Vaginal Cancer Treatment
List of Options For Treating Cancer Of The Vagina

Vaginal Cancer treatments

External Radiation Therapy

External Radiation Therapy

Vaginal Cancer Treatment

Contents

Introduction
Treatment By Stage Of Cancer
Explanation Of Treatments
Surgical Procedures
Vaginal Reconstruction After Surgery
What Follow Up Is Needed?


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Vaginal Cancer Guide

Introduction

After the diagnostic tests have been carried out (see vaginal cancer diagnosis), your healthcare team will recommend a plan of treatment. At this point it is important not to feel rushed into making a decision. Cancer of the vagina is rarely a medical emergency so taking a few weeks to consider your options should not be an issue. Like all cancer treatments, the type of therapies recommended will depend on the stage of cancer, its location and size. Other factors will include whether or not the woman has already had a hysterectomy operation or radiation to the pelvis region. Your doctor will also take into account if you want more children, your overall health and age. Every treatment option will have potential side effects so this is why it is worth seeking a second medical opinion before starting anything. If nothing else, it will help make you feel more comfortable about your choice. Additionally some insurance companies will insist on a second opinion before covering the costs.

Treatment By Stage Of Cancer

The following is an overview of the treatment options for different vaginal cancer stages. It covers the two main types of cancer: squamous cell carcinoma (85 percent of cases) which tends to effect women over 60 and adenocarcinoma (most of the remaining cases) which occurs more commonly in women under 30. If possible the goal of treatment is to completely destroy malignant cells. If a cure is not possible then the next option is to reduce the size of the tumor to prevent it from spreading. This may mean intermittent therapy over a number of years. If cancer has spread throughout the body the main focus is palliative care. That is, to make the woman as comfortable as possible because no cure is possible.

Stage 0: Vaginal Intraepithelial Neoplasia (VAIN)
VAIN is considered a precancerous condition and is also known as vaginal carcinoma in situ. Treatment could include any of the following options:

• Total or partial vaginectomy.
• Wide local excision - with/without a skin graft.
• Topical chemotherapy.
• Laser surgery.
• Brachytherapy (internal radiation therapy).

Stage 1: Squamous Cell Cancer
Treatment could include any of the following options:

• Vaginectomy or wide local excision with vaginal reconstruction. Radiation therapy may be applied after surgery.
• Brachytherapy with/without external radiation to large tumors or lymph nodes.
• Vaginectomy and lymph node dissection, with/without reconstruction of vagina. Radiation therapy may also be applied after surgery.

Stage 1: Vaginal Adenocarcinoma
Treatment for adenocarcinoma is different from squamous cell carcinoma in stage 1. For adenocarcinoma, surgery is fairly extensive. Possible options include:

• Hysterectomy, vaginectomy and lymph node dissection. This may be combined with radiation therapy and vaginal reconstruction.
• Brachytherapy with/without external radiation therapy to the lymph nodes.
• Combination of different therapies that could include brachytherapy and wide local excision with/without lymph node dissection.

Stage 2: Squamous Cell Cancer and Adenocarcinoma
Treatment is the same for both types of cancers:
• Brachytherapy and external radiation therapy to the vagina, with/without external radiation therapy to lymph nodes.
• Vaginectomy with/without radiation therapy.
• Pelvic exenteration with/without radiation therapy.

Stage 3: Squamous Cell Cancer and Adenocarcinoma
Treatment is the same for both types of cancers. It usually includes a combination of brachytherapy and external radiation, without or without surgery.

Stage 4A: Squamous Cell Cancer and Adenocarcinoma
Again treatment is the same for both types of cancers. It usually includes a combination of brachytherapy and external radiation, without or without surgery.

Stage 4B: Squamous Cell Cancer and Adenocarcinoma
At this stage treatment is focused on palliative care to relieve symptoms and improve the woman's quality of life. This may be achieved by radiation and chemotherapy. Cancer clinical trials may be considered as a last resort.

