Vaginal Cancer

Vaginal cancer is a rare cancer that forms in the tissues of the vagina, the birth canal that leads from the cervix to the outside of the body. Because early vaginal cancer often causes no symptoms, it is sometimes found during a routine pelvic exam or cervical screening.

Vaginal cancer may grow slowly over time. In some cases, precancerous changes appear in the lining of the vagina before cancer develops. The type and stage of vaginal cancer help guide treatment options.

Types & Stages

Types of vaginal cancer include:

• Squamous cell carcinoma is the most common type of vaginal cancer. It begins in the thin, flat cells that line the inside of the vagina. This layer of cells is also called the epithelium or epithelial lining. Squamous cell vaginal cancer tends to grow slowly and usually stays near the vagina.
   
• Adenocarcinoma begins in the glandular cells of the vaginal lining. These cells make and release fluids such as mucus. Adenocarcinoma is more likely than squamous cell cancer to spread to the lungs and lymph nodes.
   
• Clear cell adenocarcinoma is a rare subtype of adenocarcinoma. It is linked to being exposed to a medicine called diethylstilbestrol (DES) before birth. This form is now extremely rare.

Vaginal cancer stages describe how far the cancer has spread:

• Stage I means the cancer is found only in the wall of the vagina.
   
• Stage II means the cancer has spread through the vaginal wall to the tissue around the vagina, but not to the pelvic wall.
   
• Stage III means the cancer has spread to the wall of the pelvis or to nearby lymph nodes.
   
• Stage IV means the cancer has spread to the lining of the bladder or rectum, beyond the pelvis, or to distant parts of the body such as the lungs or bones.

Your care team will use the cancer type, stage, tumor grade and your overall health to recommend a treatment plan.

Signs & Symptoms

Early vaginal cancer often causes no symptoms. This is one reason it may be found during a routine exam. As the cancer grows, symptoms may appear.

Visit a doctor if you are experiencing any of these symptoms:

• Vaginal bleeding that is not related to your periods
• Vaginal discharge that is not normal for you
• Pain during sex
• Pelvic pain or pressure
• A lump or mass in the vagina
• Pain when urinating
• Constipation

Many of these symptoms can be caused by conditions that are not cancer. Still, it is important to pay attention to your body. If you notice changes that are not normal for you, talk with a healthcare provider.

Diagnosis

Tests and procedures used to diagnose vaginal cancer may include:

• Pelvic exam. A pelvic exam allows your doctor to inspect the reproductive organs. The doctor carefully inspects the outer genitals, then inserts two gloved fingers of one hand into the vagina while pressing on the belly with the other hand to feel the uterus and ovaries.
   
• Speculum exam. During the pelvic exam, your doctor inserts a device called a speculum into the vagina. The speculum opens the vaginal canal so your doctor can look for changes in the vagina and cervix.
   
• Colposcopy. This exam uses a special lighted magnifying instrument called a colposcope to closely examine the surface of the vagina. It helps your doctor look for any changes that might be cancer.
   
• Biopsy. A biopsy removes a small sample of tissue to test for cancer cells. A biopsy is often done during a pelvic exam or a colposcopy. The tissue sample is sent to a lab, where a pathologist examines it under a microscope to check for cancer or precancer cells.
   
• Imaging tests. If cancer is found or suspected to have spread, imaging tests such as chest X-ray, CT, MRI or PET scans may be used. These tests help your doctor learn the size of the cancer, whether lymph nodes are involved and whether the cancer has reached other parts of the body. In some cases, your doctor may also use a cystoscopy to look inside the bladder or a proctoscopy to look inside the rectum.

Treatment

Treatment for vaginal cancer depends on the type and stage of cancer, where it is located in the vagina, whether it has spread, your overall health and your personal goals. Your care team can help explain the benefits and risks of each option.

Treatment may include:

• Vaginectomy is surgery to remove all or part of the vagina. In a partial vaginectomy, only part of the vagina is removed. In a total vaginectomy, the entire vagina is removed. In a radical vaginectomy, the vagina and the supporting tissues around it are removed.
   
