The vagina is a 3- to 4-inch (7½- to 10-cm) tube. It’s sometimes called the birth canal. The vagina goes from the cervix (the lower part of the uterus) to open up at the vulva (the external female genitals). The vagina is lined by a layer of flat cells called squamous cells. This layer of cells is also called epithelium (or epithelial lining) because it is formed by epithelial cells.
The vaginal wall underneath the epithelium is made up of connective tissue, muscle tissue, lymph vessels, and nerves. The vagina is usually collapsed with its walls touching each other. The vaginal walls have many folds that help the vagina open and expand during sexual intercourse or the birth of a baby. Glands near the opening of the vagina secrete mucus to keep the vaginal lining moist.
Types of Vaginal Cancer
Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other areas of the body. To learn more about how cancers start and spread, see What Is Cancer?
There are several types of vaginal cancer.
Squamous Cell Carcinoma
About 70 of every 100 cases of vaginal cancer are squamous cell carcinomas. These cancers begin in the squamous cells that make up the epithelial lining of the vagina. These cancers are more common in the upper area of the vagina near the cervix.
Squamous cell cancers of the vagina often develop slowly. First, some of the normal cells of the vagina get pre-cancerous changes. Then some of the pre-cancer cells turn into cancer cells. This process can take many years.
The medical term most often used for this pre-cancerous condition is vaginal intraepithelial neoplasia (VAIN). “Intraepithelial” means that the abnormal cells are only found in the surface layer of the vaginal skin (epithelium).
There are 3 types of VAIN: VAIN1, VAIN2, and VAIN3, with 3 indicating furthest progression toward a true cancer. VAIN is more common in women who have had their uterus removed (hysterectomy) and in those who were previously treated for cervical cancer or pre-cancer.
In the past, the term dysplasia was used instead of VAIN. This term is used much less now. When talking about dysplasia, there is also a range of increasing progress toward cancer – first, mild dysplasia; next, moderate dysplasia; and then severe dysplasia.
Cancers that begin in gland cells are called adenocarcinomas. About 15 of every 100 cases of vaginal cancer are adenocarcinomas. The usual type of vaginal adenocarcinoma typically develops in women older than 50.
One type, called clear cell adenocarcinoma, occurs more often in young women who were exposed to diethylstilbestrol (DES) in utero (when they were in their mother’s womb). (See the section called “What are the risk factors for vaginal cancer?” for more information on DES and clear cell carcinoma.)
Melanomas develop from pigment-producing cells that give skin its color. These cancers usually are found on sun-exposed areas of the skin but can form in the vagina or other internal organs. About 9 of every 100 cases of vaginal cancer are melanomas. Melanoma tends to affect the lower or outer portion of the vagina. The tumors vary greatly in size, color, and growth pattern. More information about melanoma can be found in Melanoma Skin Cancer.
Sarcomas are cancers that begins in the cells of bones, muscles, or connective tissue. Up to 4 of every 100 cases of vaginal cancer are sarcomas. These cancers form deep in the wall of the vagina, not on its surface. There are several types of vaginal sarcomas.
Rhabdomyosarcoma is the most common type of vaginal sarcoma. It’s most often found in children and is rare in adults. A sarcoma called leiomyosarcoma is seen more often in adults. It tends to occur in women older than 50.
Cancers that start in the vagina are much less common than cancers that start in other organs (such as the cervix, uterus, rectum, or bladder) and then spread to the vagina. These cancers are named after the place where they started. Also, a cancer that involves both the cervix and vagina is considered a cervical cancer. Likewise, if the cancer involves both the vulva and the vagina, it’s considered a vulvar cancer.
This document refers only to cancers that start in the vagina, also known as primary vaginal cancers.
What Are the Key Statistics About Vaginal Cancer?
Vaginal cancer is rare. Only about 1 of every 1,100 women will develop vaginal cancer in her lifetime. The American Cancer Society’s estimates for vaginal cancer in the United States for 2016 are:
About 4,620 new cases will be diagnosed
About 950 women will die of this cancer.
What are the Risk Factors for Vaginal Cancer?
A risk factor is anything that affects your chance of getting a disease such as cancer. Different cancers have different risk factors. For example, exposing skin to strong sunlight is a risk factor for skin cancer. Smoking is a risk factor for many cancers.
There are different kinds of risk factors. Some, such as your age or race, can’t be changed. Others may be related to personal choices such as smoking, drinking, or diet. Some factors influence risk more than others. But risk factors don’t tell us everything. Having a risk factor, or even several, does not mean that a person will get the disease. Also, not having any risk factors doesn’t mean that you won’t get it, either.
Scientists have found that certain risk factors make a woman more likely to develop vaginal cancer. But many women with vaginal cancer don’t have any apparent risk factors. And even if a woman with vaginal cancer has one or more risk factors, it’s impossible to know for sure how much that risk factor contributed to causing the cancer.
Squamous cell cancer of the vagina occurs mainly in older women. Only 15% of cases are found in women younger than 40. Almost half of cases occur in women who are 70 years old or older.
DES is a hormonal drug that was given to some women to prevent miscarriage between 1940 and 1971. Women whose mothers took DES (when pregnant with them) develop clear-cell adenocarcinoma of the vagina or cervix more often than would normally be expected.
There is about 1 case of this type of cancer in every 1,000 daughters of women who took DES during their pregnancy. This means that about 99.9% of DES daughters do not develop this cancer.
DES-related clear cell adenocarcinoma is more common in the vagina than the cervix. The risk appears to be greatest in those whose mothers took the drug during their first 16 weeks of pregnancy. Their average age when they are diagnosed is 19 years.
Since the use of DES during pregnancy was stopped by the FDA in 1971, even the youngest DES daughters are older than 35 – past the age of highest risk. But a woman is not safe from a DES-related cancer at any age. Doctors do not know exactly how long women remain at risk.
DES daughters have an increased risk of developing clear cell carcinomas, but women don’t have to be exposed to DES for clear cell carcinoma to develop. In fact, women were diagnosed with this type of cancer before DES was invented.
DES daughters are also more likely to have high grade cervical dysplasia (CIN 3) and vaginal dysplasia (VAIN 3) when compared to women who were never exposed.
You can learn more about DES in DES Exposure: Questions and Answers.
Normally, the vagina is lined by flat cells called squamous cells. In about 40% of women who have already started having periods, the vagina may have one or more areas lined instead by glandular cells. These cells look like those found in the glands of the cervix, the lining of the body of the uterus (endometrium), and the lining of the fallopian tubes.
These areas of gland cells are called adenosis. It occurs in nearly all women who were exposed to DES during their mothers’ pregnancy. Having adenosis increases the risk of developing clear cell carcinoma, but this cancer is still very rare. The risk of clear cell carcinoma in a woman who has adenosis that is not related to DES is very, very small. Still, many doctors feel that any woman with adenosis should have very careful screening and follow-up.
Human Papilloma Virus
Human papilloma virus (HPV) is a group of more than 150 related viruses. They are called papilloma viruses because some of them cause a type of growth called a papilloma. Papillomas -- more commonly known as warts – are not cancers.
Different HPV types can cause different types of warts in different parts of the body. Some types cause common warts on the hands and feet. Other types tend to cause warts on the lips or tongue.
