Vaginal cancer

Your vagina, sometimes referred to as the birth canal, is the muscular tube that connects your uterus to your outer genitals (the vulva). Vaginal cancer is a rare form of gynecologic cancer that starts in the vagina.

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Types of vaginal cancer

There are four main types of vaginal cancer:

  • Squamous cell carcinoma. Squamous cells are thin, flat cells that line the surface of the vagina. Squamous cell vaginal cancer is the most common type of vaginal cancer.
  • Adenocarcinoma. Adenocarcinoma refers to cancer that starts in gland cells. Vaginal adenocarcinoma makes up around 15% of all vaginal cancer cases.
  • Vaginal melanoma. This cancer starts in the pigment-producing cells of your vagina (your melanocytes). This type of vaginal cancer is very rare and tends to be aggressive, meaning it spreads quickly.
  • Vaginal sarcoma. This type of vaginal cancer is also very rare. It starts within the vaginal wall, as opposed to on the surface.

No matter what type of vaginal cancer you have, catching it early gives you the best chance for a cure.

Vaginal cancer: causes and risk factors

No exact cause

Experts still don’t know the exact cause of vaginal cancer.

Generally, cancer happens when normal, healthy cells become mutated and grow out of control. This uncontrolled cell growth causes lumps called tumors to develop. Additionally, cancer cells can break away, travel to other parts of the body and start growing there. When this happens, it is referred to as metastasis.

Risk factors

Some things can increase your risk of developing vaginal cancer. Risk factors include:

  • Age. Most cases of vaginal cancer are diagnosed in people over the age of 60.
  • Exposure to Diethylstilbestrol (DES). DES was a miscarriage prevention drug taken from the 1940s to the early 1970s. If your mother took this drug while pregnant with you, you may be at increased risk for a type of vaginal cancer called clear cell adenocarcinoma.
  • Human papillomavirus (HPV). HPV is a risk factor for many gynecological cancers, including vaginal cancer. HPV is usually thought of as a sexually transmitted disease, but it can be transmitted through most forms of skin-to-skin contact. Thankfully, vaccines for HPV are highly safe and effective and can be obtained easily at your doctor’s office.
  • Vaginal intraepithelial neoplasia (VAIN). Vaginal intraepithelial neoplasia is a condition where you have some atypical vaginal cells, but these cells are not different enough from normal cells to be considered cancer. VAIN is often caused by HPV. It is also associated with having a history of cervical cancer, uterine cancer or having had a hysterectomy. For a small portion of people with VAIN, the abnormal cells will develop into cancer.
  • Smoking increases your risk of developing many cancers, including vaginal cancer.

Symptoms of vaginal cancer

Not everyone who has vaginal cancer experiences symptoms. You may only find out you have vaginal cancer after a regular check-up. As the disease progresses, you may experience symptoms like:

  • A lump or mass in the vagina.
  • Back pain.
  • Constipation.
  • Frequent urination.
  • Pain when urinating.
  • Vaginal pain or pelvic pain.
  • Pain during penetrative sex.
  • Unusual bleeding in between periods or after menopause.
  • Unusual vaginal itching.
  • Watery vaginal discharge.

Because vaginal cancer develops inside the vagina, you will not be able to see it. If you notice lumps, sores or color changes on the skin near your vagina, these may be signs of vulvar cancer.

Vaginal cancer symptoms often resemble those of other gynecological problems. If you have symptoms, you should schedule an appointment with your doctor right away so that you can get treated as early as possible.

How is vaginal cancer diagnosed?

Your doctor will start by asking you about your overall health, any symptoms, and your family and medical history. They will then perform a physical exam. They may also recommend one or more of the following tests:

  • Pelvic exam. In a pelvic exam, your doctor closely inspects your vulva for any signs of abnormalities. They then insert two fingers into your vaginal while pressing down on your abdomen so that they can feel your uterus and ovaries. From there, your doctor may insert a speculum into your vagina. This tool allows them to examine your cervix and vagina for abnormalities.
  • Pap test (PAP Smear). During a pelvic exam, your doctor may do a pap test. This is usually used to screen for cervical cancer, but it can sometimes also detect vaginal cancer. Your doctor will use a small brush or cotton ball to gently scrape cells from your cervix. These cells are then set off to a lab to be tested for abnormalities.
  • HPV test. Your doctor can test cells taken during a pap smear for HPV. While this doesn’t tell you whether you have vaginal cancer, it can be a sign that you need more regular check-ups and monitoring.

