Vaginal Cancer Health Article

Clinical staging, treatments, and prognosis

Clinical staging

The International Federation of Gynecology and Obstetrics (FIGO) has adopted a clinical staging system for vaginal cancer that is used by most gynecologic oncologists. Vaginal cancer is categorized into five stages (0, I, II, III, and IV) that may be further subdivided (A and B) based on the depth or spread of cancerous tissue. The FIGO stages for vaginal cancer are:

• Stage 0. Cancer is confined to the outermost layer (epithelium) of vaginal cells and is called carcinoma in situ or vaginal intraepithelial neoplasia (VAIN).
• Stage I. Cancer is confined to the vagina.
• Stage II. Cancer has spread to the tissues near the vagina.
• Stage III. Cancer has spread to the bones of the pelvis, local lymph nodes, and/or other reproductive organs.
• Stage IV. Cancer has spread to the bladder, rectum, or other parts of the body.

Treatments

The treatment of vaginal cancer varies considerably and depends on the type of cancer, stage of cancer, and the patient's age and overall health. Surgery is the most common treatment for vaginal cancer. Radiation therapy and chemotherapy are often used as adjuvant therapy to complement the surgical treatment.

SURGERY.

The amount of tissue removed depends upon the stage and type of cancer. The local lymph nodes may also be removed (lymphadenectomy). Laser surgery, which destroys the cancerous cells, may be used in the treatment of stage 0 vaginal cancer. With a wide local excision, the cancerous tissue and some surrounding healthy tissue is cut out. Wide local excisions may require skin grafts to repair the vagina.

For more extensive cancer, the vagina may be removed (vaginectomy). Following vaginectomy, skin grafts and plastic surgery are used to create an artificial vagina. Vaginal cancer that has spread to the other reproductive organs would be treated by radical hysterectomy in which the uterus, fallopian tubes, and ovaries are removed. Cancer that has spread beyond the reproductive organs may be treated by pelvic exenteration, in which the vagina, cervix, uterus, fallopian tubes, ovaries, and, as necessary, the lower colon, bladder, or rectum are removed.

Surgical complications include urinary tract infection, wound infection, temporary nerve injury, fluid accumulation (edema) in the legs, urinary incontinence, falling or sinking of the genitals (genital prolapse), and blood clots (thrombi).

RADIATION THERAPY.

Radiation therapy may be used as the sole treatment of vaginal cancer or as an adjuvant therapy to aid surgery. Radiation therapy uses high-energy radiation from x rays and gamma rays to kill the cancer cells. Radiation given from a machine that is outside the body is called external radiation therapy. Radiation given internally is called internal radiation therapy or brachytherapy. Sometimes applicators containing radioactive compounds are placed inside the vagina (intracavitary radiation) or directly into the cancerous lesion (interstitial radiation). External and internal radiation may be used in combination to treat vaginal cancer.

The skin in the treated area may become red and dry and may take as long as a year to return to normal. Fatigue, upset stomach, diarrhea, and nausea are also common complaints of women having radiation therapy. Radiation therapy in the pelvic area may cause the vagina to become narrow as scar tissue forms. This phenomenon, known as vaginal stenosis, makes intercourse painful.

CHEMOTHERAPY.

Chemotherapy is not very a very successful treatment of vaginal cancer and is generally reserved for patients with advanced disease. Chemotherapy uses anticancer drugs to kill the cancer cells. The drugs are usually given by mouth (orally) or intravenously. They enter the bloodstream and can travel to all parts of the body to kill cancer cells. Generally, a combination of drugs is given because it is more effective than a single drug in treating cancer. For vaginal cancer, anticancer drugs may be put into the vagina (intravaginal chemotherapy).

The side effects of chemotherapy are significant and include stomach upset, vomiting, appetite loss (anorexia), hair loss (alopecia), mouth or vaginal sores, fatigue, menstrual cycle changes, and premature menopause. There is also an increased chance of infections.

Prognosis

Survival is related to the stage and type of vaginal cancer. The five-year survival rates for squamous carcinoma and adenocarcinoma of the vagina are: 96%, stage 0; 73%, stage I; 58%, stage II; 36%, stage III; and 36%, stage IV. With a five-year survival rate of less than 20%, melanoma has a poor prognosis. Vaginal cancer most commonly spreads (metastasizes) to the lungs, but may spread to the liver, bone, or other sites.

Alternative and complementary therapies

Although alternative and complementary therapies are used by many cancer patients, very few controlled studies on the effectiveness of such therapies exist. Mind-body techniques such as prayer, biofeedback, visualization, meditation, and yoga have not shown any effect in reducing cancer but can reduce stress and lessen some of the side effects of cancer treatments.

Clinical studies of hydrazine sulfate found that it had no effect on cancer and even worsened the health and well-being of the study subjects. One clinical study of the drug amygdalin (Laetrile) found that it had no effect on cancer. Laetrile can be toxic and has caused death. Shark cartilage, although highly touted as an effective cancer treatment, is an improbable therapy that has not been the subject of clinical study.

The American Cancer Society has found that the "metabolic diets" pose serious risk to the patient. The effectiveness of the macrobiotic, Gerson, and Kelley diets and the Manner metabolic therapy has not been scientifically proven. The Food and Drug Administration (FDA) was unable to substantiate the anticancer claims made about the popular Cancell treatment.

There is no evidence for the effectiveness of most over-the-counter herbal cancer remedies. However, some herbals have shown an anticancer effect. Some studies have shown that polysaccharide krestin (PSK), a substance from the mushroom Coriolus versicolor, has some effectiveness against cancer. In a small study, the green alga Chlorella pyrenoidosa has been shown to have anti-cancer activity. In a few small studies, evening primrose oil has shown some benefit in the treatment of cancer. Herbals can disrupt conventional treatment; patients must discuss herbal use with their physician.

For more comprehensive information, the patient should consult the book on complementary and alternative medicine published by the American Cancer Society listed in the Resources section.