Certain HPV types can infect the outer female and male genital organs and the anal area, causing raised, bumpy warts. These warts may barely be visible or they may be several inches across. The medical term for genital warts is condyloma acuminatum. Two types of HPV, HPV 6 and HPV 11, cause most cases of genital warts. These 2 types are seldom linked to cancer, and so are called low-risk types of HPV.
Other HPV types have been linked with cancers of the cervix and vulva in women, cancer of the penis in men, and cancers of the anus and throat (in men and women). These are known as high-risk types of HPV and include HPV 16, HPV 18, HPV 31, as well as others. Infection with a high-risk HPV may produce no visible signs until pre-cancerous changes or cancer develops.
HPV can be passed from one person to another during skin-to-skin contact. One way HPV is spread is through sex, including vaginal and anal intercourse and even oral sex.
Up to 9 of every 10 vaginal cancers and pre-cancers (vaginal intraepithelial neoplasia – VAIN) are linked to infection with HPV.
Vaccines have been developed to help prevent infection with some types of HPV. Right now, 2 different HPV vaccines have been approved for use in the United States by the Food and Drug Administration (FDA): Gardasil® and Cervarix®. These are discussed in more detail later in this document.
Having cervical cancer or pre-cancer (cervical intraepithelial neoplasia or cervical dysplasia) increases a woman’s risk of vaginal squamous cell cancer. This is most likely because cervical and vaginal cancers have similar risk factors, such as HPV infection and smoking.
Some studies suggest that treating cervical cancer with radiation therapy may increase the risk of vaginal cancer, but this was not seen in other studies, and the issue remains unresolved.
Smoking cigarettes more than doubles a woman’s risk of getting vaginal cancer.
Drinking alcohol might affect the risk of vaginal cancer. A study of alcoholic women found more cases of vaginal cancer than expected. But this study was flawed because it didn’t look at other factors that can alter risk, such as smoking and HPV infection. A more recent study that did take these other risk factors into account found a decreased risk of vaginal cancer in women who do not drink alcohol at all.
Human Immunodeficiency Virus
Infection with HIV (human immunodeficiency virus), the virus that causes AIDS, also increases the risk of vaginal cancer.
In some women, stretched pelvic ligaments may let the uterus sag into the vagina or even extend outside the vagina. This condition is called uterine prolapse and can be treated by surgery or by wearing a pessary, a device to keep the uterus in place.
Some studies suggest that long-term (chronic) irritation of the vagina in women using a pessary may slightly increase the risk of squamous cell vaginal cancer. But this association is extremely rare, and no studies have conclusively proven that pessaries actually cause vaginal cancer.
Do we Know What Causes Vaginal Cancer?
The exact cause of most vaginal cancers is not known. But scientists have found that it is associated with a number of other conditions described in “What are the risk factors for vaginal cancer?” Research is now being done to learn more about how these risk factors cause cells of the vagina to become cancerous.
Research has shown that normal cells make substances called tumor suppressor gene products to keep from growing too rapidly and becoming cancers. High-risk HPV (human papilloma virus) types (like 16 and 18) produce 2 proteins (E6 and E7) that can interfere with the functioning of known tumor suppressor gene products.
As mentioned in the section on risk factors, women exposed to diethylstilbestrol (DES) as a fetus (that is, their mothers took DES during pregnancy) are at increased risk for developing clear cell carcinoma. DES also increases the likelihood of vaginal adenosis (gland-type cells in the vaginal lining rather than the usual squamous cells).
Most women with vaginal adenosis never develop vaginal clear cell carcinoma. However, those with a rare type of adenosis (called atypical tuboendometrial adenosis) do have an increased risk of developing this cancer.
Can vaginal cancer be prevented?
The best way to reduce the risk of vaginal cancer is to avoid known risk factors and to find and treat any vaginal pre-cancers. But since many women with vaginal cancer have no known risk factors, it is not possible to completely prevent this disease.
Avoid HPV Exposure
Infection with human papillomavirus (HPV) is a risk factor for vaginal cancer. HPV infections occur mainly in younger women and are less common in women over 30. The reason for this is not clear.
HPV is passed from one person to another during skin-to-skin contact with an infected area of the body. HPV can be spread during sex – including vaginal intercourse, anal intercourse, and oral sex – but sex doesn’t have to occur for the infection to spread.
All that is needed is for there to be skin-to-skin contact with an area of the body infected with HPV. The virus can be spread through genital-to-genital contact. It’s even possible for a genital infection to spread through hand-to-genital contact.
An HPV infection also seems to be able to be spread from one part of the body to another. This means that an infection may start in the cervix and then spread to the vagina and vulva.
It can be very hard to avoid being exposed to HPV. It might be possible to prevent genital HPV infection by not letting others come in contact with your anal or genital area, but even then there could be other ways to become infected that aren’t yet clear. For example, a recent study showed that HPV can be present on sex toys, so sharing sex toys could potentially spread HPV.
Infection with HPV is common, and in most cases the body is able to clear the infection on its own. But in some cases the infection does not go away and becomes chronic. Chronic infection, especially with high-risk HPV types, can eventually cause certain cancers, including vaginal cancer and pre-cancer.
Certain types of sexual behavior increase a woman’s risk of getting a genital HPV infection, such as having sex at an early age and having many sex partners. Although women who have had many sexual partners are more likely to get infected with HPV, a woman who has had only one sexual partner can still get infected. This is more likely if she has a partner who has had many sex partners or if her partner is an uncircumcised male.
Delaying sex until you are older can help you avoid HPV. It also helps if you limit your number of sex partners and avoid having sex with someone who has had many other sex partners.
A person can be infected with HPV for years without any symptoms, so the absence of visible warts cannot be used to tell if someone has HPV. Even when someone doesn’t have warts (or any other symptom), he (or she) can still be infected with HPV and pass the virus to somebody else.
HPV and Men
The 2 main factors influencing the risk of genital HPV infection in men are circumcision and the number of sexual partners. Men who are circumcised (have had the foreskin of the penis removed) have a lower chance of becoming and staying infected with HPV.
Men who have not been circumcised are more likely to be infected with HPV and pass it on to their partners. The reasons for this are unclear. It may be that the skin on the glans of the penis goes through changes that make it more resistant to HPV infection.
Another theory is that the surface of the foreskin (which is removed by circumcision) is more easily infected by HPV. Still, circumcision does not completely protect against HPV infection – men who are circumcised can still get HPV and pass it on to their partners.
The risk of a man being infected with HPV is also strongly linked to having many sexual partners over a man’s lifetime.
Condoms and HPV
Condoms (“rubbers”) provide some protection against HPV. One study found that when condoms are used correctly every time sex occurs, they can lower the HPV infection rate by about 70%. Condoms cannot protect completely because they don’t cover every possible HPV-infected area of the body, such as skin on the genital or anal area.
Still, condoms do provide some protection against HPV, and they also protect against HIV and some other sexually transmitted diseases. Condoms (when used by the male partner) also seem to help genital HPV infections clear (go away) faster in both women and men.
Not smoking is another way to lower vaginal cancer risk. Women who don’t smoke are also less likely to develop a number of other cancers, such as those of the lungs, mouth, throat, bladder, kidneys, and several other organs.
