Vaginal Cancer

21.03.2024

VAGINA CANCER DIAGNOSIS AND TREATMENT

Vaginal cancer is a type of cancer that develops as a result of uncontrolled growth and proliferation of cells in the vaginal area of ​​women. The vagina is a tunnel-shaped organ that extends from the uterus to the outer skin, and vaginal cancer can occur on the inner walls or surface of this tunnel. Vaginal cancer is a rare type, but it can lead to serious consequences. Among the risk factors, HPV (Human Papillomavirus) infections, age, smoking, sexually transmitted infections and radiation therapy stand out. Early diagnosis and treatment is critical in the treatment of vaginal cancer, because cancers caught in the early stages have a better chance of being treated. Vaginal cancer can affect women's sexual health and negatively impact their quality of life, so preventive measures such as regular gynecological exams and HPV vaccination are important.

WHAT ARE THE RISK FACTORS?

Vaginal cancer risk factors may include:

HPV (Human Papillomavirus) Infection: High-risk HPV types (e.g., HPV 16 and 18) are one of the most important risk factors for the development of vaginal cancer.

Age: The risk of vaginal cancer generally increases with age. It is rare in young ages, but may be more common in the postmenopausal period.

Smoking: Smoking may increase the risk of vaginal cancer.

Immune System Problems: A weak immune system can reduce resistance to HPV infections and increase the risk of vaginal cancer.

Chronic Vaginal Irritation: Long-term vaginal irritation or infections may increase the risk of cancer.

Radiation Therapy: Those who have had radiotherapy to the pelvic area may be at risk of vaginal cancer.

Sexual Activity: Risk factors include starting sexual activity at an early age, multiple sexual partners, or sexually transmitted infections.

Family History: People with a family history of vaginal cancer may be at higher risk due to genetic factors.

Vaginal Infections: Chronic vaginal fungal or bacterial infections may increase the risk of cancer.

Risk factors may vary from person to person, and not everyone is at the same risk. But understanding these factors can help a person pay more attention to their health and take preventive measures. Getting the HPV vaccine, having regular gynecological examinations, and paying attention to sexual health precautions are important in reducing the risk of vaginal cancer.

Image 1: Vaginal cancer is a gynecological cancer that develops in the vaginal canal.

HOW DOES IT OCCUR?

Vaginal cancer development mechanisms are a complex process and are often associated with HPV (Human Papillomavirus) infections. HPV can infect vaginal cells, causing changes in cellular DNA and leading to the formation of precancerous lesions (VIN). However, HPV infection alone is not enough and other factors also play a role. Chronic vaginal irritation, long-term infections, sexually transmitted infections, and hormonal changes can increase the risk of vaginal cancer. Genetic factors may also be effective, and the risk may be higher in people with a family history of vaginal cancer. While vaginal cancer development mechanisms are generally attributed to HPV infections, the interaction of these infections with other risk factors may affect the formation of cancer.

WHAT ARE THE SYMPTOMS?

Symptoms of vaginal cancer may include:

Vaginal Bleeding: The most common symptom is vaginal bleeding. It may occur especially after sexual intercourse or in the postmenopausal period.

Vaginal discharge: Foul-smelling or bloody vaginal discharge may occur.

Pain and Discomfort: You may experience pain, pressure or discomfort in the pelvic area.

Urinary Tract Problems: Symptoms such as urination problems, frequent urination, pain or difficulty while urinating may be observed.

Constipation or Diarrhea: Vaginal cancer can affect bowel movements and constipation or diarrhea may occur.

Painful Sexual Intercourse: There may be pain or discomfort during sexual intercourse.

The Appearance of the Mass in the Lowered Area of ​​the Society: A mass or swelling may be noticed outside or inside the vagina.

These symptoms may be signs of vaginal cancer, but they may also be associated with other health problems. In case of any concerning symptoms, it is important to contact a healthcare professional and undergo further evaluation. Early diagnosis can help treat vaginal cancer effectively.

HOW IS IT DIAGNOSED?

Vaginal cancer is diagnosed as a result of a series of medical tests and examinations. The diagnostic process begins with the patient's symptoms, medical history, and physical examination. Usually a gynecologist or oncologist evaluates the presence of vaginal lesions or abnormal tissue. One of the most common methods used in diagnosis is biopsy. During this procedure, samples of vaginal tissue are taken and the presence of cancer cells is confirmed by pathological examination. Imaging tests such as computed tomography (CT) or magnetic resonance imaging (MRI) can be used to determine the stage of the cancer and evaluate its spread. Additionally, lymph node biopsies may be performed to determine whether cancer cells have spread and spread to the lymph nodes. Diagnosis of vaginal cancer is critical to establishing the patient's cancer type, stage, and treatment plan and should be conducted by an oncologist.

WHAT ARE THE PATHOLOGICAL TYPES?

Vaginal cancer can have various pathological types that may arise from different cell types. Pathological types of vaginal cancer can be listed as follows:

Squamous Cell Carcinoma: It is the most common type of vaginal cancer and originates from vaginal surface cells.

Adenocarcinoma: It originates from the gland cells of the vaginal tissue and is less common.

Melanoma: It originates from melanocytes in or around the vagina and comes from pigment-producing cells.

Adenoid Cystic Carcinoma: It is a rare type of cancer arising from the vaginal glands.

