Vaginal cancer treatment

Chemotherapy may be given before surgery, after surgery or alone to treat vaginal cancer. In addition to managing a patient’s medical oncology treatment, gynecologic oncologists at the Jordan Center for Gynecologic Cancer work closely with dedicated chemotherapy nurse practitioners. Nurse practitioners offer specialized care for those undergoing chemotherapy, making sure they receive seamless, coordinated care from the first chemotherapy session through follow-up care.

Hormone therapy keeps cancer cells from receiving the hormones they need to grow and spread.

Hormones are chemicals produced by various glands in the body. They circulate in the bloodstream, and some hormones can affect the way certain cancers grow. Hormones that can stimulate cancer include:

• Estrogen
• Progesterone
• Testosterone

Hormone therapy blocks the production or the effects of these hormones and helps stop the cancer from growing. Treatment may include the use of drugs that change the way hormones work or surgery to remove the ovaries in order to stop hormone production.

For some types of vaginal cancer, surgeons remove the uterus and the cervix in a procedure known as a hysterectomy. A hysterectomy may be performed as an open procedure, known as an abdominal hysterectomy, in which the uterus is removed through an incision in the abdomen. If lymph node sampling is needed, this can be done through the same incision as the abdominal hysterectomy.

When the uterus is removed through the vagina, it is called a vaginal hysterectomy. Often done as a minimally invasive procedure using a laparoscope, a thin camera inserted into the abdomen to facilitate the procedure, the vagina and any lymph nodes can be removed.

A simple hysterectomy leaves the loose connective tissue around the uterus (parametrium), the tissue connecting the uterus and sacrum (uterosacral ligaments) and the vagina intact. Removing the ovaries and fallopian tubes is a separate procedure and are often performed along with a hysterectomy.

In a radical hysterectomy, the entire uterus, the tissues next to the uterus (parametrium and uterosacral ligaments) and the upper part of the vagina are removed.

A radical hysterectomy is usually performed abdominally, but can also be performed through the vagina. Most patients undergoing a radical hysterectomy also have a lymph node dissection, in which lymph nodes are removed either through the abdominal incision or by laparoscopic lymph node sampling. The lymph nodes are then checked by a pathologist to determine whether cancer has spread from the vagina to other parts of the body.

An oophorectomy is a procedure in which both ovaries are removed.

Pelvic exenteration is a radical surgery that removes all organs from the pelvic region. It is not commonly performed by Penn Medicine gynecologic oncologists, but may be used to treat cancer that has spread to surrounding reproductive and pelvic organs.

In a vaginectomy, the surgeon removes the vagina and usually some pelvic lymph nodes. A plastic surgeon can create a new vagina with grafts of tissue from other parts of the body.

Conformal radiation therapy gives us more control when treating tumors. In conformal radiation, a special computer uses computed tomography (CT) imaging scans to create 3-D maps of the location of the cancer in the body. The system permits the delivery of radiation from several directions, and the beams can then be shaped, or conformed, to match the shape of the cancer. Conformal radiation therapy limits radiation exposure to nearby healthy tissue and to the tissue in the beam’s path.

Image-guided radiation therapy (IGRT) uses frequent imaging during a course of radiation therapy to improve the precision and accuracy of the delivery of radiation treatment.

In IGRT, the linear accelerators (machines that deliver radiation) are equipped with imaging technology that takes pictures of the tumor immediately before or during the radiation treatment. Specialized computer software compares images of the tumor to images taken during the simulation to establish the treatment plan. Necessary adjustments can then be made to your position and/or the radiation beams to more precisely target radiation at the cancer and avoid healthy surrounding tissue.

Intensity-modulated radiation therapy (IMRT) is an advanced mode of high-precision radiotherapy that uses computer-controlled linear accelerators to deliver precise radiation doses to tumors or specific areas within the tumors. Radiation therapy, including IMRT, stops cancer cells from dividing and growing, thus slowing or stopping tumor growth. In many cases, radiation therapy is capable of killing all of the cancer cells.

Using 3-D computed tomography (CT) images in conjunction with computerized dose calculations, IMRT allows for the radiation dose to conform more precisely to the three-dimensional shape of the tumor by controlling, or modulating, the intensity of the radiation beam in multiple small volumes. The therapy allows higher radiation doses to be focused to regions within the tumor while minimizing the dose to surrounding normal critical structures.

Palliative care provides physical, emotional and spiritual care that can enhance your quality of life. It can be used to complement traditional cancer therapies or when curative therapies are no longer an option. Services include palliative chemotherapy, radiation therapy and surgery, as well as psychological counseling, art therapy and support groups for patients and families.

Penn Medicine offers a full range of at-home health care services, including specialized therapies and medications, for patients with cancer and cancer-related conditions.