Find and treat pre-cancerous conditions
Most vaginal squamous cell cancers are believed to start out as pre-cancerous changes, called vaginal intraepithelial neoplasia or VAIN. VAIN may be present for years before turning into a true (invasive) cancer. Screening for cervical cancer (such as with a Pap test or HPV test) can sometimes pick up these pre-cancers. If a pre-cancer is found, it can be treated, stopping cancer before it really starts.
Still, since vaginal cancer and VAIN are rare, doctors do not often do other tests to look for these conditions in women who do not have symptoms or a history of pre-cancer or cancer of the cervix, vagina, or vulva.
See Cervical Cancer: Prevention and Early Detection for more information about cervical cancer screening.
How Pap tests and pelvic examinations are done
First, the skin of the outer vaginal lips (labia majora) and inner lips (labia minora) is examined for any visible abnormalities. The health care professional first places a speculum inside the vagina. A speculum is a metal or plastic instrument that keeps the vagina open so that the cervix can be seen clearly.
Next, using a small spatula, a sample of cells and mucus is lightly scraped from the exocervix (the surface of the cervix that is closest to the vagina). A small brush or a cotton-tipped swab is then inserted into the cervical opening to take a sample from the endocervix (the inside part of the cervix that is closest to the body of the uterus).Then, the speculum is removed.
The doctor then checks the organs of the pelvis by inserting 1 or 2 gloved fingers of one hand into the vagina while feeling (palpating) the lower abdomen, just above the pubic bone, with the other. The doctor may do a rectal exam at this time also. It’s very important to know that a Pap test is not always done when a pelvic exam is done, so if you are uncertain you should ask if one was done.
Vaginal intraepithelial neoplasia (VAIN; pre-cancer of the vagina) may not be visible during a routine exam of the vagina. But it may be found with a Pap test. Because cervical cancer is much more common than vaginal cancer, Pap test samples are scraped or brushed from the cervix. However, some cells of the vaginal lining are usually also picked up at the same time.
That allows cases of VAIN to be found in women whose vaginal lining is not intentionally scraped. Still, the main goal of a Pap test is to find cervical pre-cancers and early cervical cancers, not vaginal cancer or VAIN. That’s why women who have had a total hysterectomy (removal of the uterus and cervix) stop getting Pap tests, unless the hysterectomy was done as a treatment for cervical pre-cancer (or cancer).
In women whose cervix has been removed by surgery to treat cervical cancer or pre-cancer, Pap test samples may be taken from the lining of the upper vagina to look for cervical cancer (that has come back), and to look for early vaginal cancer or VAIN. Vaginal cancer and VAIN are more common in women who have had cervical cancer or pre-cancer.
Many women with VAIN may also have a pre-cancer of the cervix (known as cervical intraepithelial neoplasia or CIN). If abnormal cells are seen on a Pap test, the next step is a procedure called colposcopy, in which the cervix, the vagina, and at times the vulva are examined with a special instrument called a colposcope.
Can vaginal cancer be found early?
Some cases of vaginal cancer can be found early. They may produce symptoms that cause patients to seek medical attention, but many vaginal cancers do not cause symptoms until after they have reached an advanced stage.
Pre-cancerous areas of vaginal intraepithelial neoplasia (VAIN) do not usually produce any symptoms. Still, well-woman exams and cervical cancer screening can sometimes find cases of VAIN and early invasive vaginal cancer.
Signs and Symptoms of Vaginal cancer
More than 8 out of 10 women with invasive vaginal cancer have one or more symptoms, such as:
Abnormal vaginal bleeding (often after intercourse)
Abnormal vaginal discharge
A mass that can be felt
Pain during intercourse
Symptoms of advanced vaginal cancer may be painful urination, constipation, and continuous pain in the pelvis.
Having these symptoms does not always mean that you have cancer. In fact, these symptoms are more likely to be caused by something besides cancer, like an infection. The only way to know for sure what’s causing these problems is to see a health care professional.
If you have any of these symptoms, discuss them with a doctor right away. Remember, the sooner the problem is correctly diagnosed, the sooner you can start treatment, and the more effective your treatment will be.
How is vaginal cancer diagnosed?
If a woman has any of the signs or symptoms of vaginal cancer, she should see a doctor. If the Pap test detects abnormal cells, or if the pelvic exam results are not normal, more tests will be needed. This may mean referral to a gynecologist (specialist in problems of the female genital system).
Medical history and physical exam
The first step is for the doctor to take a complete medical history to check for risk factors and symptoms. Then your doctor will physically examine you, including a pelvic exam and possibly a Pap test and a vaginal biopsy.
If certain symptoms suggest cancer or if the Pap test shows abnormal cells, you will need to have a test called colposcopy. In this procedure you will lie on the exam table as you do for a pelvic exam. A speculum is placed in the vagina. The doctor will use the colposcope to examine the cervix and vagina. The colposcope stays outside the body and has magnifying lenses (like binoculars).
When the doctor looks through the colposcope, he or she can see the vaginal walls and the surface of the cervix closely and clearly. Sometimes a weak solution of acetic acid (similar to vinegar) or iodine is applied to make any abnormal areas easier to see. Using a colposcope to look at the vagina is called vaginoscopy.
Colposcopy itself is no more painful than a speculum exam and can be done safely even if you are pregnant. If an abnormal area is seen on the cervix or vagina, a biopsy will be done. The biopsy can be slightly painful and may some cause pelvic cramping.
Certain signs and symptoms may strongly suggest vaginal cancer, but many of them can be caused by conditions that aren’t cancer. The only way to be certain that cancer is present is to do a biopsy. In this procedure, a small piece of tissue from the suspicious area is removed.
A doctor specializing in diagnosing diseases by laboratory tests (a pathologist) will look at the tissue sample under a microscope to see if cancer or a pre-cancerous condition is present and, if so, what type it is.
If vaginal cancer is diagnosed, a plain x-ray of your chest may be done to see if your cancer has spread to your lungs. This is very unlikely unless your cancer is far advanced. This x-ray can be done in any outpatient setting.
Computed Tomography (CT)
The computed tomography (CT) scan is an x-ray test that produces detailed cross-sectional images of your body. Instead of taking one picture, like a standard x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these pictures into an image of a slice of your body.
A CT scan can provide information about the size, shape, and position of a tumor, and
can be helpful to see if the cancer has spread to other organs. It can also help find enlarged lymph nodes that might have cancer cells.
A CT scanner has been described as a large donut, with a narrow table in the middle opening. You will need to lie still on the table while the scan is being done. CT scans take longer than regular x-rays, and you might feel a bit confined by the ring while the pictures are being taken.
Before the test, you may be asked to drink 1 to 2 pints of a liquid called oral contrast. This helps outline the intestine so that certain areas are not mistaken for tumors. You may also receive an IV line through which a different kind of contrast dye (IV contrast) is injected. This helps better outline structures such as blood vessels in your body.
The injection can cause some flushing (redness and warm feeling). A few people are allergic to the dye and get hives, or rarely, have more serious reactions like trouble breathing and low blood pressure. Be sure to tell the doctor if you have ever had a reaction to any contrast material used for x-rays.
CT-guided needle biopsy: CT scans can also be used to guide a biopsy needle precisely into a suspected tumor. For this procedure, the patient remains on the CT scanning table, while a doctor moves a biopsy needle through the skin and toward the tumor.
