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.
Understanding vaginal intraepithelial neoplasia (VAIN)
Precancerous lesions in the vagina are often called vaginal intraepithelial neoplasia (VAIN). This type of precancer cells are only in the 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 0 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 doctor may remove them to see if they are VAIN, cancer cells, or something else. This is is called a biopsy. If your doctor 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 doctor may advise one of these types of treatments:
Laser therapy. This uses a narrow beam of light to destroy or remove abnormal cells. This procedure is usually done in a hospital. 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 doctor applies a chemotherapy medicine to the lining of the vagina. The medicine kills cancer cells in the lining. 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 or 2 weeks. You may notice irritation to the vagina or vulva.
Other types of treatment. Your doctor 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 doctor may advise radiation therapy to kill any remaining cancer cells after other procedures. Your doctor may also advise radiation if other treatments are not possible.
After your treatment
Be sure to ask your doctor 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 doctor how much time you can take to explore your options. You may want to get an opinion from another doctor before deciding on treatment. You may also want to talk with your family and friends.
March 21, 2017
AAFP Conditions Ato Z, StatRed, 2010, Randolph, LK., The 5-Minute Clinical Consult (2015), 23rd ed.
Cunningham, Louise, RN,Stump-Sutliff, Kim, RN, MSN, AOCNS