Vaginal cancer is a rare malignancy that begins in the tissues of the vagina, the muscular tube connecting the cervix to the outer genitals. This disease accounts for only one to two percent of cancers affecting the female reproductive tract. Understanding the physical changes and accompanying symptoms is important, especially since many non-cancerous conditions can mimic these signs.
The Physical Appearance and Early Signs
Vaginal cancer lesions do not always produce visible symptoms early on. When they do, they manifest as a noticeable change in the vaginal lining or surrounding tissues, typically starting as a small lump, sore, or growth. These lesions may be discovered during a routine pelvic exam or felt by the patient during self-examination.
The visual characteristics depend on the cancer type. They may present as raised bumps, flat spots, or persistent, non-healing ulcers. Squamous cell carcinoma, the most common type, often forms flat, skin-like bumps. Other types, like melanoma, can cause discoloration, appearing as dark, pigmented patches.
The growth’s texture may be irregular and firm, or resemble a wart-like structure. Any persistent sore or ulcer that does not heal within a few weeks warrants medical attention. Changes in the vaginal wall, such as areas that look raw or have an unusual surface, are important physical signs.
Accompanying Symptoms Beyond Visual Changes
The primary symptom of vaginal cancer is abnormal vaginal bleeding, which is often painless. This includes bleeding outside of the regular menstrual period, such as spotting between cycles or bleeding after sexual intercourse (post-coital bleeding). Postmenopausal bleeding is never normal and requires immediate investigation.
Many individuals also experience an unusual or persistent vaginal discharge. This discharge may be watery, blood-stained, or have a foul odor, often resulting from tumor tissue breaking down. Pain during sexual intercourse, known as dyspareunia, is another common symptom as the mass grows larger within the vaginal canal.
As the tumor expands, it can press on nearby structures, leading to functional symptoms. These include persistent pelvic pain or pressure, or changes in bladder and bowel habits. A person might experience painful or frequent urination, or difficulty with bowel movements like constipation, if the growth presses on the bladder or rectum.
Primary Types and Common Locations
Vaginal cancer is primarily classified into two main types based on the cell of origin, which correlates with the tumor’s typical location. Squamous cell carcinoma is the most common form, accounting for about 85% to 90% of all cases. It starts in the thin, flat cells lining the vaginal surface and is strongly associated with the Human Papillomavirus (HPV) infection.
Squamous cell tumors are most frequently found in the upper third of the vagina, near the cervix. The second most common type is adenocarcinoma (5% to 10% of cases), which develops from glandular cells. A specific subtype, clear cell adenocarcinoma, is sometimes linked to exposure to the drug diethylstilbestrol (DES) during fetal development.
Adenocarcinomas can occur in different parts of the vagina. Other types, such as melanoma (arising from pigment-producing cells) and sarcoma (developing in connective or muscle tissue), are exceedingly rare. The specific cell type and location influence the tumor’s growth pattern.
Medical Evaluation and Confirmation
Evaluation begins with a thorough pelvic exam when a patient presents with suspicious symptoms or a visible lesion. During the exam, a speculum is used to visualize the vaginal walls and cervix, and the doctor manually feels for lumps or thickened areas. A Pap test may also be performed, though it is primarily a screening tool for cervical changes.
If an abnormality is noted, the next step often involves a procedure called a colposcopy. This procedure uses a lighted, magnifying instrument to provide a detailed view of the vaginal and cervical surfaces. The magnified view helps identify and characterize suspicious areas, such as a mass, ulceration, or abnormal vessel pattern.
The definitive diagnosis requires a biopsy, where a small tissue sample is removed and sent to a lab for microscopic examination. The biopsy can be taken during the colposcopy. Once cancer is confirmed, imaging tests such as CT or MRI scans are used to determine the extent of the disease, a process known as staging.