CT scans are repeated until the needle is within the mass. A fine-needle biopsy sample or a core needle biopsy sample is removed and looked at under a microscope. This is not used to biopsy vaginal tumors, but it may be used to biopsy possible metastases.
Magnetic Resonance Imaging (MRI)
Magnetic resonance imaging (MRI) scans use radio waves and strong magnets instead of x-rays to make images of the body. The energy from the radio waves is absorbed by the body and then released in a specific pattern formed by the type of tissue and by certain diseases. A computer translates the pattern into a detailed image of parts of the body.
Like a CT scanner, this produce cross-sectional slices of the body. An MRI can also produce slices that are parallel with the length of your body. As with a CT scan, a contrast material might be used, but it is not needed as often.
MRI scans are more uncomfortable than CT scans. They take longer – often up to an hour. You have to be placed inside tube-like equipment. This is confining and can upset people with claustrophobia (a fear of close spaces). If you have trouble with close spaces, let your doctor know before the MRI scan.
Sometimes medicine can be given just before the scan to reduce anxiety. Another option is to use a special “open” MRI machine that is less confining and more comfortable for such people, the drawback being that the images from these machines are not as good. The machine also makes a buzzing or clanging noise that some people find disturbing. Some places will provide headphones with music to block this noise.
MRI images are particularly useful in examining pelvic tumors. They may show enlarged lymph nodes in the groin. They are also helpful in finding cancer that has spread to the brain or spinal cord. This rarely occurs in vaginal cancer.
Positron Emission Tomography
Positron emission tomography (PET) uses glucose (a form of sugar) that contains a low-level radioactive atom. Because cancer cells use glucose at a higher rate than normal cells, they absorb more of the radioactive sugar. The areas of radioactivity are detected with this test.
You will be injected with the special glucose, and then about an hour later you will be moved onto a table in the PET scanner. You lie on the table for about 30 minutes while a special camera creates a picture of areas of radioactivity in the body. The picture is not finely detailed like a CT or MRI scan, but it provides helpful information about your body.
This test can be helpful for spotting collections of cancer cells, and seeing if the cancer has spread to lymph nodes. PET scans are also useful when your doctor thinks the cancer has spread, but doesn’t know where (although they aren’t useful for finding cancer spread in the brain).
PET scans can be used instead of several different x-rays because they scan your whole body. Often, a machine that combines a PET scanner and a CT scanner (called a PET/CT) is used, which gives more information about areas of cancer and cancer spread.
PET scans are not often used in patients with early vaginal cancer, but they may be helpful in finding areas of cancer spread.
These tests are not used often to evaluate women with vaginal cancer.
Proctosigmoidoscopy is a procedure that looks at the rectum and part of the colon. It’s done to check for spread of vaginal cancer to the rectum or colon. In this procedure a slender, flexible, hollow, lighted tube is placed into the rectum. Any areas that look suspicious will be biopsied.
This test may be somewhat uncomfortable, but it should not be painful. Proctosigmoidoscopy may be recommended for patients whose vaginal cancers are large and/or located in the part of the vagina next to the rectum and colon.
Cystoscopy is a procedure that looks at the inside of the bladder. It’s done to check for spread of vaginal cancer to the bladder. This procedure can be done in the doctor’s office or clinic. You may be given an intravenous drug to make you drowsy.
A thin tube with a lens and light is inserted into the bladder through the urethra. If suspicious areas or growths are seen, a biopsy will be done. Cystoscopy may be recommended if a vaginal cancer is large and/or located in the front wall of the vagina, near the bladder.
How is Vaginal Cancer Staged?
The FIGO/AJCC system for staging vaginal cancer
Staging is the process of finding out how far the cancer has spread. It’s very important because your treatment options and the outlook for your recovery and survival (prognosis) depend on the stage of your cancer.
Most vaginal cancers are staged using the FIGO (International Federation of Gynecology and Obstetrics) System of Staging combined with the American Joint Committee on Cancer (AJCC) TNM system.
This system classifies the diseases in Stages 0 through IV depending on the extent of the tumor (T), whether the cancer has spread to lymph nodes (N) and whether it has spread to distant sites (M for metastasis). The system described here is the most recent AJCC system, which went into effect January 2010. Any differences between the AJCC system and the FIGO system are explained in the text.
Vaginal cancer is staged clinically, which means that staging doesn’t take into account what is found during surgery, even if more advanced cancer is found.
These systems are not used to stage vaginal melanoma, which is staged like melanoma of the skin. Information about melanoma staging can be found in Melanoma Skin Cancer.
Tumor Extent (T)
Tis: Cancer cells are only in the most superficial layer of cells of the vagina without growth into the underlying tissues. This stage is also called carcinoma in situ (CIS) or vaginal intraepithelial neoplasia 3 (VAIN 3). It’s not included in the FIGO system.
T1: The cancer is only in the vagina.
T2: The cancer has grown through the vaginal wall, but not as far as the pelvic wall.
T3: The cancer is growing into the pelvic wall.
T4: The cancer is growing into the bladder or rectum or is growing out of the pelvis.
Lymph node spread of cancer (N)
N0: The cancer has not spread to lymph nodes
N1: The cancer has spread to lymph nodes in the pelvis or groin (inguinal region)
Distant spread of cancer (M)
M0: The cancer has not spread to distant sites
M1: The cancer has spread to distant sites.
Once the T, N, and M categories have been assigned, this information is combined to assign an overall stage in a process called stage grouping. The stages identify tumors that have a similar outlook and are treated in a similar way.
Stage 0 (Tis, N0, M0): In this stage, cancer cells are only in the top layer of cells lining the vagina (the epithelium) and have not grown into the deeper layers of the vagina. Cancers of this stage cannot spread to other parts of the body. Stage 0 vaginal cancer is also called carcinoma in situ (CIS) or vaginal intraepithelial neoplasia 3 (VAIN 3). This stage is not included in the FIGO system.
Stage I (T1, N0, M0): The cancer has grown through the top layer of cells but it has not grown out of the vagina and into nearby structures (T1). It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
Stage II (T2, N0, M0): The cancer has spread to the connective tissues next to the vagina but has not spread to the wall of the pelvis or to other organs nearby (T2). (The pelvis is the internal cavity that contains the internal female reproductive organs, rectum, bladder, and parts of the large intestine.) It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
Stage III: Either of the following:
T3, any N, M0: The cancer has spread to the wall of the pelvis (T3). It may (or may not) have spread to nearby lymph nodes (any N), but it has not spread to distant sites (M0).
T1 or T2, N1, M0: The cancer is in the vagina (T1) and it may have grown into the connective tissue nearby (T2). It has spread to lymph nodes nearby (N1), but has not spread to distant sites (M0).
Stage IVA (T4, Any N, M0): The cancer has grown out of the vagina to organs nearby (such as the bladder or rectum) (T4). It may or may not have spread to lymph nodes (any N). It has not spread to distant sites (M0).
Stage IVB (Any T, Any N, M1): Cancer has spread to distant organs such as the lungs (M1).
Survival rates for vaginal cancer
Survival rates are often used by doctors as a standard way of discussing a person’s prognosis (outlook). Some patients with cancer may want to know the survival statistics for people in similar situations, while others may not find the numbers helpful, or may even not want to know them. If you decide you don’t want to know them, stop reading here and skip to the next section.
