What is the Vagina?

It is the female organ used for the discharge of menstrual flow, for copulation, and the passageway through which babies are born. The vagina is the passageway leading to the cervix. The vagina connects the cervix (the opening of the womb or uterus) and the vulva (the folds of skin around the opening to the vagina). It is a muscular canal lined with mucous membranes that extend from the outside of the body between the vulva and the anus to the cervix of the uterus. In a woman's pelvis, the vagina and it's opening to the cervix is sandwiched between the bladder in front and the rectum in back. The inner lining of the vagina is made up of "squamous" cell, the same type of cell which is found in the mouth. This type of cell is excellent at resisting abrasion, and healing quickly after an injury. This is in contrast with the type of cells which are in the inner cervix and uterus, called "columnar" cells, which fold into glands and produce mucous. In the vagina, the squamous lining cells do not produce any mucous, but a moistening fluid does transverse to the surface of the vagina from glands deep within it, located near the muscle layer of the vagina. This is important because squamous cells give rise to different cancers than the glandular cells, and the cancers found in the vagina are very similar to their counterparts in the mouth and anus. The vagina proper does not include the clitoris, exit of the urination tube ("urethra") or the "vaginal lips" - these are classified as part of the vulva and cancers in these areas are a different topic. The vagina has a rich blood supply, becoming engorged with sexual stimulation. This blood supply can carry cancer cells to other areas of the body. The vagina also has an elaborate system of bean-sized filters to purify blood that runs through it, called "lymph glands." These lymph glands are connected by lymph channels, which is another way that cancer or infections may spread outward from the vagina. As a women ages, the lack of estrogen results in "dystrophic" changes in the vagina, with subsequent drying out and inelasticity, this can in part be prevented by estrogen pills or creams.

What is cancer of the Vagina?

Normally, vaginal cells grow quickly when girls are in the womb and again at puberty, but after full adult growth they divide rarely. In the adult, vaginal cells (and most others) only divide to replace those lost to injury or old age. The control of cells division is under tight regulation by the genes - the genetic material within each cell. Amazingly, each cell in the body contains within it's genes the total information necessary to make a whole new human body. Sometimes an abnormal cell may arise which divides out of control. This will then form a tumor . A tumor is simply a swelling, and does not necessarily mean cancer (obviously most swellings are not cancerous). If a tumor only grows in it's local area, it is called "benign" and is not cancer. If, however, it has the capability to spread to other areas of the body , then it is called "malignant" and is cancer. Vaginal cancer starts in just one single cell, but this quickly divides to form many similar cancer cells, which continue to divide. Eventually, if not cured, these cells push the normal cells out of the way, grow a large tumor within the pelvis, spread via the lymph channels to local lymph nodes, and then spread to other body areas. This spread ultimately kills the patient though anemia, infection, general weakness, malnutrition and debility.

What are the types of Vaginal Cancer?

The most common type of cancer in the vagina arises from the lining squamous cells, and is thus called "squamous cell carcinoma" . These squamous cells often divide to heal injury, and the more frequent their division, the greater the chance for a cancerous one to arise. Squamous cell carcinoma accounts for for 85% of vaginal cancer cases in the UU.S.A. The next most common type arises from glands, it is called "adenocarcinoma" and accounts for 10% of vaginal cancer in the U.S.A. The remaining 5% of cancers are a mixture of vaginal melanomas (from pigment cells), sarcomas (from fat or muscle cells) and lymphomas (from immune cells). The treatment for these rare cancers follows their treatment in other body areas where they are more common. Squamous carcinoma is usually found in women between the ages of 60 and 80. Adenocarcinoma is more often found in women between the ages of 12 and 30, especially the "clear cell" type which is associate with the patient's mother having used a drug called "Diethyl Stilbesterol" (DES) during pregnancy.

How common is Vagina Cancer?

There are about 2000 new cases of vagina cancer every year in the U.S.A. It accounts for about 2% of the total cancers in the U.S.A. each year. Considered altogether, the average patient is 70 years old.

What are the symptoms of Vaginal Cancer?

