Vaginal cancer (vaginal carcinoma)

Vaginal carcinoma is a malignant tumour in the vaginal area, which mainly affects women over the age of 60. Relatively speaking, not many women suffer from vaginal cancer; vaginal carcinoma ranks only fifth in terms of the frequency of various tumours in women. The peak of the disease is between 60 and 70 years of age. The way in which the cancer develops is not yet known. However, it is known that HPV infections (human papilloma virus) promote the development of vaginal carcinoma.

In the case of vaginal cancer, different types of tumours can be distinguished. Among them, squamous cell carcinoma, which arises from the most superficial layer of the mucous membrane, is the most common tumor. In rare cases, however, vaginal carcinoma can also arise from the glands of the vaginal mucosa and is then called adenocarcinoma. Even rarer are tumors of the melanoma type (black skin cancer).

The causative factors of vaginal carcinoma are not fully known. However, it is certain that infections with the human papilloma virus can promote the development not only of cervical cancer but also of vaginal cancer. Human papilloma virus can be divided into different subtypes, including types with higher and lower cancer risk, and predominantly affects the female genitalia. The high-risk types alter the mucosal epithelium, leading to the development of vaginal intraepithelial neoplasia, which can degenerate into vaginal carcinoma.

Metastasis

Metastasis in vaginal cancer occurs primarily through the lymphatic channels, and in some cases through the blood vessels. For this reason, vaginal cancer more often spreads to the surrounding lymph nodes and does not form metastases in other organs as often as other cancers. When carcinomas are located in the upper or middle third of the vagina, the cancer usually spreads to the pelvic lymph nodes. In contrast, when tumors are located in the lower third of the vagina, metastases are found primarily in the lymph nodes of the groin region.

Vaginal cancer can also arise from the spread of other cancers, such as metastases from cervical cancer or renal cell carcinoma.

In the early stages of the disease, vaginal carcinoma does not cause any symptoms; only as the disease progresses and the tumour grows do the first symptoms appear. These include, above all, vaginal bleeding, which occurs frequently after sexual intercourse. Increased discharge, especially if it is mixed with blood, can also be a warning sign of vaginal cancer.

In addition, vaginal cancers in later stages can cause connections between the vagina and the urinary bladder and between the vagina and the rectum, which can lead to leakage of stool and urine through the vagina.

If the vaginal cancer affects adjacent tissues or organs, it may cause abdominal pain or discomfort during urination and defecation.

As a basic examination, the vagina is usually first examined by colposcope to look for suspicious changes in the mucosal epithelium. If changes are found, small tissue samples are taken, which allows the diagnosis to be made. Taking samples, also known as a biopsy, usually does not require general anesthesia.

In order to clarify whether the vaginal cancer has already affected other organs, such as the rectum or urinary bladder, an endoscopic examination is usually carried out. It is also possible that imaging procedures such as CT or MRT are used for so-called tumour staging, i.e. to determine the progress of the disease. For example, these examinations can be used to determine whether the pelvic lymph nodes have already been affected by tumour tissue. The lymph nodes in the groin region can be well assessed by ultrasound, which is preferred because it is easier to perform.

The treatment of vaginal carcinoma depends primarily on the progress and extent of the disease, as well as the age and physical condition of the patient. Treatment options include surgery in some stages, radiotherapy in others, or a combination of both.

If the tumour is too close to the cervix, a partial resection of the vagina is necessary. This involves radical removal of the uterus and removal of the surrounding lymph nodes.

In most cases, however, vaginal cancer is treated with radiation therapy, in which both the vagina and the lymph nodes are irradiated. Radiation therapy can be administered from inside the vagina or from outside the body. If other organs are already affected by metastases of the vaginal carcinoma, chemotherapy must also be considered.

The treatment of vaginal carcinoma can lead to constriction of the vagina, which can cause discomfort during sexual intercourse in some patients.

The prognosis of vaginal cancer is determined primarily by the progress of the disease, the type of tumor, as well as the age of the woman. The five-year survival rate of vaginal carcinoma is about 40 percent. Thus, vaginal carcinoma also has a lower cure rate than cervical cancer.

However, it should be mentioned that the chances of cure can vary greatly from woman to woman and the prognosis for each affected person must be determined individually.