Understanding and treating vaginal cancer

Vaginal cancer can be one of a handful of types of cancer that affects the vaginal canal. The biggest risk factor that we know of for vagina cancer is human papillomavirus (HPV), so if there is a personal history of cervical or vulvar cancer, vaginal cancer is more of a risk. Diagnosis is most often between the ages of 60 and 65, but younger women can get vaginal cancer.

Women who were exposed to diethylstilbestrol in utero are predisposed to vaginal cancers, though this is rare. The age of diagnosis in these cases is about 19. Embryonic cancer can appear at about age three in girls who fit into this category.

Primary or secondary vagina cancer?

Any type of cancer is considered primary if it grows in a single area, and secondary when cancer in, say, the vulva, has developed as part of cancer spread from another part of the body like the uterus, cervix, bowel or other nearby organs. Secondary vaginal cancer is treated differently from primary vaginal cancer.

Types of vaginal cancer

  1. Squamous cell carcinoma (85-95 per cent) – thin, flat cells that line the vagina, usually occurs in upper vagina, grows slowly, occurs usually in women over 60
  2. Primary adenocarcinoma (5-10 per cent) – develops from the mucous-producing cells of the vagina, can spread to lung and lymph nodes, includes clear cell carcinoma
  3. Secondary adenocarcinoma – cancer spread from another cancerous organ
  4. Secondary squamous cell carcinoma (in older women) – cancer spread from another cancerous organ
  5. Clear cell adenocarcinoma (in young women)
  6. Melanoma – skin cancer, rare, cancer of melanocytes (pigment-producing cells)
  7. Sarcoma botryoides (embryonal rhabdomyosarcoma) (young girls) – develops from muscle, fat and other tissue deep in the vaginal wall, rare

Vaginal cancers most often appear in the upper third back (posterior) vaginal wall and can spread to nearby tissue, including the bladder and rectum, and lymph nodes.

Symptoms of vaginal cancer

Symptoms of advanced vaginal cancer

  • Abnormal vaginal discharge
  • Difficulty or pain when urinating
  • Pain in the pelvic area
  • Pain in the back or legs
  • Nausea and vomiting
  • Abnormal bowel function

Vagina cancer diagnosis

Diagnosis is by biopsy. Other investigations may be performed to assess the breadth of cancer.

Vagina cancer treatments

Treatment is most often surgical, with radiation therapy an option. A hysterectomy, vaginectomy and lymph node removal may be required for the upper section of the vagina. If there are severe issues, a radical pelvic exenteration (complete removal of all pelvic organs) may be recommended.

Surgeries for vaginal cancer

  • Surgery options include laser surgery, often used for precancerous cells or a tumour
  • Simple excision removes the tumour and some surrounding tissue. Repair surgery may be required
  • Vaginectomy may be indicated, which is the complete removal of the vagina and possibly the pelvic lymph nodes
  • A new vagina (the neovagina) can be grafted – sex is still possible but lubricant is required. Usually the clitoris remains intact
  • Radical hysterectomy, meaning removal of the uterus, ovaries, fallopian tubes and lymph nodes

Radiation therapy for vaginal cancer

Radiation uses high-energy beams to kill cancer cells. This can be used alone or in conjunction with surgery. Radiation therapy aims to be as targeted as possible, but due to the proximity of other reproductive organs and the vulva/clitoris, there are casualties of this type of treatment.

Radiation therapy causes what’s known as radiation-induced vaginal stenosis, which means it shrinks and tightens, with thickened skin. This can require the use of vaginal dilators after treatment to ensure the passage from the cervix to the vaginal opening stays open. Depending on your type of cancer, this is almost unavoidable.

Chemotherapy for vaginal cancer

Chemotherapy is a drug used to kill cancer cells, usually given intravenously. Chemotherapy often kills cells indiscriminately.

Palliative care for vaginal cancer

Palliative care is the care given to treating side effects and symptoms at any stage of illness, but particularly when cancer is untreatable or at the last stages of someone’s life.

Survival rates for vaginal cancer

Survival rates are based on staging when the cancer is caught, and if it has spread.

Stages and 5-year survival rate for vaginal cancer

  • Stage I Limited to the vaginal wall – 65-70 per cent
  • Stage II Invading subvaginal tissues – 47 per cent
  • Stage III Extending to the pelvic wall – 30 per cent
  • Stage IV Extending beyond the true pelvis or involving the bladder or rectal mucosa – 15-20 per cent

Emotional support during vaginal cancer diagnosis and treatments

If you are facing a cancer diagnosis, emotional support is important so find your local support group, find groups online, and find a counsellor who is skilled in dealing with those with cancer diagnoses.

The role of natural medicine in vaginal cancer treatment support

Caring for someone with any type of cancer using natural medicine can be an incredibly useful supportive measure, with vagina cancer no exception. Depending on the conventional treatments applied, the supportive treatments can include diet, herbs, supplements, pressure point therapies, relaxation treatments, and others. Vagina cancer support measure may also include topical treatments, however this will depend on the person and their specific needs.

There is no approved natural medicine cure for cancer (yet!) and conventional treatment is still the most appropriate option for care. No natural medicine practitioner is allowed under any licensing to be the primary practitioner treating a person with cancer.

If a fully informed person chooses this route, particularly for palliative care, that is their decision, since it is well observed that in many cases, conventional treatments may prolong a person’s life, but may not save them from dying of cancer. There are some palliative care options that incorporate complementary and alternative medicine (CAM) practitioners as well as conventional practitioners, so the full suite of care may be achieved.

Natural medicine support for chemotherapy or radiation treatments includes antioxidant support to combat the incredible oxidative stress put on the cells during this time. Other supportive measures may include diet modifications to ensure the right nutrients are being adequately taken in and absorbed. Nutrition can become especially important during times of nausea, vomiting and low appetite.

There are many varieties of pressure point therapies that can help boost energy when it’s low, and make someone feel more relaxed, and overall a bit better. These supports can be subjective in terms of benefit, but physical touch plus some key pressure point therapy can make small but important differences to someone who is distressed, in pain, or feeling under the weather after treatments.

Radiation therapy can cause radiation-induced stenosis, which means the vaginal canal is made smaller either through thickening of the tissue, surgery, or both. Stenosis can occur in various parts of the reproductive and genital tract due to cancer treatments, impeding various functions, ranging from normal penetrative sex to urine flow.

The vagina and vulva and often nearby organs can take a bit of a beating with cancer itself but particularly hefty treatments. Having support from a natural medicine practitioner as well as your suite of specialist doctors during and after cancer treatments can be a warm and welcome addition to your team during an extremely difficult time.

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Jessica Lloyd - Vulvovaginal Specialist Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)