Cancer of the vagina, an uncommon cancer, usually develops in the cells lining the vagina, typically in women over 60 years old.
Vaginal cancer may cause abnormal vaginal bleeding, particularly after sexual intercourse or in postmenopausal women.
If doctors suspect cancer, they remove and examine samples of tissue from the vagina (biopsy).
The cancer is surgically removed, or radiation therapy is used.
(See also Overview of Female Reproductive System Cancers.)
In the United States, vaginal cancer accounts for approximately 1 to 2% of gynecologic cancers. The average age at diagnosis is 60 to 65 years.
Locating the Internal Female Reproductive Organs
Most vaginal cancers are caused by persistent human papillomavirus (HPV) infection, the same virus that causes genital warts and cervical cancer. Having precancerous changes in the cervix or vulva, cervical cancer, or vulvar cancer increases the risk of developing vaginal cancer.
More than 95% of vaginal cancers are squamous cell carcinomas (carcinomas), which develop in the flat, skinlike cells that form the surface of vaginal lining. Most other vaginal cancers are adenocarcinomas, which develop from gland cells. One rare type, clear cell adenocarcinoma, occurs almost exclusively in women whose mothers took the medication diethylstilbestrol (DES), prescribed to prevent miscarriage during pregnancy. (In 1971, the medication was banned in the United States.)
If untreated, vaginal cancer continues to grow and invades surrounding tissue. Eventually, it may enter blood and lymphatic vessels, then spread to the bladder, rectum, nearby lymph nodes, and other parts of the body.
Symptoms of Vaginal Cancer
The most common symptom of vaginal cancer is abnormal bleeding from the vagina, which may occur during or after sexual intercourse, between menstrual periods, or after menopause. Sores may form on the lining of the vagina. They may bleed and become infected. Some women also have a watery discharge. Some women have pain during sexual intercourse. Few women have no symptoms.
Large cancers can also affect the bladder, causing a frequent urge to urinate and pain during urination. In advanced cancer, abnormal connections (fistulas) may form between the vagina and the bladder or rectum.
Diagnosis of Vaginal Cancer
Biopsy
Doctors may suspect vaginal cancer based on symptoms, abnormal areas seen during a routine pelvic examination, or an abnormal Papanicolaou (Pap) test result. Doctors may use an instrument with a binocular magnifying lens (colposcope) to examine the vagina—a procedure called colposcopy.
To confirm the diagnosis, doctors remove tissues from the vaginal wall to examine under a microscope (biopsy). They make sure to get tissue samples from any growth, sore, or other abnormal area seen during the examination.
Other tests, such as use of a viewing tube (endoscopy) to examine the bladder or rectum, a chest x-ray, and computed tomography (CT), may be done to determine whether the cancer has spread.
Staging of vaginal cancer
Doctors stage the cancer based on how far it has spread. Stages range from I (the earliest) to IV (advanced):
Stage I: The cancer is confined to the vagina.
Stage II: The cancer has spread through the wall of the vagina to nearby tissues but is still within the pelvis (which contains the internal reproductive organs, bladder, and rectum).
Stage III: The cancer has spread throughout the pelvis and/or to lymph nodes and/or blocks the ureters and/or causes a kidney to malfunction
Stage IV: The cancer has spread to the bladder or rectum or outside the pelvis (for example, to the lungs or bone).
Treatment of Vaginal Cancer
For early-stage vaginal cancers, surgery to remove the vagina, uterus, and nearby lymph nodes and sometimes radiation therapy
For most other vaginal cancers, radiation therapy
Treatment of vaginal cancer also depends on the stage.
For early-stage vaginal cancers, surgery to remove the vagina, uterus, and lymph nodes in the pelvis and the upper part of the vagina is the treatment of choice. Sometimes radiation therapy is used after the surgery.
Radiation therapy is used for most other vaginal cancers. It is usually a combination of internal radiation therapy (using radioactive implants placed inside the vagina, called brachytherapy) and external radiation therapy (directed at the pelvis from outside the body).
Radiation therapy cannot be used if fistulas have developed. In such cases, some or all of the organs in the pelvis are removed (called pelvic exenteration). These organs include the reproductive organs (vagina, uterus, fallopian tubes, and ovaries), bladder, urethra, rectum, and anus. Which organs are removed and whether all are removed depend on many factors, such as the cancer's location, the woman's anatomy, and her goals after surgery. Permanent openings—for urine (urostomy) and for stool (colostomy)—are made in the abdomen so that these waste products can leave the body and be collected in bags. After the procedure, women usually have some bleeding, a discharge, and considerable tenderness and pain for a few days. Typically, the hospital stay is 3 to 5 days. Complications, such as infection or opening of the surgical incision, blockages in the intestine, and fistulas, can occur.
Sexual intercourse may be difficult or impossible after treatment for vaginal cancer.
Prognosis for Vaginal Cancer
The prognosis for women with vaginal cancer depends on the stage of the cancer.
More Information
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
National Cancer Institute: Vaginal Cancer: This web site provides links to general information about vaginal cancer, as well as links to information about causes, prevention, screening, treatment, and research and about coping with cancer.
