Vaginal Cancer

Vaginal cancer is an overgrowth of cells in your vagina — most often, it’s the cells lining your vagina. Your vagina is the canal leading from your cervix (the opening of your uterus) to the outside of your body.

Cancer that begins in your vagina is called primary vaginal cancer. It’s rare and accounts for only 1% to 2% of all female reproductive tract cancers.

Cancers that start in other parts of your body — like cervical cancer or uterine cancer — sometimes spread (metastasize) to your vagina.

Vaginal cancer doesn’t always cause symptoms. You may not know you have it until your healthcare provider notices abnormal cells during a routine screening. This is why it’s important to get checked regularly. Your provider can detect vaginal cancer even when your body isn’t alerting you that something’s wrong.

Types

There are different types of vaginal cancer. They’re named after the cells in your vagina where cancer starts:

• Squamous cell carcinoma begins in the flat cells that line your vagina. It’s the most common type of vaginal cancer. It accounts for nearly 9 out of 10 cases.
• Adenocarcinoma begins in gland cells in your vagina. Clear cell adenocarcinoma is a rare type that’s linked to exposure to a drug called diethylstilbestrol (DES) before birth.
• Melanoma begins in the cells that give your vagina its color (melanocytes). Vaginal melanomas are extremely rare.
• Sarcoma begins in the connective and muscle tissue that make up your vaginal wall. Vaginal sarcomas are extremely rare.

Symptoms of vaginal cancer

You may not have any symptoms of vaginal cancer. If you do, they can include:

• Vaginal bleeding after sex
• Vaginal bleeding after menopause
• Vaginal discharge that’s watery, bloody or foul-smelling
• Pain during sex
• A noticeable mass in your vagina
• Pain with peeing or often feeling the urge to pee
• Constipation or black-colored poop
• Feeling the urge to poop when your bowels are empty
• Pelvic pain

Other, more common conditions can cause these symptoms. They rarely indicate a condition as serious as vaginal cancer. Still, you should see your provider as soon as possible if you have them.

Vaginal cancer causes

Researchers don’t know for sure what causes vaginal cancer. It’s likely that an infection with certain strains of human papillomavirus (HPV) can increase your risk. But you can get vaginal cancer without having HPV.

Vaginal cancer cells behave as all cancer cells do. Instead of growing, multiplying and eventually dying like a normal cell, cancer cells continue to grow. The cells multiply until they form tumors. Over time, these tumors may spread to other parts of your body (metastasize).

Risk factors

Risk factors for vaginal cancer include:

• Age: Your risk increases with age. The average age of diagnosis is 67 years. Occasionally, people younger than 60 develop vaginal cancer.
• Human papillomavirus (HPV): HPV is a sexually transmitted virus that may increase your risk of cervical cancer and vaginal cancer.
• Vaginal intraepithelial neoplasia (VAIN): With VAIN, you have cells in your vaginal lining that aren’t normal. But they’re not cancer cells either. VAIN progresses to cancer in some people but not others.
• History of cervical cancer or cervical dysplasia: It’s possible to develop vaginal cancer after being treated for cervical cancer. Abnormal cells in your cervix may increase your risk of vaginal cancer.
• Exposure to diethylstilbestrol (DES): DES is a synthetic form of estrogen prescribed between 1940 and 1971 to prevent pregnancy complications. You’re at an increased risk of developing clear cell adenocarcinoma if your mother took DES during pregnancy.
• Smoking: Smoking doubles your risk of developing vaginal cancer.

How doctors diagnose this condition

Your healthcare provider will start by asking about your symptoms. They’ll likely do a pelvic exam and a Pap smear (Pap test). If your provider finds abnormal cells, you may need further tests, like:

• Colposcopy: Your provider uses a lighted instrument to look for abnormal cells in your vagina and cervix.
• Biopsy: Your provider takes a tissue sample and sends it to a lab for testing. This is the only test that can confirm a vaginal cancer diagnosis.

Imaging procedures can help your provider see if your cancer has spread, a process called staging.

Staging

Staging allows your provider to determine how advanced the cancer is. It also lets them know which treatment is most likely to help you. In particular, providers look at these three categories:

• T (tumor): How far the tumor has progressed in your vagina
• N (nodes): Whether it’s spread to your lymph nodes
• M (metastasis): Whether it’s spread to other parts of your body

Based on this information, your provider stages vaginal cancer as one of these:

• Stage I: Limited to the inner lining of your vagina (vaginal mucosa)
• Stage II: Involvement of your subvaginal tissue without going into your pelvic sidewall
• Stage III: Extension to your pelvic sidewall
• Stage IVA: Spread to nearby organs
• Stage IVB: Spread to distant organs

How is it treated?

Treatment for vaginal cancer depends on the type, the cancer stage and your age. It may also depend on whether you’d like to have biological children.

Options typically include radiation, chemotherapy and/or surgery. You may receive a variety of treatments. In some cases, your provider may recommend joining a clinical trial to try new cancer treatments in development.

Radiation

Radiation therapy is the treatment of choice for most cases of vaginal cancer. It uses targeted energy beams to destroy cancer cells or keep them from dividing. Specific types include:

• External radiation therapy: A machine outside your body directs beams of high-energy radiation at the tumor.
• Internal radiation therapy (brachytherapy): Your provider places sealed wires or catheters containing radioactive material inside your vagina.

Chemotherapy

Chemotherapy uses medications to kill cancer cells. Chemotherapy alone isn’t an effective treatment for vaginal cancer. But your provider may suggest using it alongside radiation to make it more effective. This is called concurrent chemotherapy and radiation therapy (CCRT).

Surgery

In general, surgery options for vaginal cancer are limited. This is because your vagina is close to other important organs, like your bladder, rectum and urethra. Surgery options may include:

• Wide local excision: A surgeon removes the tumor, along with some of the healthy tissue surrounding it.
• Vaginectomy: A surgeon removes all or part of your vagina. Depending on cancer spread, they may also recommend removing your lymph nodes, cervix and/or uterus.
• Pelvic exenteration: A surgeon removes multiple organs from your pelvis. It may be an option if you have recurring cancer.

What can I expect if I have this condition?

Your prognosis (outlook) for vaginal cancer depends on the stage of cancer you have. Early-stage vaginal cancers can often be treated successfully. Late-stage cancers are harder to treat and may require ongoing chemotherapy.

Other factors that may make the prognosis worse include:

• A tumor size greater than 4 cm
• Older age
• Tumor location outside of the upper third of the vagina

In general, squamous cell carcinoma has a better prognosis than adenocarcinoma.

Each case is different. Your healthcare team will walk you through what to expect.

Can this be prevented?

You can’t prevent vaginal cancer. But here’s how you can reduce your risk:

• Get regular pelvic exams and Pap tests: Talk with your gynecologist about how regularly you should get routine checks.
• Get the HPV vaccine: Talk to your provider about getting vaccinated against HPV.
• Don’t smoke: Smoking increases your risk of all cancers, including vaginal cancer.