Precancerous conditions of the vagina
Precancerous conditions of the vagina have the potential to develop into vaginal cancer. They are abnormal changes (called dysplasiadysplasiaAbnormal development, appearance and organization of cells so that they are different from normal cells in size, shape and organization within tissue. Dysplasia almost always refers to a precancerous condition.) that have taken place in the cells of the vagina. Over time, some of these precancerous changes can turn into cancer if left untreated. It may take many years (approximately 5–10 years) for precancerous conditions to progress to invasiveinvasive1. Referring to a procedure or device that breaks the skin or enters a body cavity. 2. Referring to a disease (such as cancer) that is growing into surrounding tissue or has spread outside the tissue where it started. vaginal cancer, but sometimes this can happen in less time.
Vaginal intraepithelial neoplasia (VAIN)
VAIN is the most common precancerous condition of the vagina. Abnormal changes occur in the cells in the epithelium (inner surface layer) of the vagina. VAIN often occurs together with cervical intraepithelial neoplasiacervical intraepithelial neoplasiaAbnormal cells in the cervix (the lower, narrow part of the uterus, or womb) that can become cancerous. (CIN) and is thought to have a similar cause. VAIN is more often seen in the upper part of the vagina and is often multifocal (in more than one place). VAIN may extend from nearby areas of CIN or occur separately.
VAIN is categorized based on the severity of the abnormality in the epithelium:
- VAIN I – mild dysplasia
- Epithelium is mildly abnormal.
- VAIN II – moderate dysplasia
- Epithelium is moderately abnormal.
- VAIN III – severe dysplasia or carcinoma in situcarcinoma in situA very early stage of cancer in which tumour cells have not yet invaded surrounding tissues.
- Epithelium is severely abnormal and is considered a premalignant lesion.
- This usually occurs when CIN III (severe dysplasia of the cervix) is present.
The following risk factors may increase a woman’s chance of developing VAIN.
- history of human papillomavirus (HPV) infection – in particular, types 16 and 18
- history of CIN or cervical cancer
Signs and symptoms
Precancerous changes in the vagina often do not cause any signs or symptoms.
An abnormal Pap test result is often the first sign that some cells in the cervix or vagina are abnormal. This is why it is important to have regular Pap tests and pelvic examinations.
If the doctor suspects a precancerous condition of the vagina, tests will be done to make a diagnosis. Tests may include:
- colposcopycolposcopyA procedure that uses a colposcope (a lighted magnifying instrument) to examine the vulva, vagina and cervix.
- pelvic examinationpelvic examinationA physical examination used to check for abnormalities of the female reproductive organs, including the uterus (womb), cervix (the lower, narrow part of the uterus), ovaries and vagina (birth canal).
Often, milder changes (VAIN I) return to normal without any treatment. The doctor will discuss whether repeating the Pap test later on and waiting to see if mild changes resolve on their own is an option. Moderate changes (VAIN II) likely won’t return to normal, so treatment is usually started right away. More severe abnormalities (VAIN III) are more likely to develop into invasive vaginal cancer, especially if they are not treated. It is hard to predict which of these will become invasive and which will not.
Treatment options for VAIN may include:
- topical estrogen therapy
- topical chemotherapy – 5-fluorouracil (5-FU) cream
- wide surgical excision to remove the abnormal area and a border of normal tissue
- laser surgery
- intracavitary radiation therapyintracavitary radiation therapyA type of radiation therapy that uses implants (needles, catheters, wires or seeds) to deliver radiation directly into or near a tumour.
- partial or total vaginectomy (removal of part or all of the vagina) – for multifocal or widespread disease
- vaginal reconstruction – rebuilding the vagina using tissue grafts from another part of the body