The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. Of course, many people live much longer than 5 years (and many are cured).
Five-year disease-specific survival rates assume that some people will die of other causes and only count the deaths from the cancer itself. This is a more accurate way to describe the prognosis for patients with a particular type and stage of cancer.
In order to get 5-year survival rates, doctors have to look at people who were treated at least 5 years ago. Improvements in treatment since then may result in a more favorable outlook for people now being diagnosed with vaginal cancer.
Survival rates are often based on previous outcomes of large numbers of people who had the disease, but they cannot predict what will happen to any person specifically. Many other factors can affect a person’s outlook, such as their overall health, the treatment they receive, and how well the cancer responds to treatment. Your doctor can tell you how the numbers below may apply to you, as he or she is familiar with the aspects of your situation.
The numbers below come from the National Cancer Institute’s SEER database, and are based on women with vaginal cancer (any type) who were diagnosed between 1990 and 2004.
Survival rates for vaginal cancer, by stage
5-Year Disease Specific Survival Rate
III and IV
Survival rates also vary based on the type of vaginal cancer. The following statistics for vaginal cancer come from the SEER database, and are based on women who were diagnosed with vaginal cancer between 1988 and 2001. These are relative survival rates. Relative survival rates compare the observed survival with that expected for people without vaginal cancer. This is another way to describe the prognosis for patients with a particular type and stage of cancer.
For all cases of vaginal cancer combined, the relative 5-year survival is about 50%.
For squamous cell carcinoma of the vagina, the relative 5-year survival is 54%.
For adenocarcinoma of the vagina it is almost 60%.
For vaginal melanoma, the 5-year relative survival is only 13%.
How is vaginal cancer treated?
General treatment information
After the diagnostic tests are done, your cancer care team will recommend a treatment plan. Don’t feel rushed about considering your options. If there’s anything you do not understand, ask to have it explained again. The choice of treatment depends on the type of cancer and stage of the disease when it is diagnosed.
Other factors might play a part in choosing the best treatment plan. These could include your age, your overall state of health, whether you plan to have children, and other personal considerations. Vaginal cancer can affect your sex life and your ability to have children. These concerns should also be considered as you make treatment decisions. (See Sexuality for the Woman With Cancer and Fertility and Women With Cancer to learn more about these issues.) Be sure you understand all the risks and side effects of the various therapies before making a decision about treatment.
You might want to get a second opinion. This can provide more information and help you feel confident about the treatment plan you choose. Some insurance companies require a second opinion before they will pay for treatments.
Depending on the type and stage of your vaginal cancer, you may need more than one type of treatment. Doctors on your cancer treatment team may include:
A gynecologist: a doctor who specializes in diseases of the female reproductive tract
A gynecologic oncologist: a doctor who specializes in the treatment of cancers of the female reproductive system (including surgery and chemotherapy)
A radiation oncologist: a doctor who uses radiation to treat cancer
A medical oncologist: a doctor who uses chemotherapy and other medicines to treat cancer
Many other specialists may be involved in your care as well, including nurse practitioners, nurses, psychologists, social workers, rehabilitation specialists, and other health professionals.
Some treatments are only used to treat pre-cancers of the vagina (vaginal intraepithelial neoplasia, VAIN), such as:
Laser surgery (vaporization)
For invasive vaginal cancer, there are 3 main
Invasive vaginal cancer is treated mainly with radiation therapy and surgery. Chemotherapy in combination with radiation might be used to treat advanced disease.
Laser surgery for vaginal pre- cancer
In this treatment, a beam of high-energy light is used to vaporize the abnormal tissue. This is a very effective treatment for vaginal pre-cancer (vaginal intraepithelial neoplasia or VAIN), and works well for large lesions. However, this is not a treatment for invasive cancer. For laser surgery to be an option, the doctor must be certain that the worst lesion was biopsied and that invasive cancer is not a concern.
Topical therapy for vaginal pre-cancer
Topical therapy puts the drug directly onto the cancer. This is another way to treat vaginal pre-cancer (vaginal intraepithelial neoplasia or VAIN), but is not used to treat invasive vaginal cancer.
One choice is to apply the chemotherapy drug, fluorouracil (5-FU), directly to the lining of the vagina. This is repeated weekly for about 10 weeks or given nightly for 1 to 2 weeks. This treatment has drawbacks. It can cause severe vaginal and vulvar irritation. Also, it may not work as well using the laser or simply removing the lesion with surgery.
A second drug that can be used topically is called imiquimod. This drug comes in a cream to be applied to the area of VAIN. Imiquimod is not a chemotherapy drug. Instead, it acts by boosting the body’s immune response to the area of abnormal tissue. This treatment has led to improvement of VAIN (the lesions changed from VAIN 2 or 3 to VAIN 1). In some women, it has caused VAIN to go away completely.
Radiation therapy for vaginal cancer
This is the most common treatment for vaginal cancer.
Radiation therapy uses high-energy rays (such as gamma rays or x-rays) and particles (such as electrons, protons, or neutrons) to kill cancer cells. In treating vaginal cancers, radiation is delivered from outside the body in a procedure that is much like having a diagnostic x-ray.
This is called external beam radiation therapy. It is sometimes used along with chemotherapy to treat more advanced cancers to shrink them so they can be removed with surgery. Radiation alone may be used to treat lymph nodes in the groin and pelvis.
Another way to deliver radiation is to place radioactive material inside the vagina. One way to do this is called intracavitary brachytherapy. The 2 main types of intracavitary brachytherapy are low-dose rate (LDR) and high-dose rate (HDR). With these intracavitary methods, radiation mainly affects the tissue in contact with the cylinder. This often means fewer bladder and bowel side effects than seen with external beam radiation therapy.
For LDR brachytherapy, the radioactive material is inside a cylindrical container that is placed in the vagina and stays in place for a day or 2. Although gauze packing helps hold the cylinder in place, you have to remain in bed (in the hospital) during the treatment.
With HDR brachytherapy, the radiation source is still placed in a cylinder, but it doesn’t need to stay in place for long. This allows it to be given in an outpatient setting. Three or four treatments are given 1 or 2 weeks apart.
Another type of brachytherapy, called interstitial radiation, uses radioactive material inside needles that are placed directly into the cancer and surrounding tissues.
Vaginal cancer is most often treated with a combination of external and internal radiation with or without low doses of chemotherapy.
Side effects of radiation therapy
Radiation can destroy nearby healthy tissue along with the cancerous cells. Side effects depend on the area being treated, the amount of radiation, and the way the radiation is given. Side effects tend to be more severe for external beam radiation than for brachytherapy.
Common short-term side effects of radiation therapy include
Tiredness, which may get worse about 2 weeks after treatment begins
Nausea and vomiting (more common if radiation is given to the belly or pelvis)
Diarrhea (more common if radiation is given to the belly or pelvis)
Skin changes, which can range from mild redness to blistering and peeling. The skin may become raw and tender.
Low blood counts
The diarrhea caused by radiation can usually be controlled with over-the-counter medicines. Nausea and vomiting can be treated with medicines from your doctor. Skin that becomes raw and tender needs to be kept clean and protected to prevent infection.
These side effects tend to be worse when chemotherapy is given with radiation.
