, and bladder.

Radiotherapy

It is a treatment that involves using high-energy X-rays to destroy cancer cells and prevent them from dividing.
There are two types of radiation therapy:

External; where radiation is sent from the outside of the body to the area of the cancer.
Internal; which uses a radioactive substance sealed in needles, wires, catheters, or seeds that are placed directly into the cancer.

Chemotherapy

Another form of treatment involves the controlled administration of certain drugs to stop the formation or growth of cancer cells.
This type of drug can be indicated orally, intravenously injected or intramuscularly.

Immunotherapy

It is also known as biological therapy, in which case substances developed by the body or by a laboratory are used to direct or restore the body’s natural defenses.

Radiosensitizers

These drugs make tumor cells more vulnerable and sensitive to radiation therapy, so they can kill cancer cells faster.

Importance of early detection of vaginal or vulvar cancer

Diagnosing vaginal or vulvar cancer early allows you to find more treatment options and obtain better results.

That is why, in the case of women, emphasis is placed on routine periodic check-ups with the gynecologist, as it is the right space to pay attention to any alert situation.

Stages of vaginal or vulvar cancer

Like all types of cancer, vulvar cancer is classified according to the degree of progression of the disease at the time of detection.

Stage I

At this stage, only the cancer is seen on the wall of the vagina.
It has a survival rate of 66% in 5 years.

Stage II

By this stage we already have the presence of spread through the wall of the vagina to the surrounding tissue.
Even so, the cancer has not spread to the pelvis; since a survival rate of 50% in 5 years is managed.

Stage III

We already have spread in the wall of the pelvis, affecting the surrounding lymph nodes.
This consequently brings a greater affectation, generating a survival rate of 25% in 5 years.

Stage IV

In this last stage, there is already a great spread of cancer cells, which at the metastatic level have reached the bladder, uterus, ovaries, cervix, lungs and bones.
The survival rate in these patients is 15% in 5 years.

Types of cancer that affect the vagina or vulva

Vaginal cancer o vulva is classified based on the type of cell where it originated.
Common types include:

Squamous cell carcinoma

It originates from the thin, flat cells that line the vagina.

Adenocarcinoma

It develops in glandular cells in the vaginal area.

Melanoma

It has its point of development in the melanocytes (pigment cells of the vagina).

Sarcoma

It tends to develop and originate in the connective muscle tissue cells that make up the walls of the vagina.

Nursing care for patients with vaginal or vulvar cancer

Nursing care has the fundamental objective of improving the quality of life of patients suffering from vulvar or vaginal cancer.

Some important care nurses can provide during treatment include:

How to prevent vaginal or vulvar cancer?

Although there is no proven way to avoid it, it is possible to take some steps to reduce the risks:

Avoid tobacco use
Getting the HPV vaccine
Regularly go for a medical check-up
Do routine tests or exams (Pap smears)

Frequently asked questions

Check out the answers to these frequently asked questions and get additional information about vulvar cancer.

At what stage does vaginal or vulvar cancer become terminal?

In stage IV, due to the extent and distance of vaginal cancer from its point of origin. This distant spread or spread is called metastasis.

Is vaginal or vulvar cancer hereditary?

Currently, scientists continue to rely on the relationships between several risk factors to advance in their research; however, to date there is no direct link between vulvar cancer and family inheritance.

What do I do if I have symptoms of vaginal or vulvar cancer?

It should be noted that if any of the symptoms or signs mentioned above manifest, it does not mean that you are positive for vaginal or vulvar cancer.

In fact, some of these manifestations are caused by an infection or other pathology. What is certain is that in case of doubt, it is best to go to a specialist doctor.

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