Vaginal cancer is a very rare type of cancer that forms in the vaginal tissue. Estimates suggest that it affects around 1 of every 1,100 females.

The American Cancer Society (ACS) predict that 5,350 females in the United States will receive a diagnosis of vaginal cancer during 2019.

In this article, we take a look at the types and their symptoms, as well as how a doctor would diagnose and treat vaginal cancer.

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Vaginal cancer affects around 1 in 1,100 females.

Early stage vaginal cancer and precancerous lesions do not tend to cause noticeable symptoms. Very often, they will only become apparent during a routine exam.

Later stage vaginal cancers are more likely to cause noticeable symptoms.

One of the most common symptoms of vaginal cancer is abnormal vaginal bleeding after sexual intercourse. It is regularly one of the first symptoms that people notice.

People should always seek medical care if they experience vaginal bleeding after menopause.

Other symptoms of vaginal cancer might include:

  • abnormal vaginal discharge
  • a mass in the vagina
  • difficulty or pain when urinating
  • constipation
  • pain during sex
  • pelvic pain
  • pain in the back of the legs
  • leg swelling

If a person notices any of these symptoms, they should seek an appointment with their doctor.

There are several types of vaginal cancer. There are two more common ones, as outlined below, and a number of rarer types:

Squamous cell carcinoma

Vaginal squamous cell carcinoma develops in the squamous cells that line the vagina.

It is the most common type of vaginal cancer, making up around 9 in every 10 diagnoses. This type of squamous cell carcinoma most often develops in females aged 60 years or older.

Adenocarcinoma

Adenocarcinoma starts in the glandular cells in the vaginal lining that produce certain fluids. Adenocarcinoma is more likely to spread than squamous cell cancer.

Rarer types

Extremely rare cancers of the vagina include:

  • Melanoma: This type of cancer originates in the cells that produce skin pigment, generally on the outer portion of the vagina. Melanoma makes up fewer than 3% of all vaginal cancer diagnoses.
  • Sarcoma: This cancer develops in bone, muscle, or connective tissue cells. Fewer than 3% of vaginal cancers are sarcomas. The most common vaginal sarcoma is rhabdomyosarcoma, which most commonly affects children.
  • Cancers that spread from other organs: Cancers of the cervix, uterus, rectum, or bladder may spread to the vagina.

Researchers do not yet know the exact causes of vaginal cancer.

Generally, cancer develops when cells do not die at the natural point in their life cycle. Instead, they continue to grow and spread, draining energy from the area around it.

Researchers have, however, identified several risk factors for developing vaginal cancer. These risk factors include:

  • Age: Females over 60 years of age have the highest risk of vaginal cancer.
  • Human papillomavirus (HPV) infection: Contracting HPV increases the risk.
  • Hysterectomy: Females who have had a hysterectomy are more likely to get vaginal cancer.
  • A history of cervical cancer: A previous or current cervical cancer diagnosis is a risk factor for vaginal cancer.
  • Previous radiation treatment: This can sometimes cause an increased likelihood of vaginal cancer.
  • Use of a vaginal pessary: The use of vaginal pessaries, such as during pelvic organ prolapse, is associated with an increased risk of vaginal cancer.
  • Vaginal intraepithelial neoplasia (VAIN): Also known as precancerous cells, these cells are different from normal cells but not different enough for experts to class them as cancer cells. Sometimes, however, these cells can develop into cancer.

HPV has links with many types of cancerous lesion, including vaginal and cervical cancer. These develop before the cancer and are usually visible in a Pap smear test.

Exposure to the synthetic hormone diethylstilbestrol (DES) while in the womb can also increase the risk.

Many women took this drug during pregnancy from the 1940s until 1971. As a result, the number of cancer diagnoses that developed due to DES exposure in the womb is now declining.

Several different treatment options are available for vaginal cancer, including:

We cover each of these in more detail below:

Surgery

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Surgery is one of the treatment options for vaginal cancer.

Surgery is the most common treatment option for vaginal cancer.

Some surgical procedures aim to remove the cancerous tissue, while others also remove nearby tissues and organs to which the cancer may spread.

Possible procedures include:

  • Laser surgery: A surgeon uses an intense laser to remove cancerous tissue and lesions on the surface of the vagina.
  • Wide local excision: A surgeon removes the cancerous tissue and some healthy tissue around it.
  • Vaginectomy: A surgeon removes a section of the vagina or all of it.
  • Hysterectomy: A surgeon removes the cervix and the uterus.
  • Lymph node dissection, or lymphadenectomy: A surgeon removes nearby lymph nodes and examines them under a microscope to check for cancer. Cancer in the upper vagina will lead to the removal of lymph nodes from the pelvis. Lower vaginal cancer requires the removal of the lymph nodes from the groin.
  • Pelvic exenteration: A surgeon remove the vagina, ovaries, bladder, lower colon, and rectum. They will create artificial openings through which urine and stool will flow into a collection bag.

An individual might receive a skin graft to reconstruct the vagina. The surgeon will use a piece of skin from a noncancerous area, such as the buttocks, to repair the surgically affected area.

Radiation therapy

Depending on the stage the vaginal cancer has reached, a doctor may recommend using radiation therapy to target and kill cancer cells.