Long-term side effects
Radiation to treat vaginal cancer can also cause some long-term side effects. Pelvic radiation can lead to premature menopause. It can also weaken bones, making them more likely to break from a fall or other trauma.
Radiation to the pelvis can also severely irritate the intestines and rectum (called radiation colitis), leading to diarrhea and bloody stool. If severe, radiation colitis can cause holes or tears to form in the intestines (called perforations).
Pelvic radiation can also cause problems with the bladder (radiation cystitis), leading to discomfort and an urge to urinate often. In rare cases, radiation can cause abnormal connections (called fistulas) to form between the vagina and the bladder, rectum, or uterus.
If the skin was irritated by radiation, when it heals it may be darker and not as soft.
Radiation can cause the normal tissue of the vagina to become irritated and sore. As it heals, scar tissue can form in the vagina. The scar tissue can make the vagina shorter or more narrow (this is called vaginal stenosis). When this happens, vaginal intercourse (sex) can become painful. Stretching the walls of the vagina a few times a week can help prevent this problem.
One way to do this is to have vaginal intercourse at least 3 to 4 times a week. Since this might be uncomfortable while getting cancer treatment (and even after), another option is to use a vaginal dilator. A dilator is a plastic or rubber tube used to stretch out the vagina. It feels much like putting in a large tampon for a few minutes. Even if a woman is not interested in staying sexually active, keeping her vagina normal in size allows comfortable gynecologic exams.
This is an important part of follow-up after treatment. Vaginal estrogens may also be used to relieve dryness and prevent painful intercourse and help maintain the size of the vagina. Still, vaginal dryness and pain with intercourse can be long-term side effects from radiation.
For more information on radiation therapy, see Understanding Radiation Therapy: A Guide for Patients and Families.
Surgery for vaginal cancer
Surgery is usually only used for small stage I tumors and for cancers that were not cured by radiation. Surgery is not often used to treat squamous cell cancers of the vagina, but it is used for sarcomas and melanomas.
The extent of the surgery depends on the size and stage of the cancer.
In this procedure, the surgeon removes the cancer along with a surrounding rim of normal tissue. This is sometimes called a wide excision. For VAIN, a local excision may be all that is needed. For small stage I cancers, treatment may include a radical wide local excision along with a procedure to evaluate the lymph nodes.
Vaginectomy is surgery to remove the vagina. If only part of the vagina is removed, it’s called a partial vaginectomy. If the entire vagina is removed, it’s called a total vaginectomy. A radical vaginectomy is removal of the vagina along with the supporting tissues around it.
Vaginal cancer is most often found in the upper part of the vagina (near the cervix), so removing the cancer sometimes means also removing the cervix. If only the cervix is removed (leaving the rest of uterus behind), the operation is called a trachelectomy. This operation is rarely used to treat vaginal cancer.
Sometimes to remove a vaginal cancer, the uterus and cervix must be removed, as well as all or part of the vagina. This operation is called a hysterectomy or total hysterectomy (TH). In operations done for cancer, the connective tissue that surrounds and supports the uterus is often removed as well. In that case, the operation is called a radical hysterectomy. In either case, there are 2 major ways to remove the uterus.
Removing the uterus through the vagina it is called a vaginal hysterectomy (or VH).
Removing the uterus through an incision in the abdomen, it is called an abdominal hysterectomy (or total abdominal hysterectomy; TAH).
Often these surgeries are done with the help of a laparoscope – a thin lighted tube that is inserted into the abdomen. Many surgeries are also done using a robotic interface. For this the surgeon sits at a panel near the operating table and controls robotic arms to perform the operation through several small incisions in the patient’s abdomen/pelvis.
The approach that is best for you and your cancer will be discussed with you before surgery. The fallopian tubes and ovaries are often removed in the same operation. This procedure is known as a bilateral salpingo-oophorectomy (or BSO). You may see the abbreviation TAHBSO, which stands for total abdominal hysterectomy bilateral salpingo-oophorectomy.
If a radical hysterectomy is done as part of your treatment, you may need to have a catheter to drain your bladder for a time after surgery. This is because some of the nerves to the bladder can be damaged or removed.
If all or most of the vagina must be removed, it is possible to reconstruct (rebuild) a vagina with tissue from another part of the body, which will allow a woman to have sexual intercourse. A new vagina can be surgically created out of skin, intestinal tissue, or myocutaneous (muscle and skin) grafts.
A reconstructed vagina produces little or no natural lubricant when a woman becomes sexually excited. A woman should prepare for intercourse by using a lubricant inside the vagina. If the vagina was rebuilt using muscle and skin from the leg, touching the new vagina may make a woman feel as though her thigh is being stroked. This is because the walls of the vagina are still attached to their original nerve supply. Over time, these feelings become less distracting and may even become sexually stimulating. (For more information about vaginal reconstruction, see Sexuality for the Woman With Cancer.)
Surgery to remove lymph nodes (lymphadenectomy)
Surgery to remove lymph nodes is called lymphadenectomy or sometimes is called lymph node dissection. For vaginal cancer, lymph nodes from the groin area or from inside the pelvis near the vagina may be removed to check for cancer spread.
Removing lymph nodes in the groin or pelvis can result in poor fluid drainage from the legs. The fluid builds up, leading to leg swelling that is severe and doesn’t go down at night when you are lying down. This is called lymphedema. This is more common if radiation is given after surgery. Support stockings or special compression devices may help reduce swelling. Women with lymphedema need to be very careful to avoid infection in the affected leg or legs. They can do this by taking these precautions:
Protect the leg and foot from sharp objects and care for any cuts, scratches, or burns right away
Avoid sunburn of the affected leg(s) and avoid cutting or tearing the cuticles of the toenails
Report any redness, swelling, or other signs of infection to the nurse or doctor without delay
More information about lymphedema can be found in Understanding Lymphedema – (For Cancers Other Than Breast Cancer).
Pelvic exenteration is an extensive operation that includes vaginectomy and removing the pelvic lymph nodes, as well as of one or more of the following structures: the lower colon, rectum, bladder, uterus, and cervix. How much has to be removed depends on how far the cancer has spread.
If the bladder is removed, a new way to store and get rid of urine is needed. Usually a short segment of intestine is used to function as a new bladder. This may be connected to the abdominal wall so that urine is drained periodically when the woman places a catheter into a small opening (called a urostomy). Or urine may drain continuously into a small plastic bag attached to the front of the abdomen over the opening.
More information about urostomy can be found in Urostomy: A Guide.
If the rectum and part of the colon are removed, a new way to eliminate solid waste is needed. This is done by attaching the remaining intestine to the abdominal wall so that stool can pass through a small opening (called a colostomy) into a small plastic bag worn on the front of the abdomen. (More information about colostomy can be found in Colostomy: A Guide.) Sometimes it’s possible to remove a piece of the colon and then reconnect it. In that case, no bags or external appliances are needed.
Pelvic exenteration is rarely needed to treat vaginal cancer – radiation therapy is usually used first, and then less extensive surgery may be all that is needed to control cancer that comes back. Still, this procedure might be used for vaginal cancers that have come back after treatment with radiation therapy. It is also sometimes needed to treat vaginal cancers when radiation therapy cannot be used, for example, if a woman has been treated with radiation for cervical cancer in the past. That is because treating the same area with radiation more than once can cause severe complications.