Early disease produces no symptoms, a tumor must grow to 1 billion cells (about 9 complete doublings) just to be 1/2" across. The first symptoms seen in commonly painless vaginal bleeding (80%) followed byvaginal discharge (50%) which may be foul smelling. Itching ("pruritis") is also common (30%). The disease is often initially misdiagnosed as an infection, and patients placed on antibiotics. If vaginal bleeding is seen in a woman after her menopause, there is about a 30% chance of some cancer, with 98% of these cancers being cervical or uterine. Only 2% of these cancers start in the vagina. A cancer from the cervix can migrate down into the vagina as it grows; this should not be confused with "primary vaginal cancer." As a vaginal cancer grows, it starts to press upon or invade nearby pelvic organs - the bladder and rectum. This can cause blood in the urine or stool, or obstruction of these systems. Lymph glands in the groin may swell up ("inguinal lymphadenopathy"), and back pain may occur from spread to lymph nodes around the great aortic artery. Severe pain in the pelvis usually means advanced disease, and that the cancer has invaded into nerves. Distant spread may be noted by symptoms in the lungs, liver, bone or brain, and usually only occurs once the local cancer has grown very large.

What causes Vagina Cancer?

Like any other cancer, the precise reason why one woman gets vagina cancer and another does not is unknown. There are however "risk factors" that seem to predispose a woman to the disease. There are different risk factors for different types of vaginal cancer. Many pregnant women between 1945 and 1970 were given a drug called "diethylstilbestrol " or DES . Young women whose mothers took DES are at risk for getting tumors in their vaginas, at an average age of 20 years old. Some get a rare form of cancer called "clear cell adenocarcinoma." The risk of an exposed fetus to develop clear cell carcinoma of the vagina later in life is 1:1000. This type of cancer more commonly starts in the cervix than vagina. DES may be a factor for the young.

For the more common patient with squamous cell cancer, risk factors include:

• Being Female is obviously the biggest risk factor for vaginal cancer.
• Lots of Male Sexual Partners and having children by different men, and starting to have sex at a young age dramatically increases risk. In contrast, vaginal cancer is extremely rare in women who never were pregnant ("nulliparous") and nuns. One-quarter of the American adult female population have never had children.
• Uncircumcised Sexual Partners - vaginal cancer is very rare in the wives of circumcised Jewish men, as is cervical cancer.
• Sexually Transmitted Viruses like the "Human Papilloma Virus" (HPV), especially types 16, 18, and 33. These are found in about 50% of patients. They cause genital warts and predispose to various cancers.
• Low Social and Financial Status may reflect more sexual promiscuity or inability to get proper screening and treatment for the disease.
• Immune Deficiency Diseases like AIDS. In fact, the development of vaginal cancer in a HIV positive patient is sufficient to reclassify them as full-blown AIDS. Furthermore, getting immune-system suppressing drugs (to avoid rejecting a newly transplanted organ) also increases the risk, especially in patients with HPV.
• Having had a hysterectomy could mean that you still have a chance of developing vaginal cancer, or cancer of the remaining "cervical cuff"
• Alcohol and tobacco use is not linked to getting vaginal cancer!

What about Screening for Vaginal Cancer?

The Papaniculaou ("Pap") smear, done since 1940, is of proven value in the early detection of vaginal cancer. It is also useful after treatment to help monitor the success of therapy. A pap smear is done at the time of a pelvic examination, it involves taking a brush and a small "spatula" (Ayer's) to get some cells from the "squamocolumnar junction" of the cervix and the vagina, and also any abnormal areas. The scraping often causes slight bleeding. Too much blood in the specimen can distort the Pap smear, so it is not advised during a menstrual period. The American Cancer Society recommends a cancer "checkup" every three years for women over age 20, or starting younger if she is sexually active. This includes a pelvic exam with a Pap test every 3 years (after 2 initial "negative" tests one year apart). Those at higher risk should get more frequent (i.e. annual) screening. The cells collected from the Pap test are examined by a Pathologist (and often also checked by a computerized reading machine) to look for abnormal changes. If cells are found that are not normal you will need to have a sample taken called a biopsy. The Pathologist will look not only at cells of the vagina, but also at the other cells taken from a scraping inside the cervix. If cancer is detected, he will state the specific type.

How is Vaginal Cancer Diagnosed and Evaluated?

If a patient comes in with signs or symptoms suggestive of vaginal cancer, the following evaluation is standard:

Complete Physical Examination, with special attention to the pelvic exam. If a tumor is seen in the vagina, the size, shape, texture and location will be noted. Careful exam will be made of the cervix, to see if the cancer started there and has invaded downward into the vagina. A"bimanual" exam means the uterus, if still present, is palpated with one hand in the vagina and the other on the abdomen to check it's size, as well as the ovaries. A"rectovaginal" exam means one gloved finger is placed into the vagina and one into the rectum, with this technique the pelvic ligaments can be felt to help rule-out cancer spread there. A Pap Smear is usually taken at the time of pelvic exam. If the patient cannot be examined properly due to pain or tension, the exam can be done under anesthesia (EUA) in the operating room. At that time, visualization tubes can be put into the bladder (cystoscopy) and rectum (proctoscopy) to help rule-out spread to those neighboring organs. The lymph glands of the groin (inguinal nodes) are examined, the abdominal organs (especially liver and spleen) are felt for enlargement, and the rest of a standard physical done.

