What is it and where does it come from?
The vast majority of vaginal tumors are squamous cell carcinoma, which grows from cells of the mucous membrane. Vaginal adenocarcinoma and melanoma are much less common.
The key role is played by the high-risk human papillomavirus, the same one that causes cervical cancer. First, under its influence, a precancer is formed: vaginal intraepithelial neoplasia (VaIN). This stage does not produce symptoms, but is clearly detected by colposcopy and cytological examination, and treatment at this stage completely prevents the development of cancer.
Who's at risk
- HPV infection with high oncogenic risk, especially long-term persistence
- Age over 60 years - most cases occur during this period
- Previous history of cervical cancer or dysplasia, previous radiation therapy to the pelvic area
- Smoking independently increases the risk of HPV-associated tumors
- Chronic inflammatory and cicatricial changes in the mucous membrane, prolonged wearing of a pessary
- Immunodeficiency, including due to HIV and taking immunosuppressants
First signs
At an early stage, the disease is often asymptomatic and is detected during a routine examination. As the tumor grows, fairly specific complaints appear.
- Bloody discharge not associated with menstruation and bleeding after intimacy
- Watery, profuse, sometimes foul-smelling discharge
- Sensation of a foreign body, lump or ulcer that the woman finds herself
- Pain during intercourse
- In later stages - pelvic pain, swelling of the leg, difficulty urinating and defecating
How to make a diagnosis
- Осмотр в зеркалах с обязательным осмотром всех стенок влагалища, включая своды.
- Цитологическое исследование мазков и тестирование на ВПЧ.
- Кольпоскопия с пробами — позволяет увидеть изменения, невидимые невооружённым глазом.
- Биопсия подозрительного участка с гистологическим исследованием — единственный метод, устанавливающий диагноз.
- Уточнение распространённости: УЗИ малого таза, МРТ или КТ, оценка состояния лимфоузлов, при необходимости цистоскопия и ректоскопия.
Treatment
Tactics depend on the stage, location of the tumor along the length of the vagina, age and general condition. Surgical treatment, radiation therapy and chemotherapy are used - often in combination.
- For precancer (VaIN) - local excision, laser vaporization or local therapy
- At an early stage - radical removal of the vaginal tumor with extended lymph node dissection
- If the upper third of the vagina is affected, the scope of the operation is often expanded to the removal of the uterus and appendages
- Radiation therapy - alone or after surgery, including intracavitary
- Chemotherapy courses, including in combination with radiation therapy
- Reconstructive interventions and rehabilitation after completion of the main treatment
Prevention
- Vaccination against HPV is the most effective measure, most effective before the onset of sexual activity
- Regular examination by a gynecologist with cytology and HPV testing
- Timely treatment of cervical and vaginal dysplasia
- Quitting smoking
- Mandatory observation after treatment for cervical cancer - the vagina remains a risk area
- Immediate treatment of any bleeding during menopause
