Treatment Options for Precancerous Lesions in the Vagina
Vaginal cancer usually begins with precancerous changes. These changes may last for many years. Precancerous lesions in the vagina are often called vaginal intraepithelial neoplasia (VAIN). Intraepithelial means that the precancerous cells are only in the lining layer of the vagina. This is called the epithelium. But these changes may develop into invasive vaginal cancer in some women. There are no predictive tests to determine who will get vaginal cancer if they have a precancerous lesion. That’s why your healthcare provider will generally recommend treatment.
These are the 3 grades of VAIN.
- VAIN 1 (the thinnest)
- VAIN 2
- VAIN 3 (the thickest, also called carcinoma in situ or stage 0 vaginal cancer)
Your doctor may make a diagnosis of VAIN with colposcopy and biopsy. If so, he or she may treat it right away. The type of treatment depends, in part, on how far the lesion has progressed. Your doctor may suggest one of these types of treatment.
- LEEP (loop electrosurgical excision procedure) — Your doctor may use LEEP to remove a very thin strip of tissue. This procedure uses an electrical current. The current cuts lesions out. You may have this done in the doctor’s office after the doctor puts medicine into your vagina to numb it. You may have mild cramping during LEEP, which takes about 10 minutes. Also, expect to have mild to moderate cramping and bleeding for a few days afterward.
- Laser therapy — A narrow beam of light is used to destroy or remove abnormal cells. This procedure is usually done in a hospital under general anesthesia. You likely will not need to stay overnight. Cramping after the procedure is common. Bleeding and/or spotting may last for several weeks.
- Topical chemotherapy — Your doctor (or you) applies a chemotherapy drug to the lining of the vagina. The drug kills cancer cells in the lining. The drug most often used is Efudex (fluorouracil, also called 5-FU). You usually receive treatments once a week for about 10 weeks. Or you might be treated every night for 1 or 2 weeks. You may notice some pain or irritation to the vagina or vulva during this treatment period.
- Other types of treatment — Your doctor may suggest other types of treatment based on your own situation. Partial vaginectomy is surgery to remove part of your vagina. Your doctor may also recommend radiation therapy to kill any remaining cancer cells after other procedures. Your doctor may also suggest radiation therapy if other treatments are not possible. Radiation is not a common option for precancerous lesions in the vagina.
What to expect after your treatment depends on which treatments you receive. Your doctor will explain steps you can take to aid healing. Be sure to ask how often you’ll need follow-up exams or tests. For example, you may need more frequent Pap tests or colposcopy.
