Squamous Cell Carcinoma of the Vagina

Squamous cell carcinoma of the vagina is a rare but potentially serious cancer that develops in the thin, flat cells lining the vagina. Though it grows slowly, early detection through regular examinations is crucial, as this cancer may not cause symptoms in its early stages.

Table of contents

• What is squamous cell carcinoma of the vagina?
• Signs and symptoms
• Risk factors
• Diagnosis
• Types of squamous cell carcinoma
• Treatment approaches
• Prognosis and outlook
• How common is this cancer?

What is squamous cell carcinoma of the vagina?

Squamous cell carcinoma of the vagina is a potentially invasive type of cancer that forms in the tissues of the vagina. The vagina is the muscular tube that connects the cervix (the lower part of the uterus) to the outside of the body^[1].

Squamous cells are the thin, flat cells that line the vagina. When cancer develops in these cells, it is called squamous cell carcinoma. This type accounts for 80 to 90% of all vaginal cancers, making it the most common form of this disease^[1][2].

The cancer initially spreads superficially within the vaginal wall and can slowly spread to invade other vaginal tissues. It most commonly develops in the upper part of the vagina, closest to the cervix^[1][4]. Because of its slow growth pattern, this cancer may cause no symptoms initially, which is why regular screening is important^[1].

Squamous cell carcinoma of the vagina can spread to nearby organs such as the bladder or rectum, and can also metastasize to the lungs or, less frequently, to the liver or bone^[1][6].

SCCV, squamous cell cancer of the vagina

Signs and symptoms

Squamous cell carcinoma of the vagina may not cause any signs or symptoms in its early stages. This is one reason why regular pelvic examinations are so important^[1][2].

The most common symptom people experience is vaginal bleeding. This bleeding is often unusual or unexpected, such as bleeding in women who have already gone through menopause and no longer have monthly periods, or bleeding that occurs after sexual intercourse^[1][3].

A mass or lump in the vagina may also be noticed. This can cause pain during sexual intercourse. Some women may experience unusual vaginal discharge^[1][3].

If the disease has grown or spread from the vagina to nearby structures, it can lead to additional symptoms. These may include pain in the pelvic area, pain when urinating, frequent urination, or constipation^[1][3].

Risk factors

Squamous cell carcinoma of the vagina is strongly associated with infection with certain strains of human papillomavirus, or HPV. HPV is a sexually transmitted virus that can cause changes in vaginal cells over time. This connection is similar to the relationship between HPV and cervical cancer^[1][2].

Because of the association with HPV, risk factors for HPV infection also increase the risk of this vaginal cancer. These factors include early age at first sexual intercourse, having multiple sex partners, and not being vaccinated against HPV^[1][2].

Smoking is another important risk factor. Women who smoke have double the risk of developing vaginal cancer compared to non-smokers^[1][2].

Age plays a significant role, as this cancer becomes more common as age increases. The average age of individuals affected is around 60 years old^[1][2].

Women with a history of cervical cancer or abnormal cells in the cervix (called cervical dysplasia) have an increased risk of developing vaginal cancer^[1][2].

Other factors that have been found to increase risk include alcohol consumption and low socioeconomic status^[1].

Diagnosis

Diagnosis of squamous cell carcinoma of the vagina is made by examining tissue from the vagina under a microscope. The doctor must also confirm that there is no history of another gynecological cancer that may have spread into the vagina^[1].

To diagnose this cancer, a doctor performs a complete assessment of your medical history and a physical examination. A pelvic exam is essential, during which a tool called a speculum is inserted into the vagina to fully visualize the area and look for any irregularities or masses^[1][6].

If something abnormal is found, a biopsy is performed. During a biopsy, a small sample of tissue is removed and sent to a laboratory for testing. This is the only way to definitively diagnose cancer^[1][6].

A bimanual exam is often done, where the doctor inserts fingers into the vagina while pressing on the abdomen to feel for other masses. A rectovaginal exam may be performed to check if the cancer has spread to the rectum^[1].

Other diagnostic procedures that can be used include a Pap smear, which can detect abnormal cells, and colposcopy, which uses a special magnifying instrument to examine the vagina more closely^[1][6].

Once diagnosed, imaging tests are done to determine the stage of the cancer, meaning how far it has spread. These may include chest X-ray, CT scan (a detailed X-ray that creates cross-sectional images), MRI (which uses magnets and radio waves to create detailed images), and PET scan (which shows how tissues and organs are functioning)^[1].

Types of squamous cell carcinoma

There are different subtypes of squamous cell carcinoma of the vagina, classified by how the cells appear under the microscope. These include keratinizing, nonkeratinizing, basaloid, and warty types^[1].

A related condition called vaginal intraepithelial neoplasia, or VAIN, represents abnormal cells in the vaginal lining that are not yet cancer but may develop into cancer over time. VAIN is considered a precancerous condition. Before squamous cell cancer develops, there may be these precancerous changes to the cells^[2][4].

Treatment approaches

Treatment varies depending on several factors, including the stage of the cancer (how far it has spread), where the cancer is located in the vagina, and the characteristics of the cancer cells. The size of the tumor and whether it has spread to lymph nodes or other organs all influence treatment decisions^[1].

Treatment options typically include surgery, radiation therapy, or a combination of both. In some cases, chemotherapy (drugs that kill cancer cells) may be used along with radiation therapy^[1].

For early-stage cancer that is confined to the vagina, surgery to remove the tumor may be sufficient. For more advanced cancer, radiation therapy or a combination of chemotherapy and radiation (called chemoradiation) is often recommended^[1].

Prognosis and outlook

The prognosis, or likely outcome, depends primarily on the stage at which the cancer is diagnosed. Cancer that is found when it is still confined to the vagina has the best chance for a cure. When the cancer has spread beyond the vagina, it becomes much harder to treat^[3].

Other factors that affect survival include which part of the vagina is affected, the type and grade of the cancer cells (how abnormal they look under the microscope), and the person’s general health and fitness^[1].

How common is this cancer?

Squamous cell carcinoma of the vagina is uncommonly diagnosed. Vaginal cancer accounts for only 1 to 2% of all gynecological cancers, and squamous cell carcinoma makes up 80 to 90% of vaginal cancers^[1][2].

About 1 in 100,000 women are diagnosed with vaginal cancer each year. The average age at diagnosis is around 60 years old, though it can occasionally occur in younger women^[2].

• Vagina
• Cervix
• Uterus
• Vulva
• Bladder
• Rectum
• Pelvic lymph nodes