Routine Laboratory Tests includes Complete Blood Count("CBC") to check for anemia and infection. If the tumor has been bleeding for a long time, the patient may have an Iron Deficiency Anemia from chronic blood loss, and thus require iron supplements or even transfusions. If an infection is present, proper antibiotics will be prescribed. A blood Chemistry Panel ("SMA") tells sodium, potassium, glucose, cholesterol, and liver and kidney function. If surgery is an option, blood clotting tests ("PT andPTT") will be wanted by the surgeon, and a Urinalysis("UA") to look for blood, protein, sugar and infection is routine.

Radiology Tests include plain X-rays of the Chest to look for tumor spread or pneumonia. If a suspicious area is seen on the chest X-ray, then a fine-needle biopsy can be gotten under CT guidance (using local anesthesia in the Radiology Department) to confirm or rule-out cancer spread. CT scan of thepelvis helps tell the size of the tumor, whether it reaches the pelvic side wall, whether it invades in pelvic lymph nodes (ones larger than 1 cm. are suspicious) and can be used for radiation therapy treatment planning. CT of the abdomen can show spread to the liver and spleen, but is not routine. Magnetic Resonance Imaging uses magnetism instead of radiation, and is better than CT for looking at the soft tissues in the pelvis and the depth of invasion of the cancer. It is three times more expensive than CT (~$1000) and is not routine. If the cancer may be blocking the outlet of the kidneys and Intravenous Pyelogram (IVP) or kidney ultrasound will be gotten to look for kidney swelling ("hydronephrosis"). Tests like brain CT or bone scans are only gotten if there is suspected spread there.

Biopsy of the Tumor: the only way to absolutely diagnose any cancer is to get a piece of it under the pathologist's microscope, called a "biopsy specimen." The pathologist will then identify the type of tissue, and which type of cancer if present. If cancer is found, the pathologist will specify a"grade" . This means how aggressive the cancer looks under the microscope. "Grade I" means the cancer looks a lot like the normal tissue it arose from, and probably will grow slowly ("indolent")."Grade III" means the cancer is very malignant looking, with frequent cell divisions and not much resembling its normal tissue counterpart. Grade III is thus likely to grow and spread quickly, and behave aggressively. "Grade II" is intermediate in behavior. The pathologist may use special stains or even an electron microscope to further characterize the cancer. This can help determine where the cancer originated and whether some virus was involved in it's development. The pathologist may also be called upon after treatment to look at repeat biopsy samples to determine whether they harbor residual cancer or just scar tissue attributable to successful treatment.

How is the Extent of Vaginal Cancer Gauged?

Your chance of recovery is called the "prognosis." The choice of treatment depends upon the"stage" of the cancer and your general state of health. The "Stage" indicates how extensive the cancer is; whether it is just in the vagina or has spread to other places. The stage is based upon the "staging workup." The results are placed into categories, which allows doctors to select the best treatment and compare the results of different treatments. The "FIGO" staging is the most commonly used:

Stages of cancer of the vagina:

Stage 0 or "carcinoma in situ" means the cancer doesn't invade into the vagina and is in only a few layers of cells.
Stage I means that the cancer is superficial, limited to the vagina lining
Stage II means that the cancer has spread to the tissues just outside the vagina, but has not gone to the bones of the pelvis.
Stage III means that the cancer has spread to the bones of the pelvis. Cancer cells may also have spread to other organs and the lymph nodes in the pelvis and/or groin.
Stage IV(a) Cancer has spread into the bladder or rectum. The fat that surrounds the bladder is called "perivesical fat."
Stage IV(b) Cancer has spread to other parts of the body, such as the bladder, lungs, liver or bone.
Recurrent means that the cancer has come back (recurred) after it has been treated. It may come back in the vagina or in another place.

Note that lymph nodes are not part of the staging for vaginal cancer! However, extensive lymph node involvement approximately halves long-term survival.

What is the Conventional Survival from Vaginal Cancer?

