Vaginal Cancer

An overview of disease, diagnosis and treatment

Vaginal Cancer

Primary Vaginal cancer is rare, and more aften tumors located in the vaginal wall have spread from other tumor types and locations.

If a tumor is located in the top of the vagina, it can be difficult to differentiate it from a primary cervical cancer, or a recurrence from a previously treated cervical malignancy.

Predominantly vaginal cancers arise from the superficial layer of the internal mucuos membrane (squamous cell carcinoma) in the vagina.   

Other more rare tumour types in the vagina are cancers of the glandular tissue (adenocarcinomas), malignant melanomas, or tumors arising from connective tissue or muscles cells in the vaginal wall (sarcoma). 

The treatment options for vaginal malignancy are dependent on the tumor type, size and exact location and possible spread. Treatment and follow up for vaginal cancers are often centralized due to the limited number of patients. This allows for specialization among the professionals treating the patients. 

Epidemiology

Vaginal squamous cell carcinoma is a rare disease, and the median age of onset is 74 years. Human Papilloma Virus (HPV) infection and smoking predispose to development of vaginal cancer.

Most Commong Type of vaginal Cancer

Squamous cell carcinoma is the most common histological type of vaginal cancer. It develops in the squamous cells in the mucous membrane, which lines the internal surface of the vagina. If not treated, the carcinoma may grow deeper into the vaginal wall, and eventually penetrate the vagina and invade e.g. bladder or rectal tissue nearby. The cancer can also spread to distant sites incl. bones, lungs, and liver.

Examination Methods

Transvaginal Ultrasound

A vaginal ultrasound (VUL) examination of the internal genital organs is performed with an ultrasound probe inserted into the vagina (transvaginal sonography). It demonstrates pelvic structures well, and can roughly estimate the size of a vaginal tumor. 

It is a painless examination and can be repeated any number of times. It does not expose the patient to any radiation.

VUL can also be used for visual guidance during tumor biopsi procedures.

Blood tests

Blood tests provide information about the general health condition of a patient.

The test results are important with regard to an upcoming treatment, and usually evaluates haematological status, kidney-, and coagulation function.

Abdominal Ultrasound

Ultrasound examination of the abdomen provides view of the internal organs such as the liver, kidneys, spleen, and to some degree the intestines.

It may visualize, possible tumor spread (metastases) to nearby organs or structures. It can be useful as visual guidance during tumor biopsi procedures.

Treatments Options

Radiation Therapy

Radiation therapy uses high-powered energy beams (usually fotons) to destroy and kill cancer cells. The vaginal tumor and surrounding tissue is irradiated from the outside through the skin (external beam radiation therapy), or from the inside through the vagina (brachytherapy). In a range of patients a combination of the two modalities is recommended for sufficient effect.

During radiation treatment care is taken to protect the surrounding normal tissue such as bladder, rectum, and bowel etc. However, it is often unavoidable that a limited dose affects the surrounding tissue, and consequentially results in side effects of varying degree.

The side effects may be urinary problems, diarrhea, inflammation of the mucous membranes in the vagina, bladder, rectum and bowel, as well as nausea, discomfort/pain, development of scar-tissue in the pelvic area (fibrosis), and swelling af the leg(s) due to lymphoedema. For vaginal cancers the radiotherapy often results in shortening and hardening (due to fibrosis) of the vagina, resulting in sexual disabilities.

Always discuss the riscs and possible treatment options with your radiation oncologist prior to commencing your treatment.

Radiation therapy can be combined with chemotherapy as treatment for vaginal cancer, and this is referred to as chemoradiation treatment.  

Surgery

Very small vaginal cancers can be surgically removed. In most cases however, surgical treatment would result in significant morbidity and damage to the pelvic area, as complete removal of the vagina (vaginectomy), as well as other organs e.g. urinary bladder, rectum and lymph nodes, may be necessary. Therefor radiotherapy is often the preferred treatment, even for stage 1 disease.

Making Decisions about your care

The choice of therapy for your cancer is an individual decision, and many factors are taken in to consideration, when your doctor(s) discuss the best option(s) with you. These include the type, size and location/spread of the tumor, as well as your age and general health status. 

We recommend, that you have a thorough discussion with your doctor(s) about the results upon your diagnosis, the treatment-plan and your chances of recovery (e.g. prognosis).

You are encouraged to include family and/or friends for participation in doctors appointments etc. for improving your/their understanding and remembrance of relevant information, as well as for emotional and physical support during appointments and treatments. 

Your doctor can give a detailed explanation of the various therapy options, and has knowledge of the possibility to participate in a clinical trial. Each patient is different and so is their wish upon information needed/wanted prior to making important decisions. 

