Precancer in the Vagina
What is precancer?
Precancer means changes to cells that occur before the cells become cancer. Vaginal cancer often begins with precancerous changes that may take place over many years. If not treated, the changes can turn into cancer over time.
Understanding vaginal intraepithelial neoplasia (VAIN)
Precancerous lesions in the vagina are often called vaginal intraepithelial neoplasia (VAIN). These precancerous cells are only in the inner lining layer of the vagina. These changes can turn into invasive vaginal cancer in some women. Women with VAIN may need to be checked often for cancer. Or treatment may be done to remove or destroy the precancer cells.
VAIN is graded as 1 to 3. The number depends on how deep it goes into the lining of the vagina. The most advanced grade of VAIN is VAIN 3. It’s also called carcinoma in situ, or stage 0 vaginal cancer.
VAIN can be found with a colposcopy and biopsy. A colposcopy is done by using a lighted, magnifying camera to look closely at the inside surface of the cervix and vagina. The camera is outside your body. If any areas of changed cells are seen during this close look, the healthcare provider may remove them to see if they are VAIN, cancer cells, or something else. This is called a biopsy. If your healthcare provider makes a diagnosis of VAIN with colposcopy and biopsy, he or she may treat it right away.
Treatment options for VAIN
The type of treatment can depend on whether the cancer has spread, and other factors. Your healthcare provider may advise 1 of these types of treatments:
Laser therapy. This uses a narrow beam of high-energy light to destroy or remove abnormal cells. This procedure is usually done in a hospital with anesthesia. You will likely not need to stay overnight in the hospital. Cramping after the procedure is common. Bleeding may occur and then go away over several weeks.
Topical chemotherapy. Your healthcare provider applies a chemotherapy medicine to the lining of the vagina. This medicine is not absorbed into your system. The medicine kills cancer cells in the lining of the vagina. The medicine most often used is fluorouracil, also called 5-FU. Treatments are usually done once a week for about 10 weeks. Or they may be done every night for 1 week. You may notice irritation to the vagina or vulva.
Other types of treatment. Your healthcare provider may advise other types of treatment based on the grade of VAIN and your own needs. Partial vaginectomy is surgery to remove part of your vagina. Your healthcare provider may advise radiation therapy to shrink tumors before surgery or to kill any remaining cancer cells after other procedures. Your healthcare provider may also advise radiation if other treatments are not possible.
After your treatment
Be sure to ask your healthcare provider how often you’ll need follow-up exams or tests. For example, you may need to have Pap tests more often, or you may need colposcopy on a regular basis.
Working with your healthcare provider
Your healthcare provider will work with you to make a treatment plan for VAIN. It may take time to choose the best plan. Ask your healthcare provider how much time you can take to explore your options. You may want to get an opinion from another healthcare provider before deciding on treatment. You may also want to talk with your family and friends.
June 19, 2018
AAFP Conditions Ato Z, StatRed, 2010, Randolph, LK., The 5-Minute Clinical Consult (2015), 23rd ed.
Goodman, Howard, MD,Stump-Sutliff, Kim, RN, MSN, AOCNS