The importance of regular check-ups. Sometimes vaginal cancer is identified during a regularly scheduled pelvic exam or pap test, well before symptoms happen. This is why regular gynecological check-ups are so important.

When further testing is indicated

If you have an abnormal PAP test or pelvic exam, your doctor may recommend further testing:

  • Biopsy. A biopsy involves taking samples of abnormal tissue from the vagina and cervix and sending them to a lab. At the lab, a specialist will examine the cells for cancer and provide a diagnosis.
  • Colposcopy exam. Your doctor may use a special magnifying device (colposcope) to closely inspect the inside of your vagina and see any abnormal cells.

Your doctor may recommend the following additional tests to see if your cancer has spread to other organs:

  • Cytoscopy. Your vagina and bladder are located close together. During a cystoscopy, your doctor will use a tool called a cystoscope to examine the inside of your bladder for signs of cancer. The cystoscope is inserted through your urethra. If your doctor sees any abnormal tissue, they may do a biopsy.
  • Proctoscropy. Your vagina is also very close to your rectum, the muscular tube that holds feces and your anus. Your doctor may use a tool called a proctoscope to inspect the anus and rectum for signs that vaginal cancer has spread. If they see suspicious tissue, they may take a biopsy.
  • Imaging exams. Imaging tests may be done to see if the cancer has spread to your chest or abdomen. They can include an X-ray, computerized tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET).

Vaginal cancer staging

If you are diagnosed with vaginal cancer, your doctor will need to stage the disease. Staging is a way of talking about how far a disease has progressed and whether it has spread to other parts of the body (metastasized). Staging is used to help you and your doctor discuss your treatment options.

There are 4 stages of vaginal cancer. The higher the stage, the more serious the cancer:

  • Stage I: Cancer is limited to the vagina only. It has not spread anywhere else.
  • Stage II: Cancer has spread through the vaginal wall and to the tissue immediately surrounding the vagina. It has not spread to the pelvic wall or nearby organs.
  • Stage III: Cancer has spread to the pelvic wall and nearby lymph nodes.
  • Stage IV: Cancer has spread to the bladder, rectum, uterus, ovaries or other areas not near the vagina (such as the lungs).

Treatments for vaginal cancer

Vaginal cancer treatment can vary widely, depending on its stage, your overall health and your goals.

Surgery

Surgery is the standard treatment for vaginal cancer. Different surgical procedures are used for different stages of cancer. They include:

  • Laser surgery. This involves using a high-energy beam to remove surface lesions or very small tumors.
  • Local excision. For small tumors, your doctor may perform a local excision. This involves removing the tumor itself and a small amount of the surrounding healthy tissue.
  • Vaginectomy. Depending on the size of the cancer, your doctor may recommend removing part or all of your vagina. This is referred to as a partial vaginectomy and radical vaginectomy, respectively. These surgeries are usually reserved to treat vaginal cancer in later stages.
    • If you undergo a radical vaginectomy, you may have your vagina reconstructed using muscle or tissue from other parts of your body. This will allow you to have vaginal intercourse. However, a reconstructed vagina will feel different from your vagina, and it will not produce the natural lubrication that your vagina produces during sex.
  • Hysterectomy and oophorectomy. If you need a radical vaginectomy, your doctor may also recommend removing nearby lymph nodes (lymphadenectomy). You may also need to have your uterus and ovaries removed (hysterectomy with oophorectomy).
    • Having a hysterectomy and oophorectomy are major procedures. If you have a hysterectomy, you will not be able to carry a pregnancy. If you have an oophorectomy, you will no longer produce the hormones that drive your menstrual cycle, you will enter into menopause.
  • Pelvic exenteration. For cancer that has spread extensively throughout the pelvic region, your doctor may recommend a pelvic exenteration. This involves removing most of your major pelvic organs, including your vagina, uterus, ovaries, bladder, rectum and surrounding tissue. Your doctor will create openings in your abdomen to allow urine and feces to be collected in small bags called ostomy bags.