One of two types of radiation therapy might take place:

  • External radiation therapy: A healthcare professional uses a machine to direct radiation at the cancer from outside of the body.
  • Internal radiation therapy: This procedure involves administering a radioactive substance inside the tissue. A healthcare professional places a seed, wire, needle, or catheters near the site of the cancer.

A person may also need radiation therapy to destroy any remaining cancer cells in the area. Doctors refer to this as adjuvant radiotherapy.

Clinical trials continue to study the use of radiosensitizer drugs. These make cancer cells more sensitive to radiation, improving the effectiveness of radiation therapy.

Chemotherapy

During chemotherapy, a healthcare professional administers drugs that prevent the growth and spread of the cancer. They achieve this by destroying the cells or disrupting cell division.

If a person takes these drugs either by mouth or via an injection into the veins or muscles, they affect cancer cells throughout the whole body. Regional chemotherapy, meanwhile, involves applying chemotherapy drugs to a particular part of the body and only treats that area.

People with squamous cell vaginal cancer can apply topical chemotherapy creams or lotions as a local chemotherapy measure.

A person should speak with their doctor about what to expect, possible side effects, and the risks and benefits of treatment.

At an initial consultation with a doctor, the doctor will ask about the person's medical history and conduct a physical exam. They will ask about any symptoms or concerns the individual might be having, including:

  • any medications they are currently taking
  • any family medical history, especially of cancer
  • any recent sexual practices that could have links to HPV, such as having sex without a condom

The physical examination will generally include:

  • Pelvic exam: The doctor visually examines the vagina and feels for anomalies.
  • Pap smear: This is a test for cervical cancer, which could be causing similar symptoms.
  • Colposcopy: A healthcare provider may carry out a colposcopy if the first investigations reveal unusual or suspicious results. They will use a colposcope, which is a magnifying instrument with a light attached.

To make a definitive diagnosis, a doctor will need to request a biopsy.

During a biopsy, a healthcare professional collects small tissue samples before sending them to a laboratory. Here, a pathologist will examine them.

Biopsies commonly take place during a colposcopy, usually under local anesthetic.

If the doctor confirms a diagnosis of vaginal cancer, they will request several more tests to determine the stage of the cancer and devise a treatment plan. These tests include:

  • imaging scans, such as an X-ray, an MRI, and CT scans
  • examinations in a different area, such as a proctoscopy for the rectum and anus, a cystoscopy for the bladder, or a ureteroscopy for the tubes leading from the kidneys

Here, learn more about Pap smears and how they can help prevent cancer.

Staging

The stage of vaginal cancer defines how treatable the cancer is and what the outlook for a person will be.

When cells in the tissue of the vaginal lining are abnormal but have not yet reached the stage of cancer, it is known as VAIN. These cells may still become cancerous; some doctors call VAIN "stage 0 vaginal cancer."

Other stages depend on how far vaginal cancer has spread from the vaginal wall. These include:

  • Stage 1: The cancer has not spread from the vaginal wall.
  • Stage 2: Cancerous cells are also identifiable in the tissue surrounding the vagina but not the pelvis.
  • Stage 3: The cancer has reached the wall of the pelvis.
  • Stage 4: Two substages define the most severe form of cancer. In stage 4A, the cancer has spread from the vagina to the linings of the bladder or rectum, or beyond the region of the bladder, cervix, and pelvis. In stage 4B, the cancer has reached a distant organ, such as the lung or bone.

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An early diagnosis can improve the outlook for vaginal cancer.

The ACS calculate a 5 year survival rate to indicate how likely it is that a person will live for 5 years beyond their diagnosis.

The rate compares their likelihood of survival with that of a person who does not have cancer.

If a doctor identifies and treats vaginal cancer before it spreads, the 5 years survival rate is 66%.

If vaginal cancer spreads around the region, the rate is 51%. If it reaches distant organs, the rate reduces to 19%.

Early detection and treatment are essential for improving the outlook for females with vaginal cancer.

The best way a person can reduce their risk of vaginal cancer is to prevent infection with HPV. This is an extremely common sexually transmitted infection.

HPV can cause many types of cancer, including cervical cancer. Researchers believe that there may be a link between vaginal cancer and HPV.

People should take the following steps to help prevent vaginal cancer:

  • use condoms or other barrier methods during sexual activity, as these provide some protection against HPV
  • get HPV vaccines to protect against new infections with the virus (vaccines cannot treat people who already have HPV)
  • quit smoking, or don't start
  • undergo regular Pap tests to find and treat VAIN

There is no way to prevent vaginal cancer completely, but a person can minimize their risk and improve their outlook through early detection.

Q:

How likely is it that vaginal cancer will spread?

A:

Predicting this likelihood depends on the stage of the cancer at detection. Staging is a standard way of categorizing cancers to determine the outlook and treatment plan.

Once a doctor has staged vaginal cancer, the question of how likely it will spread to nearby tissues, lymph nodes, nearby organs, and distant organs such as the lungs depends on the person’s response to treatment, current health, and other individual factors.

There are not reliable predictors for cancer progression, as this depends on a combination of factors that when taken together provide different likelihoods.

Christina Chun, MPH Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.