Vaginal Intraepithelial Neoplasia (VAIN) is a cellular change in the surface tissue of the vagina. This condition is not malignant, but could develop into cancer; a patient may receive treatment to prevent this potential complication if it appears necessary. Patients with a history of cellular changes around the vagina and cervix may be considered candidates for aggressive treatment, because they can have a higher risk of cancer. In other cases the changes may be monitored, but not treated, to determine if they resolve on their own.
Patients usually receive a vaginal intraepithelial neoplasia diagnosis after an examination for an unrelated issue, like a routine Peroxidase-Antiperoxidase smear test (PAP smear) to check the cervix. Growth may be described as precancerous to reflect the fact that it can become malignant, but this doesn’t mean the cells are dangerous. They can appear in several regions of the vagina and sometimes spread to the neighboring vulva and other areas. Grading is based on the level of infiltration; if the whole epithelium is involved, it is a grade three, while a thinner vaginal intraepithelial neoplasia may be a grade one or two.
A care provider can meet with the patient to discuss options. Increases in routine testing and improvements in pathology techniques have increased the number of diagnoses of cellular changes, and sometimes result in situations where patients pursue aggressive treatment for something that wasn’t dangerous. The doctor may consider whether the patient has a history of human papilloma virus or other potential cancer risk factors when deciding whether to recommend treatment. If the patient’s medical history is generally healthy, a wait and see approach may be best.
For cases of vaginal intraepithelial neoplasia that do need treatment, there are several options. A topical chemotherapy cream can be used to attack the cells, and radiation therapy may be considered for patients with deeper cancers. Surface ablation and surgery to resect cells are also available for patients with vaginal intraepithelial neoplasia that has the potential to keep growing and eventually turn cancerous. Patients can discuss the risks and benefits of all the options to determine which would be best for their needs.
Receiving a pathology report indicating cellular changes are occurring can be frightening, because patients may assume it means they have cancer. It is important to be aware that abnormal cell growth can occur without being malignant, and that precancerous growths sometimes resolve on their own without treatment, or never turn into cancer. Patients need an individual assessment to determine the level of concern based on the specifics of the situation as well as their history.