Recurrent Vaginal Cancer
If cancer comes back, it may come back locally in the same site or if it has spread to other parts of the body it is considered a distant recurrence. Recurrent vaginal cancer treatment options may include:

• Radiation therapy combined with radiosensitizers.
• Pelvic exenteration.
• Clinical trial in the hope a new therapy will prove beneficial.

What Are The Signs?
Symptoms of Vaginal Cancer.

Explanation Of Treatments

Laser Surgery

Laser involves the use of a high energy beam or light to destroy cancerous or abnormal cells. It is a very effective treatment for the precancerous condition VAIN and large lesions. It is not an option for invasive cancer and if it is to be used the surgeon will want to ensure the worst lesions have been removed by biopsy.

Topical Chemotherapy

This is another alternative for treating VAIN, but it is never used for invasive cancer. It involves rubbing the cream directly to the suspicious area. One option is the chemotherapy drug fluorouracil (5-FU) which is rubbed directly to the vaginal lining once a week for 10 weeks or nightly for up to 14 days. However, it can cause irritation to the vulva and vagina and it may not work as well as laser combined with biopsy. Another option is the drug Imiquimod cream (not a chemo drug) which acts by boosting the body's immune response to abnormal cells. It has had excellent results in completely curing some women of VAIN.

Chemotherapy

The benefits of Chemo (see Chemotherapy Guide) as a systemic therapy (where chemotherapy drugs are taken orally to work throughout the body) for vaginal cancer are not clear. For this reason it is rarely used on its own as a treatment. It may be used alongside radiation therapy to enhance the benefits of radiation.

Radiation Therapy

External Radiation
Radiation which comes from a machine outside the body is called external radiation. The idea of the therapy is to attack the DNA of cancerous cells so that they either die immediately or are so damaged they can no longer divide and grow. Although the whole body cannot tolerate even small doses of radiation (which is why leaks from nuclear power stations are so dangerous), the body can tolerate high doses to small areas. Radiation alone may be used for vaginal cancer or it can be used in combination with other therapies to treat lymph nodes in the pelvis or groin area. It may also be used as a follow up to surgery. Side effects tend to more severe with external rather than internal radiation. Common side effects include serious fatigue, nausea and diarrhea. These problems may not kick in until 2 weeks into therapy. Diarrhea is a particularly common problem if radiation is directed at the pelvis region. Pelvic radiation can also cause premature menopause and brittle bones (see osteoporosis in women). It can also cause interstitial cystitis and colitis (irritation of the rectum and intestines). Radiation may cause the vagina to become very sensitive and sore. Scar tissue can form which makes the vagina narrower (vaginal stenosis) making sexual intercourse painful. Using a vaginal dilator to stretch the walls of the vagina can help prevent this from happening. Another way is to make love 3 or 4 times a week to keep the area stretched. Unfortunately vaginal dryness (vaginal atrophy) and pain with intercourse may remain long-term side effects.

Internal Radiation
This is another way to receive radiation and involves placing a radioactive device inside the vagina which then emits radiation for a specific time. It is known as intracavitary brachytherapy and there are two main types. One dose involves staying in bed in hospital for 24 to 48 hours. Movement is restricted so that the radiation capsule is not dislodged. The woman is considered radioactive and visitors and medical staff will have very strict guidelines on how close they can be to her. The other type is a higher dose which means it stays in for a shorter time. The woman can complete treatment in one day, although treatment will need to be repeated 3 or 4 times, one to two weeks apart. With brachytherapy, radiation only touches the vaginal tissues thus lessening the chance of harming nearby organs such as the bowels and bladder. Another type of internal radiation (called interstitial radiation) involves injecting radioactive seeds directly into the tumor so that malignant cells decay naturally without ever having to be removed. The woman will be advised on precautions she needs to take when around other people.

Very often both types of radiation therapies are combined in treating vaginal cancer - typically external radiation followed by brachytherapy. Small doses of chemotherapy may also be given. Radiosensitizers are drugs that are still in clinical trials. They are sometimes combined with radiation therapy in later stages of the disease to boost the amount of malignant cells killed.