This depends upon the type of cancer, the stage, and treatment selected. In general:

Conventional Treatment of Vaginal Cancer

Surgery is the conventional and current treatment for the earliest vaginal cancer. In a younger woman with very early cancer, usually detected by "Pap" smear, just freezing the cancer ("Cryotherapy"), burning it off ("fulguration") or cutting it off can be curative and preserve fertility. For the earliest "pre-invasive" cancer, this is 97% curative. If the cancer cells have invaded deeper, then more drastic surgery may be necessary, such as removal of the vagina ("vaginectomy"). If the cancer has spread outside the vagina, a "vaginectomy"may be combined with surgery to take out the uterus("hysterectomy"). Any thorough cancer operation, with the removal of lymph glands and all suspicious tissues, requires an abdominal hysterectomy. Often, both ovaries and fallopian tubes are also removed at hysterectomy, this is called a "Total Abdominal Hysterectomy with Bilateral Salpingo - Oophorectomy" (TAH - BSO). This is a very safe operation with about a 10% risk of complications from infection and bleeding, and about a 1% chance of death attributable to the surgery itself. There is about a 3% chance of injury to the ureter with subsequent urinary problems. There are various levels of hysterectomy, depending upon how much tissue is removed. In general, surgery is preferred to radiation for early cancers, especially in younger women, since the suppleness of the vagina and sexual function is usually better after limited surgery. If, however, the cancer has spread to pelvic lymph nodes or to the pelvic side wall, then surgery alone will probably not be curative, since it is nearly impossible to remove every last cancer cell even with radical surgery. For moderately large cancers, it is appropriate to combine "debulking" surgery followed by radiation therapy, giving the best benefit of each treatment while trying to avoid the worst side-effects of each. The most radical surgical procedure (seldom used initially but occasionally to try to salvage radiation failure) is "pelvic exenteration." In "anterior exenteration," the uterus, cervix, vagina, bladder and lymph nodes are removed, while with "total pelvic exenteration," the rectum is also removed. There is about a 10% death risk with this type of surgery, and patients may need collection bags for urine and stool depending upon what is removed. In general, radiation (even if repeated) is safer and more effective than pelvic exenteration, so this operation is uncommon today.

Radiation Therapy is the conventional and effective treatment for vaginal cancer. It has been used since the turn of the century for treating women's cancers. it can be used alone to cure the patient, or in conjunction with surgery. It can also be used to relieve symptoms from advanced disease. Radiation is prescribed and administered by a "radiation oncologist," a physician who specializes in treating cancer with radiation. Over the past 3 decades, tremendous advancements have been made in radiation therapy, and it is now safe and effective treatment. Radiation for vaginal cancer may be given by two different methods, and often both are used for the same patient. The first is called "External Beam" therapy, where the patient lies on a hard table and gets daily treatment with a beam of photons. The second is "Intracavitary" or "Brachytherapy" treatment where the patient has radioactive seeds temporarily placed into the vagina while they lie in a hospital bed for several days. While "External Beam" treatment covers a large area to which the cancer may have spread, "Intracavity" targets radiation to the local tumor area. To cure vaginal cancer with radiation alone, doctors use both methods for optimal treatment.

"External Beam" treatment starts with a "simulation" during which the patient is positioned on a mock machine and the area to be treated is marked out. Often a marker is placed in the vagina, and some barium contrast in the rectum, to visualize those areas on X-Ray. The whole procedure takes less than 1 hour, and the patient then gets a CT scan or goes home. Information from the simulation and CT scans is fed into a "Treatment Planning Computer," and a "plan" is generated, and custom shielding blocks are cut. The patient returns to the department to start treatment, which takes only a few minutes each day, Monday through Friday, for 5 - 7 weeks. the total dose given by external beam is usually about 50 gray (units of radiation). The treatment is painless, patients do not get sick, radioactive, or lose their hair. Side effects of radiation are divided into "acute" and "late" reactions. Acute reactions occur during the course of treatment, while late reactions may occur months to years later. Expected "acute" reactions include treatment area skin redness, vaginal and rectal irritation, urinary frequency, and diarrhea. These resolve after treatment. "Late" reactions may include vaginal dryness, bowel obstruction (5%) urinary stricture (3%) and development of a second cancer from radiation (1%). In general, External Beam radiation is well tolerated and effective. It is capable of treating a wider "field" than surgery and "mopping up" cancer cells missed at surgery. When radiation (or chemotherapy or both) is given after surgery, it is called"adjuvant" (meaning extra) therapy. Dividing External Beam treatment up into many "fractions" (instead of giving it all at once) helps reduce the chance of late reactions. However, it is inevitable to treat some normal tissues in the area when giving External Beam. The idea of radiation is that normal tissues can heal radiation damage, but cancer cells cannot.