For more information on surgery, see A Guide to Cancer Surgery.
Chemotherapy for vaginal cancer
Chemotherapy (chemo) uses anti-cancer drugs that are usually given intravenously (into a vein), by mouth, or applied to the skin in an ointment. Drugs taken by mouth or injected into a vein, called systemic chemotherapy, enter the bloodstream to reach throughout the body, making this treatment potentially useful for cancer that has spread to
Chemo is the main treatment for vaginal cancer that has spread. It may also be helpful as a way to shrink tumors before surgery. When it is used before surgery, it may be given with radiation to make radiation work better.
Because vaginal cancer is rare, there haven’t been many studies to see which chemo is best. Often, the chemo given is similar to that used for cervical cancer. Drugs that have been used include
Many chemo drugs work by attacking cells that are rapidly dividing. This is helpful in killing cancer cells, but these drugs can also affect normal cells, leading to some side effects.
Side effects of chemo depend on the type of drugs, the amount taken, and the length of time you are treated. Common side effects include:
Loss of appetite
Nausea and vomiting
Changes in the menstrual cycle, premature menopause, and infertility (inability to become pregnant). Most women with vaginal cancer, however, have gone through menopause.
Chemo can also affect the blood forming cells of the bone marrow, leading to low blood counts. This can cause:
Increased chance of infections (due to low white blood cells)
Easy bruising or bleeding (due to low blood platelets)
Fatigue (due to low red blood cells)
Other side effects can occur depending on which drug is used. For example, cisplatin can cause nerve damage (called neuropathy). This can lead to numbness, tingling, or even pain in the hands and feet.
Most side effects are temporary and stop when the treatment is over, but chemo drugs can have some long-lasting or even permanent effects. Ask your cancer care team about the chemo drugs you will receive and what side effects you can expect. Also be sure to talk with them about any side effects you do have so that they can be treated. For example, you can be given medicine to reduce or prevent nausea and vomiting.
Treatment options, by stage and type of vaginal cancer
The type of treatment your cancer care team will recommend depends on the type of vaginal cancer you have and how far the cancer has spread. This section summarizes the choices available according to the stage of your cancer.
Vaginal intraepithelial neoplasia (VAIN)
Many cases of low-grade VAIN (VAIN 1) will go away on their own, so some doctors will choose to watch them closely without starting treatment. This means getting repeat Pap tests – often with colposcopy if needed. If the area of VAIN doesn’t go away or gets worse, treatment is started. VAIN 2 is not likely to go away on its own, so treatment is usually started right away.
VAIN is often treated using topical therapy (like 5-FU or imiquimod) or laser treatment. When there are many areas of VAIN, intracavitary radiation (brachytherapy) may be used. Sometimes, surgery is used to remove the lesion. Surgery may be chosen if other treatments fail or if the doctor wants to be sure that the area isn’t invasive cancer. Surgery may involve a wide local excision, removing the abnormal area and a rim of surrounding normal tissue. A partial vaginectomy (removal of part of the vagina) is rarely needed to treat VAIN.
Stage 0 (VAIN 3 or CIS)
The usual treatment options are laser vaporization, local excision, and intracavitary radiation (brachytherapy).
Topical chemotherapy with 5-FU cream is also an option, but this requires treatment at least weekly for 10 weeks. This treatment can severely irritate the vagina and vulva. Topical immunotherapy with imiquimod may also be used.
If the cancer comes back again after these treatments, surgery (partial vaginectomy) may be needed. The surgeon would remove the entire tumor and enough surrounding normal tissue to ensure that it doesn’t come back.
Squamous cell cancers: Radiation therapy is used for most stage I vaginal cancers. If the cancer is less than 5 mm thick (about 3/16 inch), intracavitary radiation may be used alone. Interstitial radiation is an option for some tumors, but it’s not often used. For tumors that have grown more deeply, intracavitary radiation may be combined with external beam radiation.
Removing part or the entire vagina is an option for some cancers (partial or radical vaginectomy). Reconstructive surgery to create a new vagina after treatment of the cancer is an option if a large portion of the vagina has been removed.
If the cancer is in the upper vagina, it may be treated by a radical hysterectomy, bilateral radical pelvic lymph node removal, and radical or partial vaginectomy.
Following a radical partial or complete vaginectomy, postoperative radiation (external beam) may be used to treat tiny deposits of cancer cells that have spread to lymph nodes in the pelvis.
Adenocarcinomas: For cancers in the upper part of the vagina, the treatment is surgery: a radical hysterectomy, partial or radical vaginectomy, and removal of pelvic lymph nodes. This can be followed by reconstructive surgery if needed or desired. Radiation therapy may be given as well.
For cancers lower down in the vagina, one choice is to give both either interstitial or intracavitary radiation therapy and external radiation beam therapy. The lymph nodes in the groin and/or pelvis are treated with external beam radiation therapy.
The usual treatment is radiation, using a combination of brachytherapy and external beam radiation.
Radical surgery (radical vaginectomy or pelvic exenteration) is an option for some patients with stage II vaginal squamous cell cancer if it’s small and in the upper vagina. It’s also used to treat women who have already had radiation therapy for cervical cancer and who would not be able to tolerate additional radiation without severe damage to normal tissues.
Chemotherapy (chemo) with radiation may also be used to treat stage II disease.
Giving chemo to shrink the cancer before radical surgery may be helpful.
Stage III or IVA
The usual treatment is radiation therapy, often with both brachytherapy and external beam radiation. Curative surgery is generally not attempted. Chemo might be combined with radiation to help it work better.
Since the cancer has spread to distant sites, it can’t be cured. Patients often receive radiation therapy to the vagina and pelvis to improve symptoms and reduce bleeding. . Chemo might also be given, but it has not been shown to help patients live longer. Because there’s no accepted treatment for this stage, often the best option is to enroll in a clinical trial.
Recurrent squamous cell cancer or adenocarcinoma of the vagina
If a cancer comes back after treatment it is called recurrent. If the cancer comes back in the same area as it was in the first place, it is called a local recurrence. If it comes back in another area (like the liver or lungs), it is called a distant recurrence.
A local recurrence of a stage I or stage II vaginal cancer may be treated with radical surgery (such as pelvic exenteration). If the cancer was originally treated with surgery, radiation therapy is an option. Surgery is the usual choice when the cancer has come back after radiation therapy.
Higher-stage cancers are difficult to treat when they recur. They usually can’t be cured by currently available treatments. Care focuses mostly on relieving symptoms, although participation in a clinical trial of new treatments may be helpful.
For a distant recurrence, the goal of treatment is to help the woman feel better. Surgery, radiation, or chemo may be used. Again, a clinical trial is a good option.
Surgery is the main treatment for vaginal melanoma. Because vaginal melanoma is very rare, it hasn’t been well studied. Doctors are still not certain about how much tissue needs to be removed to give the best chance of cure. One choice is to remove the cancer and a margin of the normal tissue around it. This is how a melanoma on the skin of an arm or leg would be treated. Another option is to remove the entire vagina and some tissue from nearby organs. Some (or all) of the lymph nodes that
drain the area of the tumor are also removed and checked for cancer spread.