• Hysterectomy may be needed to remove the cancer. In this operation, the uterus and cervix are removed along with all or part of the vagina. The fallopian tubes and ovaries are often removed as well. A total hysterectomy can be done through a traditional open incision or through a minimally invasive approach.
   
• Lymph node dissection removes lymph nodes so they can be checked for cancer. If the cancer is in the upper vagina, pelvic lymph nodes may be removed. If the cancer is in the lower vagina, lymph nodes in the groin may be removed.
   
• Vaginal reconstruction can rebuild a vagina using tissue from another part of your body, so that you may be able to have sex after surgery. A new vagina can be created from skin, intestinal tissue or grafts made of muscle and skin.
   
• Pelvic exenteration is a major operation that may be used for advanced or recurrent cancer. It includes vaginectomy and removal of the pelvic lymph nodes, along with one or more of the following: the lower colon, rectum, bladder, uterus and cervix. How much is removed depends on how far the cancer has spread. Artificial openings, called stomas, may be created so urine and stool can leave the body.
   
• Radiation therapy uses high-energy beams or internal radiation to kill cancer cells. External radiation comes from a machine outside the body. Internal radiation places a radioactive source directly into or near the cancer. Radiation may be used alone, after surgery or together with chemotherapy.
   
• Chemotherapy uses medicines to kill cancer cells or slow their growth. It may be combined with radiation or used for cancer that has spread or returned. For some squamous cell vaginal cancers or precancerous changes, topical chemotherapy may be applied to the vagina as a cream.
   
• Immunotherapy and other topical treatments may be options in select cases, especially for precancerous changes. These approaches are sometimes studied in clinical trials.

Clinical trials may also be available. These research studies test new treatments or new ways to use current treatments. Ask your care team whether a clinical trial may be right for you.

Causes & Risk Factors

The exact cause of vaginal cancer is not always known. It often develops slowly, and precancerous changes may appear before cancer forms.

Factors that may increase vaginal cancer risk include:

• Older age. The risk of vaginal cancer increases as you get older. Many cases are found in women age 60 or older.
   
• HPV infection. Certain high-risk types of human papillomavirus (HPV) are linked to squamous cell carcinoma of the vagina.
   
• DES exposure before birth. In the 1950s, the medicine diethylstilbestrol (DES) was given to some pregnant women to help prevent miscarriage. People exposed to DES before birth have a higher risk of a rare form of vaginal cancer called clear cell adenocarcinoma.
   
• History of hysterectomy. Having had a hysterectomy, for either benign tumors or cancer, may increase the risk of vaginal cancer.
   
• Vaginal intraepithelial neoplasia (VaIN). VaIN is a precancerous condition in which abnormal cells are found in the lining of the vagina. These cells are not cancer, but they can sometimes develop into cancer over time, so treatment or close follow-up may be recommended.

A history of cervical cancer or precancer may also raise the risk, partly because these cancers share certain risk factors, such as HPV infection. You can take steps that may help lower your risk, such as getting the HPV vaccine, not smoking and treating precancerous changes when they are found. Talk with your healthcare provider about your personal risk.

Screening

There is no routine screening test for vaginal cancer for people who do not have symptoms.

A Pap test screens for cervical cancer, not vaginal cancer. There is currently no simple, reliable test to find vaginal cancer before symptoms appear.

Even so, routine pelvic exams and cervical cancer screening can sometimes find abnormal changes in the vagina that lead to further testing. During a pelvic exam, your provider may notice a change in the vagina, and a Pap test may occasionally pick up abnormal cells that need follow-up.

People with a higher risk, such as those with VaIN, prior DES exposure or a history of cervical cancer, should talk with a healthcare provider about how often they should be checked and what follow-up is right for them.
If you notice abnormal vaginal bleeding, unusual discharge, pelvic pain, a lump or any other change that is not normal for you, do not wait for a screening test. Talk with a healthcare provider so the cause can be found and treated early.

This information is for general education only and is not a substitute for medical advice. Please consult a qualified healthcare provider for diagnosis, treatment recommendations and guidance based on your personal health history.