Well designed and conducted clinical trials are essential to determine the effectiveness of a promising new drug or intervention. Many gynaecologic oncology departments have studies open for inclusion during the course of your cancer treatment. Talk to your doctor(s) about your thoughts regarding possible inclusion in a clinical trial now or in the future.

                                                                                                               (References; www.DGCG.DK, Kræft Klinik og sygepleje, FADL’s forlag 2019) 

Author: Kristine Madsen, MD, Deputy Medical Director NSGO-CTU

Privacy Policy for NSGO

NSGO treats personal information and complies with the laws and principles of good data processing practices. Therefore, we have adopted this Privacy Policy, which briefly describes how we treat personal information, so legal and transparent processing is ensured.

We are responsible for processing your personal information:

NSGO is the data controller and you can always contact the organization’s data protection officer:

Kristine Madsen

Nordic Society of Gynecologic Oncology – Clinical Trial Unit
Copenhagen University Hospital
Department of Oncology, 9431
Blegdamsvej 60
DK-2100 Copenhagen
Office phone: +45 35 45 33 78
fax: +45 3545 2898
nsgo-dpo.rigshospitalet@regionh.dk

We treat the following personal information about members:

  • General personal information: For example, contact information such as name, work address, work phone number, private phone number, date of birth, email address, country, work title, date of membership, date of membership termination and cv in relation to membership application. Parts of credit card number via Epay and, if applicable, Bank account number for reimbursement purposes. When applicable, Board Members may be asked to give NSGO copies of other personal documents (for example passport or tax bill) in relation to the Danish Laundering Act.
  • Other information: For example, positions of trust, board membership and other duties in relation to the organization.

We collect personal information from:

Usually we will get the information from you, when you register to become a member of NSGO and when you apply for reimbursements or pay your membership fee

The organization’s legal basis to process personal information:

  • That we as an organization have a (legitimate) interest in processing your information
  • That it is necessary for us to fulfill an agreement with you
  • You have agreed that we can process your information via becoming a member of the

The purpose of processing personal information:

  • That we can run the organization’s activities, including planning, implementing and following up on them
  • To invite to vote for Board and President Elect elections
  • To distribute newsletters
  • To comply with legislation
  • To deliver services, in the form of the possibility to participate in the Annual Meeting, Investigator Meeting and if applicable Strategic Meetings, Board Meetings, Scientific Committee Meetings, Foundation Meetings.
  • To notify members about other Gynecologic Cancer Managing your relationship with the organization
  • To handle your membership rights
  • For you to fulfill your obligations as a member of the organization, including paying the membership fee, etc.
  • Being able to display situation images from a specific event in the organization for instance from NSGO Annual Meetings
  • To maintain historical value data for statistics and the like

Consent:

When you become a member, we have a legal basis to process your personal information for the (legitimate) interest of the organization. However, it may happen that we judge it necessary to obtain your written consent for other purposes. In that case you will have the opportunity to voluntarily agree, and you may withdraw it at any time by notifying us.

Dispatch of your personal information:

We do not disclose information about you to anyone outside the organization without your consent, however, it should be noted, that if you e.g. accept an invitation to a meeting, your personal information might be forwarded to the meeting location or the meeting organizer. Only personal information relevant for the 3rd party will be disclosed in these circumstances.

Storing and deleting your personal information:

For historical reasons and as your details might be saved in old attendance lists, email correspondence and minutes from meetings, we cannot promise that all personal information about you will be deleted, if you terminate your membership.

Your rights:

You have a number of rights via the General Data Protection Regulation (GDPR):

  • The Right to Information (to be informed what information we process about you)
  • The Right to Rectification (to have false information about you corrected)
  • The Right to Restriction of processing (under certain conditions, to have the processing of your data restricted)
  • The Right to Object (to object to your information being used for wrong purposes)

You may make use of your rights by contacting us. If you submit a request to have your personal information corrected or deleted, we will investigate whether the conditions are met and, in that case, make changes or deletions as soon as possible and, if applicable, also notify our data processors to do so.

You can file a complaint with the supervisory authorities – The Danish ‘Datatilsynet’ – About processing your personal information (www.datatilsynet.dk).

Revision of Privacy Policy:

We reserve the right to change the organization’s privacy policy. When we change privacy policy, we also change the date and version number at the bottom of this document. In case of significant changes, you will receive a notification.

The current privacy policy is always available on our website.

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Privacy Policy for NSGO-CTU

NSGO-CTU treats personal information and complies with the laws and principles of good data
processing practices. Therefore, we have adopted this Privacy Policy, which briefly describes how we treat personal information, so legal and transparent processing is ensured.

