Vaginal cancer risk factors

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Who is at highest risk?

Clinical data has suggested that the development of vaginal cancer is related to several factors.

• Vaginal adenosis: Clinical research suggest that having adenosis increases the risk of developing clear cell carcinoma. Although it is very small, many doctors feel that any woman with adenosis should have very careful screening and follow-up.
• Cervical cancer: Surveies show having cervical cancer increases the risk of vaginal squamous cell cancer. This is most likely because cervical and vaginal cancers have similar risk factors.
• Diethylstilbestrol (DES): Clinical data show women whose mothers took Diethylstilbestrol (DES) develop clear-cell adenocarcinoma of the vagina more often than would normally be expected. These women are called "DES daughters".
• Human papillomavirus (HPV) infection: Certain types of HPV (type 16 and 18) have been strongly associated with vaginal cancers.
• HIV infection: Clinical studies show human immunodeficiency virus (HIV) also increases the risk of vaginal cancer.
• Unhealthy lifestyle: Epidemiological research demonstrates smoking and alcohol increase th erisk of vaginal cancer.
• Age: Vaginal cancer is always found in women above 70 years old.

Risk Factors

Clear cell adenocarcinomas are rare and occur most often in patients less than 30 years of age who have a history of in utero exposure to diethylstilbestrol (DES). The incidence of this disease, which is highest for those exposed during the first trimester, peaked in the mid-1970s, reflecting the use of DES in the 1950s.[3] Young women with a history of in utero DES exposure should prospectively be followed carefully to diagnose this disease at an early stage. In women who have been carefully followed and well-managed, the disease is highly curable.

Vaginal adenosis is most commonly found in young women who had in utero exposure to DES and may coexist with a clear cell adenocarcinoma, though it rarely progresses to adenocarcinoma. Adenosis is replaced by squamous metaplasia, which occurs naturally, and requires follow-up but not removal. The natural history, prognosis, and treatment of other primary vaginal cancers (sarcoma, melanoma, lymphoma, and carcinoid tumors) may be different, and specific references should be sought.