Radiation therapy

Using high-powered energy beams like X-rays and protons, radiation therapy kills cancer cells. It can also be used to shrink large tumors before surgery. There are two ways radiation therapy can be delivered:

  • External radiation. A machine generates high-energy beams and directs them precisely at vaginal tumors.
  • Internal radiation (brachytherapy). Small radioactive seeds are implanted near tumors and left for a set amount of time.

Sometimes, internal radiation alone is enough. In other cases, you may need external radiation followed by internal radiation.

Radiation therapy can come with unpleasant side effects, like bladder problems, changes in menstruation, vaginal itching or burning, and temporary or permanent fertility problems.

Other treatments

  • Chemotherapy. Chemotherapy uses medications to kill cancer cells. It can be administered as a pill or through a vein (IV). However, chemotherapy may not be effective for vaginal cancer. Sometimes, it is combined with radiation therapy to enhance its effectiveness.
  • Clinical trials. Clinical trials are research studies performed on patients to test the effectiveness of new treatments. There is no guarantee that the treatment will be effective against your cancer, but it gives you a chance to try the latest treatment advances.

Vaginal cancer prognosis and outlook

A prognosis is your doctor’s best estimate of how your cancer will affect you and how it will respond to treatment. Your prognosis depends on many factors, including:

  • Your current age and health.
  • Your medical history.
  • The type of cancer.
  • The stage of your cancer.

The average 5-year survival rate for vaginal cancer is 59%, although different cancer types have different averages. Vaginal adenocarcinoma and clear cell adenocarcinoma have the highest survival rates, followed by squamous cell cancer.

Survival rates improve the sooner your cancer is caught. Stage I vaginal cancer, for instance, has a 5-year survival rate of over 80%. This is why getting regular Pap tests and check-ups are important. And, if you notice any changes, don’t wait to talk to your doctor.

Finding a care team that can give you empathetic and expert care is an important step to getting the treatment you need. At UCHealth, you can find services to fight your cancer and make the most of your everyday life.

Living with vaginal cancer

Vaginal cancer not only impacts your physical health. It can have serious effects on your entire life, from your friendships to your future plans. You may want to look into other services to address these side effects.

Mental health support. Vaginal cancer is hard on your body, but it can also be hard on your mind. It can disrupt your daily life, make you feel isolated from your friends, family and partner. All of this can contribute to mental health problems like anxiety and depression. You may want to consider finding a support group or getting professional help during or after your treatment.

Intimacy. Treatment for vaginal cancer may make sex and intimate activities uncomfortable, even temporarily impossible. It is an understatement to say that this can be distressing. Treatments like radiation therapy can be taxing on your body, and surgery can change how you feel about your body or what you feel during sex.

Before and during treatment, you should talk to your doctor about how your sexual function may change. Being armed with this knowledge can help prepare you for the changes and make it easier for you to talk to your partner(s).

If you have surgery, ask your healthcare team about when and how it will be safe for you to start having sex. Your healthcare team can also help you find ways to make sexual activity more comfortable and enjoyable. Depending on your situation, your doctor may recommend using water or silicone-based lubricants or a device called a dilator, which helps reduce pelvic pain during sex. Other treatments may also be available.

Remember that sexual health and well-being are part of your overall health and well-being, so never be ashamed to bring sex up with your medical team.

Fertility treatments. Vaginal cancer treatments can affect your fertility. For instance, removing your uterus prevents you from carrying a pregnancy. Removing your ovaries means you will no longer produce eggs. Sometimes, radiation treatments can reduce your fertility. You may want to talk to your doctor about treatments like in vitro fertilization, freezing your eggs and surrogacy.

References


National Cancer Institute (NCI). Vaginal Cancer Treatment (https://www.cancer.gov/types/vaginal/patient/vaginal-treatment-pdq)

MedlinePlus: National Library of Medicine. Vaginal Cancer (https://medlineplus.gov/vaginalcancer.html)

Center for Disease Control and Prevention (CDC). What Are the Symptoms of Vaginal and Vulvar Cancers? (https://www.cdc.gov/cancer/vagvulv/basic_info/symptoms.htm)

National Center for Biotechnology Information (NCBI): National Library of Medicine. Vaginal Cancer (https://www.ncbi.nlm.nih.gov/books/NBK559126/)