What are my chances of surviving?
See: Vaginal Cancer Survival Rates

Surgical Procedures

Surgery is only usually given for stage 1 tumors or for cancers which are not cured by radiation. It is not generally the choice for treating squamous cell vaginal cancer (the most common type). It is however used for rarer types: malignant melanoma and sarcoma cancers.

Wide Local Excision

This removes the cancer and some of the healthy surrounding tissue (to create a safe margin). Skin grafts may be needed to repair the vagina. For VAIN a small local excision may be all that is required. A radical wide local excision can be used for small stage 1 cancers. Some lymph nodes may also be extracted for biopsy. This is also an option for vulva cancer treatment.

Skin Grafts

If sections of the vagina are removed by surgery then skin grafts may be necessary to repair the area. This involves taking skin from another part of the body such as the thigh or buttocks and attaching it to the damaged area.

Vaginectomy

This surgery removes the entire vagina (total vaginectomy). If only part of the vagina is removed it is called a partial vaginectomy. If surrounding supporting tissues are also removed it is known as a radical vaginectomy. It is sometimes combined with a radical hysterectomy. Lymph nodes in the pelvis are also usually extracted (lymphadenectomy). A vaginal reconstruction will be necessary.

Lymphadenectomy

Sometimes called lymph node dissection, a lymphadenectomy involves surgically removing lymph nodes. For vaginal cancer, sometimes the lymph nodes in the groin area or in the pelvis need to be removed to check for signs of cancer. This can cause poor fluid drainage in the legs leading to swelling, a condition known as lymphedema. After the operation women are usually advised to wear special support stockings or compression devices to reduce the chance of swelling.

Trachelectomy

As most vaginal cancers are located in the upper section of the vagina near the cervix, it may be necessary to remove the cervix. The procedure which removes the cervix but leaves the rest of the uterus behind is called a trachelectomy. This operation is rarely performed for vaginal cancer.

Pelvic Exenteration

Pelvic exenteration is an extensive operation that includes vaginectomy and removing the pelvic lymph nodes, as well as of one or more of the following structures: the lower colon, rectum, bladder, uterus, and cervix. How much has to be removed depends on how far the cancer has spread. If part of the colon is removed the woman will need to wear a colostomy bag in the front of the abdomen to remove stool waste. A urostomy or small plastic bag worn in front of the abdomen is necessary to collect urine if the bladder is removed. Given the severity of the procedure, it is rarely performed. Generally it is viewed as a treatment of last resort when all else has failed.

Vaginal Reconstruction After Surgery

This is a follow-up treatment for women who have had all or part of their vagina removed. It involves taking sections of skin and muscles (usually cut from the inner thigh) to create a new vagina. A tube is created in the pelvic cavity to replace the original vagina. After surgery the area will be packed with sterile gauze. The woman may also wear a stent or vaginal mold for several weeks to aid the healing process. Once the tissue has healed she will be encouraged to use a vaginal dilator, probably for the rest of her life. She may also need to apply estrogen creams to encourage blood vessel formation. Douching daily with vinegar may also be recommended. Generally the woman can start having sexual intercourse again after about 2 months. The new vagina will not be able to naturally lubricate so a water soluble lubricant will be necessary. When the vagina is touched the woman may initially have the sensation that her thigh is being stroked. This is because the thigh muscle transferred to the vagina is still attached to its original nerve supply.

What Follow Up Is Needed?

Follow-up consists of a regular Pap test and pelvic exams with a colposcopy. Lab tests, X-rays and diagnostic scans may be ordered to check for any side effects from treatments. Signs for a recurrence will be monitored carefully. If cancer is likely to come back, it typically does so within the first 2 years. It is important to read about cancer prevention and specifically vaginal cancer prevention. Do introduce healthy lifestyle options into your life including eating cancer prevention foods.

  Related Articles on Cancer of The Vagina

For more female cancers, see the following:

Cancer Guide
Causes of Vaginal Cancer

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