Cervical and vaginal cancers are diseases in which malignant (cancer) cells form in the tissues of the cervix or the vagina.

The cervix is the lower, narrow end of the uterus (the hollow, pear-shaped organ where a baby grows). The cervix leads from the uterus to the vagina (birth canal). The vagina is the canal leading from the cervix to the outside of the body. At birth, a baby passes out of the body through the vagina.

A sign of cervical or vaginal cancer is bleeding from the vagina.

The most common sign of cervical and vaginal cancer is bleeding from the vagina. Other conditions may also cause vaginal bleeding. Check with your child’s doctor if your child has vaginal bleeding.

Tests that examine the cervix and vagina are used to help diagnose cervical or vaginal cancer and to find out if cancer has spread.

The following tests and procedures may be used:

• Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
• Biopsy: A transvaginal needle biopsy is the removal of tissue using a needle that is guided by ultrasound. The tissue is viewed under a microscope by a pathologist to check for signs of cancer.
• Pap test: A procedure to collect cells from the surface of the cervix and vagina. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the cervix and vagina. The cells are viewed under a microscope to find out if they are abnormal. This procedure is also called a Pap smear.
• Serum tumor marker test: A procedure in which a sample of blood is examined to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumor markers.
• Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs in the pelvis and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
• MRI (magnetic resonance imaging): A procedure that uses a magnet and radio waves to make a series of detailed pictures of areas inside the body, such as the pelvis. The pictures are made by a computer. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the pelvis, taken from different angles. The pictures are made by a computer linked to an x-ray machine. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.

• Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope is inserted through the urethra into the bladder. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
• Proctoscopy: A procedure to look inside the rectum and anus to check for abnormal areas, using a proctoscope. A proctoscope is a thin, tube-like instrument with a light and a lens for viewing the inside of the rectum and anus. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.

Children are often diagnosed with cervical or vaginal cancer that is advanced at diagnosis.

There is no standard staging system for childhood cervical and vaginal cancer.

The process used to find out if cancer has spread from the cervix or vagina to nearby areas or to other parts of the body is called staging. The results of tests and procedures done to diagnose cervical and vaginal cancer are used to help make decisions about treatment.

Sometimes childhood cervical and vaginal cancer can recur (come back) after treatment. The cancer can come back in the cervix or vagina or in other parts of the body, such as the lymph nodes.

There are three ways cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

• Tissue. The cancer spreads from where it began by growing into nearby areas.
• Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
• Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

• Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
• Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if cervical or vaginal cancer spreads to the lymph node, the cancer cells in the lymph node are actually cervical or vaginal cancer cells. The disease is called metastatic cervical or vaginal cancer, not cancer of the lymph nodes.

Treatment Option Overview

KEY POINTS

• There are different types of treatment for children and adolescents with cervical and vaginal cancer.
• Children and adolescents with cervical and vaginal cancer should have their treatment planned by a team of doctors who are experts in treating childhood cancer.
• Three types of treatment are used for cervical and vaginal cancer.
  • Surgery
  • Radiation therapy
  • Chemotherapy
• New types of treatment are being tested in clinical trials.
• Targeted therapy
• Treatment for childhood cervical and vaginal cancer may cause side effects.
• Patients may want to think about taking part in a clinical trial.
• Patients can enter clinical trials before, during, or after starting their cancer treatment.
• Follow-up tests may be needed.

There are different types of treatment for children and adolescents with cervical and vaginal cancer.

Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.

Children and adolescents with cervical and vaginal cancer should have their treatment planned by a team of doctors who are experts in treating childhood cancer.

Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other pediatric health professionals who are experts in treating children with cancer and who specialize in certain areas of medicine. This may include the following specialists and others:

• Pediatrician.
• Pediatric surgeon.
• Gynecologist.
• Pediatric nurse specialist.
• Rehabilitation specialist.
• Social worker.
• Psychologist.

Three types of treatment are used for cervical and vaginal cancer.

Surgery

Surgery is used to remove as much cancer as possible from the cervix or vagina. If cancer cells remain after surgery or cancer has spread to the lymph nodes, more treatment may be needed.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can affect cancer cells throughout the body (systemic chemotherapy).

It is not known if chemotherapy is an effective treatment for childhood cervical and vaginal cancer.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy and radiation therapy do.

Targeted therapy is being studied for the treatment of childhood cervical and vaginal cancer that has recurred (come back).

Treatment for childhood cervical and vaginal cancer may cause side effects.

Side effects from cancer treatment that begin after treatment and continue for months or years are called late effects. Physical problems, such as problems with fertility, may be a late effect of treatment.

Some late effects may be treated or controlled. It is important to talk with your child's doctors about the possible late effects caused by some treatments.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Treatment of Childhood Cervical and Vaginal Cancer

Treatment of newly diagnosed cervical and vaginal cancer in children may include the following:

• Surgery to remove as much of the cancer as possible, followed by radiation therapy, if cancer cells remain after surgery or cancer has spread to the lymph nodes.
• Chemotherapy may also be used, but it is not yet known how well this treatment works.

Treatment of Recurrent Childhood Cervical and Vaginal Cancer

Treatment of recurrent cervical and vaginal cancer in children may include the following:

• A clinical trial that checks a sample of the patient's tumor for certain gene changes. The type of targeted therapy that will be given to the patient depends on the type of gene change.