Vaginal Cancer

What is vaginal cancer?

Vaginal cancer is a rare form of cancer that most often occurs in the cells lining your vagina. The vagina is a tube-like organ that connects your cervix (the lower part of your uterus) to your vulva (genitals).

Cancers that start in other parts of your body – like cervical cancer or uterine cancer – sometimes spread to your vagina. It’s less common for cancer to begin in your vagina, as with vaginal cancer.

What are the different types of vaginal cancer?

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, called squamous cells. Squamous cell carcinoma is the most common type of vaginal cancer. It accounts for nearly 90% of all cases.
• Adenocarcinoma begins in gland cells in your vagina. It’s most common in people over 50. Clear cell adenocarcinoma is the exception, often affecting people under 50 who were exposed to a drug called diethylstilbestrol (DES) when they were developing in the uterus.
• Melanoma begins in the cells that give your vagina its color (melanocytes). Vaginal melanomas are extremely rare.
• Sarcoma begins in the connective tissue and muscle tissue that make up your vaginal wall. Like vaginal melanomas, vaginal sarcomas are extremely rare. There are different types of sarcoma. Rhabdomyosarcoma is the most common and mostly occurs in children. Leiomyosarcoma occurs most often in people over 50.

How common is vaginal cancer?

About 1 in 100,000 women and people assigned female at birth is diagnosed with vaginal cancer, usually squamous cell carcinoma. Vaginal cancer accounts for only 1 to 2% of gynecological cancers.

Who gets vaginal cancer?

Your chances of getting vaginal cancer increase if:

• You’re over 60. Your risk of getting vaginal cancer increases with age. The average age that people get diagnosed with squamous cell carcinoma (the most common type) is 60. Occasionally, people younger than 60 develop vaginal cancer.
• You have human papillomavirus (HPV). HPV is a sexually transmitted virus that may increase your cervical cancer and vaginal cancer risk. Having multiple sex partners and being unvaccinated against HPV puts you at greater risk of infection.
• You’ve been diagnosed with 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 vaginal cancer in some people but not others. Researchers aren’t sure why. You’re more likely to develop VAIN if you have HPV.
• You’ve had cervical cancer or cervical dysplasia. It’s possible to develop vaginal cancer after being treated for cervical cancer. Abnormal cells in your cervix, or cervical dysplasia, may increase your risk of vaginal cancer.
• You’ve been exposed to diethylstilbestrol (DES). DES is a synthetic form of estrogen prescribed between 1940 and 1971 to prevent pregnancy complications. You’re at increased risk of developing adenocarcinoma if your birthing parent took DES during pregnancy and you were exposed.
• You smoke. Smoking doubles your risk of developing vaginal cancer.

What are the signs and symptoms of vaginal cancer?

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.

When symptoms occur, they include:

• Vaginal bleeding (unrelated to menstruation) after intercourse.
• Vaginal bleeding after menopause (when you no longer get periods).
• Vaginal discharge that’s watery, bloody or foul-smelling.
• Pain during intercourse.
• A noticeable mass in your vagina.
• Painful urination or frequently feeling the urge to pee.
• Constipation or black-colored stools.
• Feeling the urge to poop when your bowels are empty.
• Pelvic pain.

Although 8 in 10 people with invasive vaginal cancer have one or more of these symptoms, these symptoms rarely indicate a condition as serious as vaginal cancer. Still, you should see your provider as soon as possible if you notice these signs.

What causes vaginal cancer?

Researchers don’t know for sure what causes vaginal cancer. Still, as with cervical cancer, there’s likely a relationship between vaginal cancer and high-risk strains of HPV. Studies have shown that many people diagnosed with vaginal cancer have also tested positive for antibodies associated with the types of HPV linked to cervical cancer.

How does vaginal cancer spread?

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) and invade healthy tissue.

How is vaginal cancer diagnosed?

Your healthcare provider will begin your examination by asking about your symptoms. You’ll most likely receive several tests to check for cancer or precancerous cells. Imaging procedures can help your provider see if your cancer has spread, a process called staging.

Testing

You’ll likely have a pelvic exam and a Pap smear (Pap test). If your provider finds abnormal cells, you may need further tests, like a colposcopy and a vaginal biopsy. A biopsy is the only test that can confirm a cancer diagnosis.

• Pelvic exam: Your provider will visually inspect your vulva and insert two fingers inside your vagina to feel for any abnormalities. They’ll use a tool called a speculum to widen your vagina so that it’s easier to see your vaginal canal and cervix.
• Pap smear: While holding your vagina open with a speculum, your provider will use a spatula-like tool and a brush to scrape cells from your cervix. These cells will get tested in a lab for signs of cancer or HPV.
• Colposcopy: In this procedure, your doctor uses a lighted instrument called a colposcope to look for abnormal cells in your vagina and cervix.
• Biopsy: A biopsy often accompanies colposcopy. Your provider will take a tissue sample that will be sent to a lab and tested for cancer cells.