There are a few drugs that can be helpful in treating metastatic melanoma. These and other treatments are discussed in more detail in Melanoma Skin Cancer. Radiation therapy may also be used for melanoma that has spread. It’s most often used for spread to the brain or spinal cord. A good option for women with metastatic vaginal melanoma is to receive treatment as a part of a clinical trial.
Treatment of rhabdomyosarcoma is discussed in Rhabdomyosarcoma.
This is the conventional method which is not the choice for everyone. Some people will prefer to consider alternative cancer treatment protocols.
Thinking about taking part in a clinical trial
Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the art cancer treatment. In some cases, they may be the only way to get access to newer treatments. They are also the best way for doctors to learn better methods to treat cancer. Still, they are not right for everyone.
If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials.
Considering complementary and alternative methods
You may hear about alternative or complementary methods that your doctor hasn’t mentioned to treat your cancer or relieve symptoms. These methods can include complete cancer treatment protocols vitamins, with herbs, and special diets, special supplements, or other methods such as what you can find HERE.
Complementary methods refer to treatments that are used along with your regular medical care. Alternative treatments are used instead of a doctor’s medical treatment.
Many alternative cancer treatment protocols have been proven to work. Some might even be the cure for your type of cancer.
Be sure to talk to your cancer care team about any method you are thinking about using. They can help you learn what is known (or not known) about the method, which can help you make an informed decision. See the Complementary and Alternative Medicine section of our website to learn more.
What should you ask your doctor about vaginal cancer?
It’s important to have honest, open discussions with your cancer care team. They want to answer all of your questions, no matter how minor you might think they are.
Among the questions you might want to ask are:
What kind of vaginal cancer do I have?
Has the cancer spread beyond my vagina?
What’s the stage of the cancer? What does this mean to me?
What treatment choices do I have? What do you recommend? Why?
What risks and side effects can I expect from treatment?
Will I be able to have children after treatment?
What should I do to be ready for treatment?
Should I follow a special diet?
Based on what you’ve learned about my cancer, what’s my prognosis (chances of survival)?
What are the chances my cancer will recur (come back) with the treatment plans we have discussed?
How long will it take me to recover from treatment?
Will I be able to have sex after treatment? What reconstructive surgery, if any, will I need?
When can I go back to work after treatment?
How many patients with vaginal cancer do you treat each year?
Should I get a second opinion?
You will no doubt have other questions about your own situation. Write your questions down so that you remember to ask them during each visit with your cancer care team. Keep in mind, too, that doctors are not the only ones who can provide you with information. Other health care professionals, such as nurses and social workers, may be able to answer your questions.
What happens after treatment for vaginal cancer?
For some people with vaginal cancer, treatment may remove or destroy the cancer. Completing treatment can be both stressful and exciting. You may be relieved to finish treatment, but find it hard not to worry about cancer coming back. (When cancer comes back after treatment, it is called recurrence.) This is a very common concern in people who have had cancer.
It may take a while before your fears lessen. But it may help to know that many cancer survivors have learned to live with this uncertainty and are living full lives. Living With Uncertainty: The Fear of Cancer Recurrence gives more detailed information on this. It can be read online, or call us to have a free copy sent to you.
For other people, the cancer may never go away completely. These people may get regular treatments with chemotherapy, radiation therapy, or other therapies to try to help keep the cancer in check. Learning to live with cancer that does not go away can be difficult and very stressful. It has its own type of uncertainty.
When Cancer Doesn’t Go Away talks more about this.
When treatment ends, your doctors will still want to watch you closely. It’s very important to go to all of your follow-up appointments. During these visits, your doctors will ask questions about any problems you are having and may do pelvic exams and Pap tests as well as lab tests or x-rays and scans to look for signs of cancer or treatment side effects. Almost any cancer treatment can have side effects. Some may last for a few weeks to months, but others can last the rest of your life.
This is the time for you to talk to your cancer care team about any changes or problems you notice and any questions or concerns you have.
Treatment can leave vaginal tissue fragile and prone to injury. Follow-up will require checking these tissues for injury or tightening and scarring. Some women will be advised to use vaginal dilators, which a woman inserts in her vagina to gently stretch her vaginal tissue, gradually making it more elastic and normal over time.
It’s important to keep your health insurance. Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.
Should your cancer come back, When Your Cancer Comes Back: Cancer Recurrence can give you information on how to manage and cope with this phase of your treatment.
Seeing a new doctor
At some point after your cancer diagnosis and treatment, you may find yourself seeing a new doctor who doesn’t know anything about your medical history. It’s important that you be able to give your new doctor the details of your diagnosis and treatment. Gathering these details soon after treatment may be easier than trying to get them at some point in the future. Make sure you have the following information handy:
A copy of your pathology report(s) from any biopsies or surgeries
If you had surgery, a copy of your operative report(s)
If you were hospitalized, a copy of the discharge summary that doctors prepare when patients are sent home
If you had radiation therapy, a copy of your treatment summary
If you had chemotherapy or were treated with topical therapy, a list of the drugs, drug doses, and when you took them
Copies of your x-rays and other imaging studies (these can often be put on a DVD)
The doctor may want copies of this information for his records, but always keep copies for yourself.
Can I get another cancer after having vaginal cancer?
Cancer survivors can be affected by a number of health problems, but often their greatest concern is facing cancer again. If a cancer comes back after treatment it is called a “recurrence.” But some cancer survivors may develop a new, unrelated cancer later. This is called a “second cancer.” No matter what type of cancer you have had, it is still possible to get another (new) cancer, even after surviving the first.
Unfortunately, being treated for cancer doesn’t mean you can’t get another cancer. People who have had cancer can still get the same types of cancers that other people get. In fact, certain types of cancer and cancer treatments can be linked to a higher risk of certain second cancers.
Survivors of vaginal cancer can get any type of second cancer, but they have an increased risk of:
Cancer of the ureter (the tube that connects the kidney to the bladder)
They may also have an increased risk of lung cancer. The risk of bladder cancer is also increased in women treated with radiation.
These cancers are all linked to smoking, which is also a risk factor for vaginal cancer. In addition, both vaginal and vulvar cancer are linked to infection with human papilloma virus (HPV).
Follow-up after treatment
After completing treatment of vaginal cancer see their doctors regularly to look for signs of their cancer coming back, as well as a new cancer of the vulva. Experts do not recommend additional testing to look for second cancers in patients without symptoms. Let your doctor know about any new symptoms or problems, because they could be caused by the cancer coming back or by a new disease or second cancer.
Survivors of vaginal cancer should follow the American Cancer Society guidelines for the early detection of cancer and stay away from tobacco products. Smoking increases the risk of many cancers, including the second cancers seen in women treated for vaginal cancer.
To help maintain good health, survivors should also:
Achieve and maintain a healthy weight
Adopt a physically active lifestyle
Consume a healthy diet, with an emphasis on plant foods
Limit consumption of alcohol to no more than 1 drink per day
These steps may also lower the risk of some cancers.
See Second Cancers in Adults for more information about causes of second cancers.
Lifestyle changes after vaginal cancer
You can’t change the fact that you have had cancer. What you can change is how you live the rest of your life – making choices to help you stay healthy and feel as well as you can. This can be a time to look at your life in new ways. Maybe you are thinking about how to improve your health over the long term. Some people even start during cancer treatment.