Intracavitary Radiation ("Brachytherapy") means seeds of radioactive material (usually cesium-137) are placed in a special applicator which is inserted up into the vagina. Different applicators are used for different treatments. If the /cancer is only in the vagina proper, and superficial, then a "Declos" applicator is used. This is simply a cylinder with some radioactive sources placed into the vagina and held there with a cloth truss. The typical insertion requires no anesthesia and lasts for about 2 days while patient lays in a hospital bed in a shielded room. If the cancer is thought to have spread beyond the vagina, Intracavitary Radiation will be administered to treat the cervix and uterus also. The typical "applicator" for this type or treatment is the "Henshke" or "Fletcher" types, which are made up of a "tandem" (a long cylinder loaded with radioactive seeds inserted into the cervix) and "ovoids" (they are spherical appendages to the tandem containing radioactive seeds and are inserted into the upper vagina). The insertion of these devices is done under general anesthesia in the operating room, and the patient is then taken down to the radiation therapy suite for X-rays to determine the exact position of the applicator relative to the cancer, bowel, and bladder. A physicist designs a "plan" for how the applicator is to be loaded with the radioactive seeds, and what the strength of each seed will be, and how long the applicator should remain in place. The patient is taken to a hospital bed in a special room insulated for giving radiation treatments. the doctor then loads in the radioactive sources according to the "plan," this is painless. Like the vaginal cylinder (Declos) applicator, The patient rests in a hospital bed for 2 days or so while the treatment is given, and is given anti-diarrhea medicine. Then the applicator is removed (no anesthesia is needed for this) and the patient goes home. The side-effects of this kind of treatment are much like external beam, except the skin surface will not be reddened and the chance of infection is higher (5%). If an infection develops (as determined by pain and fever) the applicator must be removed right away. Sometimes several "applications" of brachytherapy are given, spaced every couple weeks, to allow the tumor time to shrink between treatments. The main advantage of brachytherapy is that the tumor and areas at highest risk get the most radiation, with normal tissues getting much less than with external beam treatment. Again, combining external beam and brachytherapy is often the optimal treatment. Radiation will be recommended if the tumor is high stage or bulky ("barrel shaped"), if lymph glands are involved, if the tumor comes back after surgery, or if the patient cannot tolerate surgery. It may be alone, prior to surgery, or after it (adjuvant). Bear in mind that both surgery and radiation are local treatments; they cannot be used to cure cancer that has spread distantly. On the other hand, treating the whole body with enough of anything to kill local bulky disease will kill the patient, given the limits of our current technology. So, whole body treatment is always combined with local therapy.

Chemotherapy has not been widely used in vaginal cancer. It is currently mostly used for patients that have recurrent disease within a previously irradiated area; that area can tolerate no further radiation. Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein. Chemotherapy is called a "systemic treatment" because the drugs enter the bloodstream, travel through the whole body, and can kill cancer cells outside the vagina. Also, it is used for patients with widespread, metastatic cancer (for lack of other effective therapy). The current most effective drugs are cisplatin (derived from platinum) and doxorubicin (a bright red liquid). Either cisplatin, doxorubicin, or even together give a "response rate" of 40% - 60%, meaning the tumor shrinks. Only about 10% of patients get a "complete response," meaning the tumor disappears altogether. Unfortunately, even a complete response does not signal cure. This is because cancers become resistant to chemotherapy agents, much the same as bacteria become resistant to antibiotics. The average response lasts only about 6 months, then the disease progresses again. This helps explain why chemotherapy is used so little for vaginal cancer. Also, it can be very toxic, causing nerve, lung, kidney, and heart damage as well as anemia and infection. It obviously must be very carefully monitored. Although many regimens of chemotherapy have been tried, the average duration of response has always been less than one year. Therefore, current chemotherapy has very little usefulness in squamous cell or adenocarcinoma of the vagina. However, it is essential in treating lymphomas, sarcomas, and the very rare "small cell" cancer of the vagina. In treating vaginal cancer, chemotherapy may also be put directly into the vagina itself, which is called "intravaginal chemotherapy." However, this is only useful for very superficial cancers.

What is the Latest Effective Therapy for Vaginal Cancer?

A large part of winning the war on vaginal cancer is making more effective use of the currently available treatments, and using them in proper combination.

