Vaginal cancer starts in the vagina, a tube-like structure that connects the cervix to the vulva (the exterior portion of the female genitals). Vagina cancer is not common. It occurs when healthy cells in the vagina grow and change rapidly, causing a tumor to form.
Most vaginal cancers (85%) start elsewhere in the body (such as the cervix or uterus) and spread to the vagina. There are five main types of vaginal cancer:
- Squamous cell carcinoma: This causes about 85% of vaginal cancer cases and affects the cells that line the vagina, often near the cervix. It develops from a precancerous condition called vaginal intraepithelial neoplasia.
- Adenocarcinoma: This cancer is responsible for 5 to 10% of vaginal cancer cases. It begins in the vaginal gland tissue.
- Clear cell adenocarcinoma: This cancer occurs in women who took the miscarriage-prevention drug diethylstilbestrol (DES) during pregnancy from 1940 to 1970.
- Melanoma: While it’s rare, it’s possible for melanoma to begin in the vagina. Melanoma is most common on areas of the body that are exposed to the sun, but can develop anywhere, including in the vagina.
- Sarcomas: Sarcomas are rare tumors that can sometimes develop in the vagina.
Certain factors can increase the risk of developing vaginal cancer, including:
- Human papillomavirus (HPV) infection
- Being age 50 or older
- Being exposed to DES, a drug given to some pregnant women between 1940 and 1970 to prevent miscarriage
- A history of abnormal cells in the cervix or cervical cancer
- A hysterectomy for health problems that affect the uterus
- Smoking
- Previous radiation therapy to the vaginal area
- A history of abnormal cells in the uterus or uterine cancer
Getting the HPV vaccine early may reduce your risk of vaginal precancer and cancer. Research has shown the following factors may also reduce your risk of vaginal cancer:
- Getting regular Pap tests
- Not smoking (or quitting if you currently smoke)
- Not having sexual intercourse until your late teens or older
- Limiting your number of sexual partners
- Avoiding sexual intercourse with someone who has had many partners
- Practicing safe sex and using condoms
Symptoms of vaginal cancer include:
- Abnormal bleeding or discharge
- Blood in your stool or urine
- Constipation
- Going to the bathroom more often than usual
- Pain during urination or sexual intercourse
- Pain in your pelvic region
- Swelling in your legs
Your gynecologic oncologist may use one or more of the following tests to diagnose vaginal cancer:
- Pelvic exam: During this exam, your doctor will check your vagina, cervix, uterus, ovaries, bladder and rectum for changes. If you’re due for a Pap test, it will be done during your pelvic exam.
- Pap test: During this test, your physician will lightly scrape the inner and outer portion of the cervix and vagina to take samples of your cells. These cells will be tested for precancerous or cancerous changes.
- Colposcopy: This test is used to look for abnormal or cancerous cells in the vagina and cervix. During this test, your doctor will use an instrument called a colposcope to get a better view of the tissues in your vagina and surrounding areas. The colposcope never goes inside your body; rather, it just gives your doctor a better view of potentially abnormal cells.
- Biopsy: If your doctor believes you may have abnormal or cancerous cells, they may take a small tissue sample through a biopsy. Only a biopsy can tell your doctor for sure if you have precancerous or cancerous changes in the vagina.
- Ultrasound: An ultrasound creates a picture of the vagina and surrounding tissues using sound waves.
- Endoscopy: This procedure allows your physician to look inside your body with a thin, flexible tube with a light at the end of it. During the procedure, you’re sedated and the tube is inserted through the vagina, urethra, anus, mouth or small surgical opening.
- Computed tomography (CT) scan: A CT scan takes X-rays of the body from different angles to create a three-dimensional image that shows tumors or abnormalities.
- Positron emission tomography (PET) scan: During a PET scan, a small amount of a radioactive sugar substance is injected into the body. Cells that use the most energy, such as cancer cells, absorb more of this substance than other cells. Then a scanner creates images of your organs and tissues.
- Magnetic resonance imaging (MRI): This test uses magnetic fields instead of X-rays to create images of the inside of the body. An MRI can also help your doctor measure the size of the tumor.
Staging is based on where your cancer started, if or where it has spread, and if or how it’s affecting other areas of the body. Here are the stages of vaginal cancer:
- Stage I: The cancer is only located in the vagina and hasn’t spread elsewhere.
- Stage II: The cancer has spread through the vaginal wall, but not to the pelvic wall.
- Stage III: The cancer has either spread to the lymph nodes in the pelvis or spread to the pelvic wall.
- Stage IV:
- Stage IVA: The tumor has spread to the rectum, bladder or organs outside the pelvis. The lymph nodes may not be affected.
- Stage IVB: The cancer has spread to a distant part of the body.
Your doctor will use staging to determine what type of treatment is right for you.
During vaginal cancer treatment, you’ll be cared for by a multidisciplinary team. This team may include:
- A gynecologic oncologist
- A radiation oncologist
- A nurse navigator
- Nurse practitioners
- Physician assistants
- Oncology nurses
- Social workers
- Dietitians
- Counselors
- Pharmacists
The treatment will depend on the type and the stage of the disease and may include:
- Surgery: You may need surgery to remove the tumor and surrounding tissue. Sometimes only
surgery is necessary. Common surgical procedures include:
- Vaginectomy: This includes removing a portion or all of the vagina and possibly the pelvic lymph nodes. If tissues next to the vagina need to be removed, this procedure is called a radical or modified radical vaginectomy. After this procedure, the surgeon will repair or reconstruct the vagina with tissue from elsewhere on the body.
- Hysterectomy: This includes a simple hysterectomy (removing the uterus and cervix) or a radical hysterectomy (removing the uterus, cervix, upper portion of the vagina and some surrounding tissues).
- Radiation therapy: Radiation therapy can be administered either as external radiation therapy (from outside the body) or internal radiation therapy (a radioactive substance is placed in or near the tumor). Internal radiation therapy (also known as brachytherapy) is very effective at treating vaginal cancer and is often used in combination with external-beam radiation therapy.
- Chemotherapy: Chemotherapy uses specific drugs to slow or kill cancer cells. With systemic chemotherapy, the medication is injected into a vein or given orally for specific types of vaginal cancer. The goal of chemotherapy is to shrink the tumor and slow its growth.
Robotic Surgery for Vaginal Cancer Treatment
Your gynecologic oncologist may recommend robotic surgery, a type of minimally invasive surgery. Robotic surgery gives your doctor more control, a better view and high-definition 3D vision during the procedure. Because this type of surgery requires just a few small incisions, you may experience:
- Quicker recovery
- Less blood loss and transfusions
- Reduced pain
- Less scarring
- Lower risk of infection
Ask your doctor if you’re eligible for robotic surgery.
If you have vaginal cancer, you may be wondering if you’ll still be able to have children after treatment. If you’re pre-menopausal, talk with your physician about possible ways to preserve your fertility. You may be referred to a fertility specialist called a reproductive endocrinologist before you begin cancer treatment. Be sure to ask which fertility treatments (if any) your insurance will cover.
See Sarah Cannon’s blog on fertility preservation for more information.