Pathological types of vaginal cancer may affect the biological characteristics of the cancer and the treatment approach. Once diagnosed, pathological examination helps determine the type and stage of the cancer and is important in shaping the treatment plan. The pathological type, the patient's medical history, and the characteristics of the cancer must be taken into account to determine the appropriate treatment for each patient. There are important receptors and molecular markers that need to be evaluated in the treatment of vaginal cancer. These markers are used to understand the biological characteristics of cancer and treatment options. First, HPV (Human Papillomavirus) status is evaluated to detect the presence of high-risk HPV types, as HPV infections are one of the leading causes of vaginal cancer. The expression of hormonal receptors ER (Estrogen Receptor) and PR (Progesterone Receptor) is important in determining hormonal treatment options. Her2 (Human Epidermal Growth Factor Receptor 2) expression is effective in identifying some types of vaginal cancer and selecting targeted treatments. Additionally, PD-L1 (Programmed Death-Ligand 1) expression is examined to evaluate the potential for immunotherapy treatment. These receptors and markers play a critical role in creating the treatment plan and meeting the patient's cancer-specific needs. However, which markers to test and which treatment options to use should be determined by an oncologist, taking into account the patient's medical history and the characteristics of the cancer.

Image 2: Vaginal cancer can cause different complaints such as pelvic pain, bleeding and discharge.

HOW IS TUMOR STAGING DONE?

Vaginal cancer staging is a process used to determine the extent and progression of cancer. This staging is important in determining the patient's treatment options and predicting prognosis. Vaginal cancer staging is done as follows:

Stage 0 (Carcinoma in Situ or VIN 3): This early stage refers to a stage where cancer cells are confined to the layer just below the surface of the vagina. Treatment is usually done by surgical removal of the lesions or close monitoring.

Stage I: At this stage, the cancer is limited to tissues on or near the surface of the vagina.

Stage II: The cancer has spread further in the vaginal area, but is still limited to this area.

Stage III: At this stage, the cancer has spread beyond the vaginal area and may have spread to surrounding lymph nodes or other pelvic organs.

Stage IV: In this advanced stage, the cancer has metastasized to organs outside the vaginal area or to other parts of the body.

Vaginal cancer staging is usually done by physical examination, imaging studies such as computed tomography (CT), magnetic resonance imaging (MRI), and sometimes positron emission tomography (PET), and pathological examination. As a result of these stagings, the stage of the cancer is determined and the treatment plan is created according to this information. The treatment plan for each patient is personalized based on the specific condition of the cancer and the patient's health condition.

HOW IS TREATMENT DONE ACCORDING TO STAGES?

Vaginal cancer treatment may involve different approaches depending on the stage and type of cancer and the patient's general health condition. Here is a general treatment approach according to the stages of vaginal cancer:

Stage 0 and Stage I: Among the treatment options, surgical intervention plays a key role. This surgery involves removing the tumor and trying to control the cancer. Often, removal of part or all of the vaginal area (vaginectomy) may be necessary. Adjuvant treatments such as radiotherapy or sometimes chemotherapy may also be used after surgery, but are determined individually for each patient.

Stage II and Stage III: Treatment usually involves surgery, although surgery may be applied to a more widespread area. In this case, vaginectomy may be performed on a larger area and lymph nodes may need to be removed. Adjuvant treatments such as radiotherapy or chemotherapy can often be used after surgery. If cancer has spread to lymph nodes or other organs, additional treatments targeted to these areas may be required.

Stage IV: Treatment usually focuses on palliative treatments (controlling symptoms and improving quality of life). Options such as systemic treatments (chemotherapy, targeted drugs) and immunotherapy can be used at this stage.

The treatment plan is customized for each patient and is determined by taking into account the patient's health status, the biological characteristics of the tumor and other factors. Vaginal cancer treatment requires a multidisciplinary approach and should be managed by an oncologist, surgeon, radiation oncologist, and other specialists.

Image 3: Vaginal cancer is diagnosed by pelvic examination and biopsy.

WHAT ARE THE DRUGS USED IN TREATMENT

Chemotherapy, smart drug treatments and immunotherapies used in the treatment of vaginal cancer may include:

Chemotherapy drugs:

Platinum-Based Chemotherapies: Platinum-containing drugs such as carboplatin or cisplatin can generally be used depending on the extent and stage of the cancer.

Paclitaxel or Docetaxel: These drugs can treat cancer cells by stopping them from growing.

Smart Drug Treatments:

Bevacizumab: This medication is used to treat vaginal cancer by preventing the tumor's vessels from growing.

Immunotherapies:

Immunotherapy is a newer approach to treating vaginal cancer and is used specifically for patients with certain molecular markers. Immunotherapies include:

Pembrolizumab: This drug can be used as immunotherapy in patients with positive PD-L1 expression.

Nivolumab: It is an immunotherapy option for patients with positive PD-L1 expression.

The treatment plan is determined depending on the specific condition of the patient, the characteristics and stage of the tumor. Therefore, vaginal cancer treatment is created by a specialist doctor according to the individual needs of the patient

HOW SHOULD FOLLOW-UP BE CARRIED OUT AFTER RECOVERY?

Follow-up after vaginal cancer treatment is important to monitor the patient's health and evaluate possible recurrences or response to treatment. The follow-up program usually includes regular doctor exams, blood tests (such as CA-125 levels), imaging studies (computed tomography or magnetic resonance imaging), and monitoring of symptoms. Frequency of follow-up may vary depending on the patient's stage of cancer, response to treatment, and other individual factors. Follow-up plays a critical role in order to diagnose early and detect possible recurrences or complications early. Patients should follow their follow-up plan regularly, report their symptoms, and communicate with their physicians. In this way, the quality of life after vaginal cancer treatment can be improved and patients can be ensured a healthy recovery.