We are responsible for processing your personal information:

NSGO-CTU is the data controller and you can contact the organization’s data protection officer:

Kristine Madsen

Nordic Society of Gynecologic Oncology – Clinical Trial Unit
Copenhagen University Hospital
Department of Oncology, 9431
Blegdamsvej 60
DK-2100 Copenhagen
Office phone: +45 35 45 33 78
fax: +45 3545 2898
nsgo-dpo.rigshospitalet@regionh.dk

We treat the following personal information about personnel participating in NSGO-CTU trials:
• General personal information: For example; contact information such as name, work
address, work phone number, date of birth, email address, country, work title, date of start
of participation and termination in a trial and, if applicable, CV, GCP certificates, records of
training and other qualification data.
• If applicable, financial disclosure forms and/or Bank account number for reimbursement
purposes.

We collect personal information from:
• We will ask you to provide us the information yourself, when you in decide to take part
in NSGO-CTU trials.
The organization’s legal basis to process personal information:
• That we as an organization have a (legitimate) interest in processing your information, for
example to secure your qualifications in handling the care of the participants in a trial.
• That it is necessary for us to fulfill an agreement with your employer
• You have agreed that we can process your information via signing the delegation log.
The purpose of processing personal information:
• The participation of an investigator or of other individuals in a clinical trial which is being
conducted according to the principals governing clinical research as set out in the
Declaration of Helsinki and with the acceptance of all involved Regulatory Health
Authorities and involved Ethical Committees, requires collection, recording, storage,
transfer and/or other use of personal data (personal data processing).
• Communicate regarding studies.
• To handle payments and reimbursements.
• To comply with legislation.
• To deliver services, in the form of the possibility to participate in the Annual Meeting,
Investigator Meeting.
• To be able to give you access to IT systems, databases, eCRFs etc. related to the functioning
of each individual trial.

Consent:
When you decide to take part in a NSGO-CTU trial NSGO-CTU either makes a contract with you or
your employer where terms and conditions are described, or if you put your name on the
Delegation Log of a trial, you agree to the information described in this Privacy Policy.
However, it may happen that we judge it necessary to obtain your written consent for other
purposes. In that case you will have the opportunity to voluntarily agree, and you may withdraw it
at any time by notifying us.
Be aware that there are legal bases for certain forms of processing of your data for the abovementioned purposes and that your consent is the only legal basis for other forms of processing.

Dispatch of your personal information:
Depending on your role in a trial, your personal information might be shared with personnel at
other sites, monitors, group staff in other countries, NSGO-CTU office staff, members of NSGO,
CRO staff, Ethics Committees and Competent Authorities, both in Europe, but also in countries
outside the European Economic Area (for example the US). If your data (personal information) has
been transferred, they will be subject to the data protection legislation of the respective country,
also if a less severe data protection law should exist.
We do not disclose information about you to anyone outside the organization without the above
consent, however, it should be noted, that if you e.g. accept an invitation to a meeting, your
personal information might be forwarded to the meeting location or the meeting organizer. Only
personal information relevant for the 3rd party will be disclosed in these circumstances.
Furthermore, your data can be transmitted to public databases for registration, as well as
publication of a trial and your data can be stored and published in those databases.
Storing and deleting your personal information:
For historical reasons and as your details might be saved in old attendance lists, email
correspondence and minutes from meetings, we cannot promise that all personal information
about you will be deleted, when you end your participation in a study. In general, all information
about a trial is deleted at least 20 years after end of study.

Your rights:
You have a number of rights via the General Data Protection Regulation (GDPR):
• The Right to Information (to be informed what information we process about you)
• The Right of Access (to get a print of the information we process about you)
• The Right to Rectification (to have false information about you corrected)
• The Right to Erasure (to delete information we process about you, however, information
already received cannot be deleted)
• The Right to Restriction of processing (under certain conditions, to have the processing of
your data restricted)
• The Right to Object (to object to your information being used for wrong purposes)

You may make use of your rights by contacting us, however, the legality of the processing carried out
prior to e.g., a withdrawal will not be affected. If you submit a request to have your personal
information corrected or deleted, we will investigate whether the conditions are met and, in that
case, make changes or deletions as soon as possible and, if applicable, also notify our data
processors to do so.

If you do not believe that NSGO-CTU handles your data correctly, you can file a complaint with the
supervisory authorities – The Danish ‘Datatilsynet’ – About processing your personal information
(www.datatilsynet.dk).

Revision of Privacy Policy:
We reserve the right to change the organization’s privacy policy. When we change privacy policy,
we also change the date and version number at the bottom of this document. In case of significant
changes, you will receive a notification.

The current privacy policy for NSGO-CTU is always available on our website.

Practice Areas

Newsletter

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