Staging

Staging allows your provider to determine how advanced your cancer is. Vaginal cancer is staged in three ways, based on how far the tumor has progressed in your vagina, whether it has spread to your lymph nodes, and whether it has spread to other parts of your body. These three categories are called T (tumor), N (nodes), and M (whether it has spread, or metastasized).

Your provider can stage your cancer by using information from the test results and by performing procedures that allow them to see inside your body.

• Imaging procedures used to stage cancer include X-rays, computerized tomography (CT) scans, magnetic resonance imaging (MRI) and positron emission tomography (PET) scans. MRIs provide details about a tumor’s size. PET scans can show abnormal lymph nodes.
• Cystoscopy can show if cancer has spread to your bladder. A small lighted tube with a camera is inserted into your bladder for this procedure.
• Proctoscopy can show if cancer has spread to your small intestine or rectum. A small lighted tube with a camera is inserted into your rectum for this procedure.

How is vaginal cancer treated?

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

In general, laser surgery and topical treatments are used to treat precancerous cells. Invasive vaginal cancer will often require surgery, radiation and chemotherapy. You may receive a variety of treatments.

Surgery

• Wide local excision: Your healthcare provider removes the tumor along with some of the healthy tissue surrounding it.
• Vaginectomy (partial or radical): Your provider removes all or part of your vagina depending on tumor size and location. Depending on how far the cancer has spread, your provider may recommend removing your lymph nodes (lymph node dissection) and your uterus and cervix (hysterectomy).
• Pelvic exenteration: This surgery removes multiple organs from your pelvis, including the bottom part of your colon (rectum), bladder, uterus, cervix, vagina, ovaries and nearby lymph nodes. Your provider will make an opening in your abdomen that will allow you to pee and poop (called a stoma or ostomy bag). This type of surgery may be an option if you have recurring cancer.

Radiation

Radiation uses targeted energy beams, like X-rays, to destroy cancer cells or keep them from dividing.

• External radiation therapy: A machine outside your body directs beams of high-energy radiation at your tumor.
• Internal radiation therapy: Sealed wires or catheters containing radioactive material are placed inside your vagina, either into or near the tumor.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. Chemotherapy alone isn’t an effective treatment for vaginal cancer, but it may be used alongside radiation to enhance its effectiveness. Sometimes, chemotherapy is used to treat tumors that disappear with treatment and later return.

Clinical trials

Your provider may recommend you take part in a clinical trial to try new cancer treatments in development. The American Cancer Society and the National Cancer Institute are good resources for locating current clinical trials involving vaginal cancer treatments.

How can I reduce my risk of getting vaginal cancer?

You can’t prevent vaginal cancer, but you can reduce your risk.

• Get regular pelvic exams and Pap tests. Talk with your provider about how regularly you should be receiving routine checks from your gynecologist.
• Get the HPV vaccine. Talk to your provider about getting vaccinated against HPV. Currently, there are three FDA-approved vaccines available, Gardasil, Gardasil 9 and Cervarix.
• Don’t smoke. Smoking increases your risk of all cancers, including vaginal cancer.

What is the outlook for vaginal cancer?

Your prognosis for vaginal cancer depends on the stage at which it’s diagnosed. Early-stage vaginal cancers can often be successfully treated, and you can go on to live a full life. Later-stage cancers are harder to treat and may require ongoing chemotherapy and other treatment options. For this reason, it’s important to get regular gynecological exams, even when you feel healthy. Seek medical advice at the first sign of symptoms.

Can you get cancer in your vagina?

Yes. But it’s rare for cancer to begin in your vagina, as with vaginal cancer. More often, cancers that begin in other parts of your body spread to your vagina. Cancers that spread to your vagina most commonly begin in your cervix (cervical cancer) or the lining of your uterus (uterine cancer/endometrial cancer).

What cancer causes vaginal bleeding?

Vaginal bleeding is a common symptom of multiple cancers, including vaginal cancer, cervical cancer, uterine cancer and ovarian cancer. But abnormal bleeding is a common sign of multiple conditions, not just cancer. Don’t assume you have cancer if you have unusual bleeding. Still, see your healthcare provider to get checked.

What does vaginal cancer feel like?

The most common symptom of vaginal cancer is painless vaginal bleeding, which means you may not feel vaginal cancer at all. Less commonly, you may experience pain in your pelvis, painful urination or discomfort related to constipation.

A note from Cleveland Clinic

If you receive a vaginal cancer diagnosis, it’s important to have an honest discussion with your provider about the type of cancer, if it’s spread, and what your treatment options are. Your prognosis will depend on multiple factors. Your provider is your best resource for explaining what this diagnosis means for you.

In the meantime, establishing a support network that includes family members, friends, current cancer patients and cancer survivors is an essential part of your care plan, too. The American Cancer Society can connect you with cancer support groups. Speak to a counselor to process your diagnosis. Getting your emotional needs met is as important as the clinical care you receive.