Surgery for Vaginal Cancer - An Overview

Introduction:

Vaginal cancer is an uncommon type of cancer that originates in the vaginal cells. The vagina is made up of muscles and is the canal linking the uterus to the external genitals. The primary type of vaginal cancer is squamous cell carcinoma which arises from the thin and flat cells in the vaginal lining. Adenocarcinoma affects the glandular cells of the vagina. Treatment for vaginal cancer depends on various factors, and it is meticulously planned after appropriate staging and diagnosis of the condition. Treatment methods for vaginal cancer include radiation therapy, surgical approaches, and chemotherapy. Newer treatment methods include immunotherapy and radiosensitizers. Individual therapy or a combination of these will be advised for the patients, and a specialized team of healthcare professionals will choose the appropriate treatment protocol.

What Are the Causes and Symptoms of Vaginal Cancer?

Symptoms of vaginal cancer include irregular vaginal bleeding, bleeding after sexual intercourse, and pain between menstrual periods. Other symptoms are pain during intercourse, pelvic pain, pain while urinating, constipation, and a vaginal lump or mass in the vagina that has been reported by a few women. The causes of vaginal cancer are yet to be known. Certain risk factors can lead to vaginal cancer:

• HPV (human papillomavirus) infection can increase the risk of vaginal cancer.

• Aging is a factor, as women older than 60 are more at risk of acquiring vaginal cancer.

• A history of cervical cancer can also predispose to vaginal cancer.

• Smoking increases the likelihood of vaginal cancer.

• Diethylstilbestrol (DES) exposure has been known to increase the risk of clear-cell adenocarcinoma. A clear-cell carcinoma is a rare form of vaginal cancer.

How Is Vaginal Cancer Diagnosed?

1. Pelvic Exam: A thorough examination of the vaginal area that includes the vagina, cervix, ovary, rectum, and fallopian tubes is done. A speculum is inserted through the vagina to visualize the vagina and cervix for identification of signs of disease. For assessing the health of the cervix, a Pap test is performed. A manual examination will also be performed by the doctor by inserting a gloved finger into the rectum to check for abnormalities and lumps.

2. Pap Test: This is a procedure in which cells are collected from the cervical and vagina surface using a cotton piece, brush, or a small stick made of wood. Abnormalities in the cells are found through microscopic examination.

3. HPV Test: This examination is done in order to check for DNA (deoxyribonucleic acid) and RNA (ribonucleic acid) of specific types of HPV. Samples are obtained from the cervix and vagina to be examined under a microscope.

4. Colposcopy: In this procedure, a magnifying instrument that has light called a colposcopy is used to examine abnormal areas in the cervix and vagina. A spoon-shaped instrument, known as a curette, is used to take tissue samples in these abnormal areas so as to enable microscopic examination.

5. Biopsy: A pathologist determines cancerous indications after examining the tissue sample under a microscope (biopsy). This is done after obtaining a tissue sample from a colposcopy.

What After the Diagnosis of Vaginal Cancer?

A comprehensive evaluation is done for diagnosing pelvic cancer, which includes a pelvic examination, colposcopy, biopsies, MRI (magnetic resonance imaging), and CT (computed tomography) scans done for the staging of cancer and to identify the location of cancer.

Non-surgical methods include:

1. Radiation Therapy: It uses high-powered energy beams like X-rays for killing cancer cells. The external beam radiation is focused on the entire abdomen or pelvis, which is dependent on the extent of cancer metastasis. In internal radiation therapy, radioactive devices like wires, seeds, cylinders, and other materials are placed in the vagina and adjacent structures. They are removed after some time once the treatment gets over.

2. Chemotherapy: In chemotherapy, medicines are used for the purpose of eradication of cancer.

3. Immunotherapy: Immunotherapy is the latest promising treatment that helps the body's immune system combat cancer cells. The drugs used hinder certain proteins found in the cancer cells, which will intensify the immune response. Improving the immune response through immunotherapy helps to target and identify cancer cells effectively.

4. Radiosensitizers: Radiosensitizers help in improving the cancer cells’ sensitivity while radiation therapy is done. This will subsequently enhance the radiotherapy’s effectiveness. Radiosensitizers can be administered either before or during radiation therapy to optimize their efficacy. They operate through a variety of mechanisms including boosting reactive oxygen species generation and DNA repair within cancer cells.

What Are the Surgical Approaches for Vaginal Cancer?

Following are some of the surgical techniques to eradicate vaginal cancer:

1. Excision: For early stages of vaginal cancer, removal of small tumors limited to the vaginal lining can be achieved by a procedure known as local excision or wide local excision. It also involves eliminating the tumor along with the surrounding margin of healthy tissue.

2. Partial Vaginectomy: If the cancer is large or affects a certain portion of the vagina, partial vaginectomy can be performed. This procedure involves the removal of the cancerous portion of the vagina while attempting to preserve as much healthy tissue as possible.

3. Radical Vaginectomy: In advanced and severe cases where cancer has extensively spread inside the vagina, radical vaginectomy may be necessary. It involves complete vaginal removal, including nearby lymph nodes to ensure thorough eradication of cancer.

4. Total Hysterectomy: Surgical removal of the uterus including the cervix. If the cervix and uterus are taken out through the vagina, then it is called a vaginal hysterectomy. It is called a total abdominal hysterectomy if the cervix and uterus are taken out with a large cut in the abdomen. If it is done using a laparoscopy, it is called a laparoscopic hysterectomy.

5. Pelvic Exenteration: In rare instances, if vaginal cancer has metastasized to adjacent organs, such as the rectum, bladder, and anus, pelvic exenteration can be done. This procedure involves the removal of the vagina with affected organs to achieve complete cancer eradication.

Conclusion:

Patients diagnosed with vaginal cancer have various treatment options that include standardized treatment methods and those under clinical trials. Clinical trials are still under experiment, and their efficacy is not understood clearly. Surgical methods along with adjuvant therapies, have significantly improved the prognosis of vaginal cancer. Patients may consider any of the treatment options, and the physician also helps in providing a clear description of each treatment method.