Vaginal Cancer Services at Hoag Gynecologic Oncology

Vaginal cancer is cancer that occurs in the vagina, which connects the outer genitalia with the cervix and uterus. One of the rarest types of gynecologic cancers, less than 1,500 cases of vaginal cancer are diagnosed in the U.S. each year.

There are four main types of vaginal cancer:

• Vaginal squamous cell carcinoma: The most common type of vaginal cancer, vaginal squamous cell carcinoma is cancer that begins in the cells that line the interior surface of the vagina.

• Vaginal sarcoma: Cancer which impacts the muscle cells and connective tissue that make up the walls of the vagina.

• Vaginal melanoma: Cancer which occurs in the melanocytes, or skin-color-producing cells of your vagina

• Vaginal adenocarcinoma: Cancer which begins in the glandular cells that line the surface of the vagina.

In its early stages, vaginal cancer often produces no symptoms, making regular gynecological screening especially important.

Symptoms of more-advanced vaginal cancer can include:

• Pain in the pelvic region

• Unexplained vaginal bleeding following intercourse or after menopause

• Vaginal discharge that’s watery

• Urination pain, or frequent urination

• Unexplained constipation

• A noticeable lump in your lower abdomen

Like cervical cancer, vaginal cancer can sometimes be caused by an infection by the Human Papilloma Virus (HPV), a common sexually-transmitted condition. Most people who carry HPV will never develop vaginal cancer. Other risk factors for vaginal cancer can include:

• Being older, with most cases occurring in people between 50-70, though young women can be diagnosed too

• Being diagnosed with vaginal intraepithelial neoplasia (VAIN), which are abnormal cells in the lining of the vagina. While most people with VAIN don’t develop cancer, a small percentage do.

• Being infected with the Human papillomavirus (HPV) or not receiving the HPV vaccine before becoming sexually active as a young person.

• Smoking

• Previous treatment for cervical cancer or radiation therapy to the pelvis

• During pregnancy prior to your birth, your mother took the miscarriage reducing drug Diethylstilbestrol (DES)

Ways to reduce your risk of developing vaginal cancer include:

• Get vaccinated against HPV before beginning sexual activity

• Get screened for infection with HPV

• Don’t smoke

• Use condoms during sexual activity

If you have symptoms that might suggest vaginal cancer, your doctor will talk to you about the issues you’re experiencing, followed by a pelvic exam or Pap test to check for infection with HPV, which can cause vaginal cancer. If those tests suggest further investigation, the doctor may refer you for additional tests, including:

• Colposcopy: an exam using a special kind of magnifying device called a Colposcope into the vagina. The Colposcope is then used to examine the lining of the vagina closely for abnormal cells.

• Biopsy: in which a small sample of tissue is removed so it can be checked for cancer

• Imaging tests: Which may include x-rays, CT scans, PET scans or MRI.

As a leading provider of advanced gynecologic care, Hoag treats more women than any other hospital in Orange County. Trust Hoag for your gynecologic cancer treatment.

Our gynecologic cancer specialists and support staff with Hoag Oncology and The Hoag Women’s Health Institute will be there for you following your diagnosis to help you find resources, review your options and make informed decisions at every step of your cancer treatment and recovery.

Treatment options for vaginal cancer depend on many factors, including how advanced the cancer is when detected, your age, other health issues you may have, the size and location of the tumors and whether you wish to have children in the future. Some treatment options Hoag offers for vaginal cancers include:

• Radiation therapy/radiotherapy. Learn more about Hoag Radiation Oncology.

• Surgery to remove tumors or affected tissues More information about surgical options for vaginal cancers at Hoag

• Chemotherapy

• Brachytherapy, also known as “internal radiation therapy,” is a radiation treatment in which a small radioactive source is temporarily placed inside the body. Because of the high dose rate, brachytherapy treatments are usually delivered on an outpatient basis or with a minimal hospital stay. Explore advanced treatment options at Hoag.

• Robotic-assisted surgery from Hoag, the unmatched leader on the West Coast in the field of robot-assisted, minimally-invasive surgery to help treat gynecologic cancers. Explore robotic surgery at Hoag. There are many conditions and patients that can benefit from Minimally Invasive Gynecology Surgery including:

  • Hysterectomy

  • Cancers of the uterus, cervix, and ovary

  • Endometriosis

  • Patients at high risk of gynecologic cancers who want preventative surgery

  • Patients with a history of surgery complications

  • Obese patients at a high risk for surgical complications

  • Ovarian masses

Facing surgery can be a frightening prospect, but it is a vital component in the successful treatment of many gynecologic cancers. The Hoag Family Cancer Institute’s medical team includes experienced, fellowship-trained oncologists who utilize the latest techniques and technology in the surgical management of many different cancers found in women, including vaginal cancers.

Radical cancer surgery is a surgical procedure in which physicians remove the entire tumor, a margin of normal tissues, and in some cases, nearby lymph nodes. At Hoag, our surgeons have undergone extensive training in radical gynecologic cancer surgery and procedures, including in the areas of:

• Debulking surgery: In cases where the cancer has spread, as much of the cancer is removed as possible. This can often involve extensive surgery including removal of sections of the small or large intestine, as well as tumors from the liver, diaphragm and pelvis.

• Radical hysterectomy

• Excision of vulvar and vaginal cancers

At Hoag, our team applies a multidisciplinary approach to cancer surgery. Our physicians work together on your care, consulting with colleagues in plastic surgery, anesthesia and other specialties to help patients achieve better outcomes, maintain sexual and urinary function and preserve overall quality of life. Hoag surgeons utilize the Enhanced Recovery After Surgery (ERAS) pathway, an approach focused on understanding a patient’s specific biology to improve recovery time and pain management. With ERAS, patients become an active participant in their recovery in four key areas:

• Planning and preparing before surgery

• Reducing the physical stress of surgery

• Post-surgery pain relief planning

• Early feeding and movement after surgery

With ERAS, post-surgical patients require fewer narcotics, suffer from less constipation, are able to return to eating normally sooner and have a recovery period that is, on average, two days faster.

Hoag’s non surgical options, including chemotherapy and radiation therapies, are world-class as well. Hoag Newport Beach was recently named a Radiopharmaceutical Therapy Center of Excellence (RTCoE) by the Society of Nuclear Medicine and Molecular Imaging (SNMMI), a distinction held by only 17 centers in the U.S. including Stanford Health Care, Harvard Medical School and the University of California — San Francisco.

Explore advanced treatment technologies for gynecologic cancers available at Hoag.

The stages of gynecological cancer treatment, including radiation therapy and surgery, can sometimes impact a person’s ability to conceive and bear a child. If you are considering having children in the future, you can discuss fertility options with your doctor. These may include:

• Egg freezing

• Embryo freezing

• Fertility-preserving surgery

• Gestational surrogacy

Fertility preservation works best if initiated prior to your cancer treatment. These options, such as egg or embryo freezing, can be completed within approximately two weeks of diagnosis so as not to compromise initiation of your cancer treatment.

To help patients understand the impact of gynecological cancer treatment on their fertility, Hoag has developed a series of questions you can ask your oncologist or fertility specialist.