Surgery Advancements: Include always using a qualified "gynecologic oncologist" who attends the "Gynecology Oncology Group" ("GOG") meetings and knows their latest protocols. previously, many patients were treated by general gynecologists who did not do complete cancer operations, so were at a higher risk for recurrence. A good gynecologic oncologist knows not only how and when to extensively, but when not to, sending the patient for other therapies. Get the patient referred to gynecologic oncologist!

Radiation Therapy Advancements: All patients who have greater than stage II disease should get radiation. Furthermore, since we may "understage" the cancer, it is also often appropriate for patients with supposed stage I or II. Interestingly, adjuvant radiation is standard to the vagina for any invasive uterine cancer, since the vagina has about a 10% chance of unknowingly being involved at surgery. If the lymph nodes in the pelvis are involved, then giving radiation to the lymph nodes in the abdomen around the aorta (the "paraaortic" nodes) increases survival at 5 years from 55% to 65% in stages I and II disease. When patients get the intracavity part of their treatment, about 20% less failure is seen if they get more than one application, spaced several weeks apart . For advanced disease (stages III and IVA) chemotherapy can be used to "sensitize" the tumor to radiation. A high complete response rate has been seen using 5-FU and Mitomycin C with 30 Gray of radiation; other agents that can be used with radiation are cisplatin and hydroxyurea. While the side effects of combined treatment are higher, so are the response rates. Also, newer research has shown that if appreciable tumor remains after radiation treatment survival is higher if it is surgically removed several weeks after completion of radiation. For small recurrences, bulky parametrial or persistent disease, additional radiation can be tolerated by "interstitial" therapy. This involves placing needles with radioactive sources (Iridium-192) directly into the tumor, using a template placed on the vulva. There is now available"High Dose Rate" (HDR) interstitial therapy, at many University academic centers. This enables the cancer to be treated over a 5 - 10 minute period, instead of over 3 days in a hospital bed. The "HDR" treatments should be "fractionated" (given multiple time) to lower the risk of tissue late reactions. 4 to 7 HDR fractions have been shown in studies to be as effective as conventional interstitial. HDR can also be used for the non-invasive vaginal cylinder. The only real disadvantage is having to make multiple trips to the hospital. Using a combination of External Beam, several Intracavity applications and Interstitial radiation, a very high and possibly curative radiation dose can be delivered directly to the tumor with minimal side effects.

Chemotherapy Advancements: Includes new protocols to try to find more effective agents, usually given as "clinical trials" sponsored by the "GOG." The gynecologic oncologist not only is a surgeon, but he also prescribes this chemotherapy. Two major ideas in chemotherapy are "chemoprevention" of recurrent squamous cell cancers with vitamin A derivatives ("retinoin") can prevent new cancers in those with HPV virus, but can have side effects of liver damage. The chance for this damage is less if retinoin is used as a cream locally. The newest protocol for advanced cancer uses Platinum and Navelbine (protocol GOG-76Z) for advanced or recurrent squamous cell cancers, it is available at major University Academic Centers. Overall, although vaginal cancer is only 2% of primary cancers, it represents the majority of uterine and cervical cancer recurrences. Therefore it is critical to get proper adjuvant therapy after those cancers to minimize the risk of "vaginal recurrence." Patients should at least have scrupulous follow up appointments to immediately detect any clinical recurrence ("clinical" means it can be noticed). It is very sad to see a patient come in with a large recurrence which could have been much more easily (and successfully) treated if picked up earlier. Be vigilant!

In conclusion, therapy for vaginal cancer is much better than it was previously. Patients should not rely on just one therapy but use multiple approaches to maximize the chance for success. This means using a combination of:

1) Latest Medical Treatments (listed above) given by a gynecologic oncologist.
2) Consultation with a Radiation Oncologist for all but the tinniest disease.
3) Proper Nutritional and Vitamin Supplement Program (to help healing).
4) Increased Exercise Program (boosts the immune system).
5) Reasonable Alternative Therapy (simultaneous with accepted treatment).
6) Positive Attitude and Outlook (including "mind over cancer" exercises).
7) A Program of Spiritual Renewal (helps with all of the "above"!).

This seven point plan for vaginal cancer will not only help with this condition, but help prevent all sorts of future illness and increase well-being. One good day at a time is all any of us mortals can hope to have.

This is the full transcript, offered freely in the spirit of internet sharing, of CancerAnswers' report on Vaginal Cancer. Much more, including latest additional treatments for Vaginal Cancer can be found on our order page. Thank you for using CancerAnswers as your information resource.