Vaginal Cancer

disease in which malignant (cancer) cells form in the vagina. occurs more often in women over age 50, but can occur at any age, even in infancy

two main types of vaginal cancer:

Squamous cell carcinoma: Cancer that forms in squamous cells, the thin, flat cells lining the vagina. spreads slowly and usually stays near the vagina, but may spread to the lungs and liver. most common type of vaginal cancer. found most often in women aged 60 or older.

Adenocarcinoma Cancer
begins in glandular (secretory) cells. Glandular cells in the lining of the vagina make and release fluids such as mucus. more likely than squamous cell cancer to spread to the lungs and lymph nodes. found most often in women aged 30 or younger.

Risk Factors :
Being aged 60 or older. Being exposed to DES while in the mother's womb. In the 1950s, the drug DES was given to some pregnant women to prevent miscarriage(premature birth of a fetus that cannot survive). Women who were exposed to DES before birth have an increased risk of developing vaginal cancer. Some of these women develop a rare form of cancer called clear cell adenocarcinoma. Having human papilloma virus (HPV) infection. Having a history of abnormal cells in the cervix or cervical cancer.

Signs and Symptoms :

Bleeding or discharge not related to menstrual periods. A lump in the vagina. Pain during sexual intercourse. Pain in the pelvic area.

Diagnostic Procedures :
Pelvic exam An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. speculum is also inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. Pap test or Pap smear of the cervix is usually done. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.

Pap smear
procedure to collect cells from the surface of the cervix and vagina. piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the cervix and vagina. cells are viewed under a microscope to find out if they are abnormal. procedure is also called a Pap test.

Biopsy
removal of cells or tissues from the vagina and cervix so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a Pap smear shows abnormal cells in the vagina, a biopsy may be done during a colposcopy.

Colposcopy
procedure in which a colposcope (a lighted, magnifying instrument) is used to check the vagina and cervix for abnormal areas. Tissue samples may be taken using a curette (spoon-shaped instrument) and checked under a microscope for signs of disease.

Medical Management :
Surgery Laser surgery - uses a laser beam Wide local excision -takes out the cancer and some of the healthy tissue around it. Vaginectomy - removes all or part of the vagina. Total hysterectomy - to remove the uterus Lymphadenectomy - lymph nodes are removed Pelvic exenteration - to remove the lower colon, rectum, and bladder.

Nursing Interventions :
Observe characteristics and amount of discharge need for fluid and blood component replacement. Monitor vital signs at frequent intervals during episodes of heavy bleeding to detect shock early. Encourage patient to drink large volume of fluid to prevent dehydration. Monitor intake and output and urine specific gravity to detect renal dysfunction. Administer IV fluids as prescribed to replace lost fluid volume. Monitor lab reports to detect development of anemia.