Vaginal Cancer

Introduction

Vaginal cancer is not common. When found in early stages, it can often be cured. 

There are two main types of vaginal cancer:

Squamous Cell Carcinoma (SCC)

Cancer that forms in squamous cells, the thin, flat cells lining the vagina. This cancer spreads slowly and usually stays near the vagina but may spread to the lungs and liver. This is the most common type of vaginal cancer and is found most often in women aged 60 or older.

Learn More about SCC

Adenocarcinoma

Cancer that begins in glandular (secretory) cells. Glandular cells in the lining of the vagina make and release fluids such as mucus. Adenocarcinoma is more likely than squamous cell cancer to spread to the lungs and lymph nodes and is found most often in women aged 30 or younger.

Risk Factors

Research is increasing regarding what we know about vaginal cancer. Scientists are learning more about its causes. Following are common risk factors for the disease:

  • Age - Being aged 60 or older
  • Exposure to the drug DES (Diethylstilbestrol) before birth
  • Human Papillomavirus - Being infected with HPV
  • Personal history of cervical pre-cancer or cancer changes - having a history of abnormal cells in the cervix or cervical cancer

Signs & Symptoms

Vaginal cancer often does not cause early symptoms and may be found during a routine Pap Test. When symptoms occur, they may be caused by vaginal cancer or by other conditions. A doctor should be consulted if any of the following problems occur:

  • Pain or abnormal vaginal bleeding
  • Bleeding or discharge not related to menstrual periods
  • Pain during sexual intercourse
  • Pain in the pelvic area
  • A lump in the vagina

 

Diagnosis

If you have symptoms that could be vaginal cancer, the doctor will test for fever and high blood pressure and check general signs of health. The patient will likely have one or more of the following tests:

Biopsy
Your doctor will examine your vagina. He or she may remove the growth or part of it. This is called a vaginal biopsy. A biopsy is needed to confirm a diagnosis. To get a sample of the suspicious spot, the area will be numbed with a medication applied to or injected into that site. Then the doctor will remove the growth or part of the tissue that appears concerning on examination. A different doctor (called a pathologist) will look at this tissue under the microscope to check for cancer cells. There are several types of biopsies.

A biopsy may also be done to find out if cancer has spread to the cervix. A sample of tissue is cut from the cervix and viewed under a microscope. A biopsy that removes only a small amount of tissue is usually done in the doctor’s office. A woman may need to go to a hospital for a cone biopsy (removal of a larger, cone-shaped piece of tissue from the cervix and cervical canal). A biopsy of the vulva may also be done to see if cancer has spread there.

Chest X-Ray
An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

Cystoscopy
A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope is inserted through the urethra into the bladder. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are then checked under a microscope for signs of cancer.

Ureteroscopy
A procedure to look inside the ureters to check for abnormal areas. A ureteroscope is inserted through the bladder and into the ureters. A ureteroscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease. A ureteroscopy and cystoscopy may be done during the same procedure.

Proctoscopy
A procedure to look inside the rectum to check for abnormal areas. A proctoscope is inserted through the rectum. A proctoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease. CT Scan (CAT Scan) - A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

MRI
An imaging study that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). A dye may be injected into the veins to help organs or tissues show up more clearly.

Lymphangiogram
A procedure used to x-ray the lymph system. A dye is injected into the lymph vessels in the feet. The dye travels upward through the lymph nodes and lymph vessels and x-rays are taken to see if there are any blockages. This test helps find out whether cancer has spread to the lymph nodes.

CT Scan (CAT Scan)
An imaging study that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

Questions to Ask Your Doctor:

  • What type of biopsy do you suggest?
  • How soon will I know the results?
  • What stage is my cancer?
  • What treatment is most likely to work?
  • Are there side effects I need to be aware of?
  • How likely is it that it will return?
  • What should I be doing to help protect myself in the future?
  • Do you have experience treating this type of cancer, or know someone who does?
  • Should I get a second opinion?

Treatments & Side Effects

Treatment will depend on the size, location and how deep the tumor is in the skin, as well as if it has spread elsewhere.

Squamous cell carcinoma (SCC) usually grows slowly and is contained to the outer layer of the skin. In the majority of cases, early-stage vaginal cancer (when the cancer is small and has not spread outside of the vagina) is treated using local surgery. Pre-cancerous changes in the vagina can be treated by laser removal and/or medications applied to the skin (called topical therapies).

In some cases, especially if it is untreated, vaginal cancer can invade nearby tissue. If this happens, surgery to remove the cancer is not enough to keep the cancer from returning. Although rare, it is also possible for SCC to spread (metastasize) to other parts of the body. More advanced-stage vaginal cancers require treatment with radiation therapy and/or chemotherapy.

For organ transplant patients who have many SCCs, transplant physicians can consider adjusting the immunosuppressive treatment if appropriate.

Treatments usually include:

Early-stage vaginal cancer (when the tumor is small and it has not spread outside of the vagina) can be treated with surgery. This surgery includes a radical hysterectomy (removal of the uterus, cervix, at least part of the vagina, and pelvic lymph nodes.

If multiple surgeries are needed, it can be disfiguring and may affect function. For example, if SCC of the lip grows deeply, surgeries to remove it may cause cosmetic issues and also interfere with someone’s ability to smile or close their mouth.

Radiation therapy is the use of high-energy rays to kill or damage cancer cells. 

Radiation therapy is used when the vaginal cancer has spread outside the vagina to nearby organs or the cancer cannot be removed in its entirety with surgery alone.

Learn about radiation therapy

Chemotherapy involves the use of drugs to destroy cancer cells. It is a systemic (whole body) treatment.

Chemotherapy for vaginal cancer is given through the vein. This treatment is used when the cancer has spread outside the vagina.

Learn about chemotherapy

For SCC that has spread (metastasized), other systemic therapy can be considered such as targeted therapy and clinical trials. For organ transplant patients who have many SCCs, transplant physicians can consider adjusting the immunosuppressive treatment if appropriate.

Be sure to ask about clinical trials. These are research studies to test new treatments or learn how to use current treatments better. In some cases, the treatments with the best chance of success may be available only through clinical trials. Trials are offered for many cancers, at many different stages. Everyone is not eligible for every trial. If you have cancer that has come back or spread, it is especially important to ask about clinical trials.

Learn about clinical trials