Vaginal Cancer
Vaginal cancer is a rare disease where cells grow out of control in the vagina, most commonly affecting women over 60, and while it may not cause symptoms at first, early detection through regular check-ups offers the best chance for successful treatment.
Table of contents
- What is vaginal cancer?
- Types of vaginal cancer
- Associated anatomy
- Who is at risk?
- Signs and symptoms
- How is it diagnosed?
- Treatment options
- Prevention and screening
What is vaginal cancer?
Vaginal cancer is a disease where malignant cells (cancer cells) grow out of control in the vagina. The vagina is a muscular tube that connects the cervix, which is the lower part of the uterus, to the outside of the body. It is sometimes called the birth canal because babies pass through it during delivery.[1]
Vaginal cancer is very rare. About 1 in 100,000 women are diagnosed with this disease each year. It accounts for only 1 to 2% of all cancers affecting the female reproductive system.[2][7] Most cancer found in the vagina actually started somewhere else in the body, such as the cervix or uterus, and then spread to the vagina. Cancer that begins directly in the vagina is much less common.[1][2]
When vaginal cancer is found early and is still limited to the vagina, it has the best chance of being cured. Once the cancer spreads beyond the vagina to other parts of the body, it becomes much harder to treat.[1]
Types of vaginal cancer
There are different types of vaginal cancer, named according to the type of cells where the cancer begins.[2][9]
Squamous cell carcinoma is the most common type. It begins in the flat cells called squamous cells that line the inside of the vagina. This type accounts for nearly 90% of all vaginal cancer cases. Squamous cell vaginal cancer spreads slowly and usually stays near the vagina at first, but it may spread to other organs such as the lungs, liver, or bone.[2][12]
Adenocarcinoma begins in the gland cells that line the vagina. These gland cells make and release fluids such as mucus. Adenocarcinoma is most common in people over 50 years old. This type is more likely than squamous cell cancer to spread to the lungs and lymph nodes (small bean-shaped organs that are part of the body’s defense system).[2][12]
A rare form of adenocarcinoma called clear cell adenocarcinoma is linked to exposure to a drug called diethylstilbestrol (DES) before birth. This drug was given to some pregnant women between 1940 and 1971 to prevent pregnancy complications. Clear cell adenocarcinoma most often affects people under 50 who were exposed to DES while developing in the uterus.[2][12]
Melanoma begins in the cells that give the vagina its color, called melanocytes. Vaginal melanomas are extremely rare and may not have visible color.[2]
Sarcoma begins in the connective tissue and muscle tissue that make up the vaginal wall. Like 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.[2]
Associated anatomy
- Vagina
- Cervix
- Uterus
- Vulva
Who is at risk?
Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean you will definitely get cancer, and not having risk factors does not mean you will not get the disease.[12]
The risk of developing vaginal cancer increases with age. Most people are diagnosed at age 60 or older. The average age at diagnosis for squamous cell carcinoma, the most common type, is 60 years.[2][8]
Infection with human papillomavirus (HPV) is a major risk factor. HPV is a virus that spreads through sexual contact. Certain high-risk types of HPV can increase the risk of both cervical cancer and vaginal cancer. Having multiple sex partners and not being vaccinated against HPV increases the risk of infection.[2][8]
Having a condition called vaginal intraepithelial neoplasia (VAIN) increases risk. With VAIN, cells in the vaginal lining are not normal, but they are not cancer cells either. VAIN progresses to vaginal cancer in some people but not others. You are more likely to develop VAIN if you have HPV.[2]
People who have had cervical cancer or cervical dysplasia (abnormal cells in the cervix) are at higher risk of developing vaginal cancer. It is possible to develop vaginal cancer even after being treated for cervical cancer.[2][8]
Exposure to DES during pregnancy puts the child at increased risk. Women whose mothers took DES during pregnancy have a higher risk of developing clear cell adenocarcinoma.[2][8]
Smoking tobacco doubles your risk of developing vaginal cancer.[2]
Having had a hysterectomy (surgery to remove the uterus) for tumors that were not cancerous or for cancer may also increase risk.[8]
Signs and symptoms
Vaginal cancer often does not cause symptoms in its early stages. Many cases are found during routine pelvic exams and Pap tests (tests that check for abnormal cells in the cervix and vagina). This is why regular check-ups are important. Your healthcare provider can detect vaginal cancer even when your body is not showing any signs.[1][2]
When symptoms do occur, they may include unusual vaginal bleeding, such as bleeding after sex or after menopause. Many people also experience vaginal discharge that is not normal for them.[1][5]
Some people notice a lump or mass in the vagina that they can feel. Pain during sexual intercourse is another common symptom.[1][8]
Other symptoms can include painful urination, frequent urination, constipation, or pelvic pain. In more advanced cases, people may experience back pain or swelling in the legs.[1][5]
These symptoms can be caused by many conditions other than vaginal cancer. However, if you have any of these symptoms that worry you or do not go away, it is important to see a doctor. Only a healthcare professional can determine if you have cancer.[1]
How is it diagnosed?
If your doctor suspects vaginal cancer, several tests and procedures may be used to confirm the diagnosis.[11]
A pelvic exam is often the first step. During this exam, your doctor carefully inspects your outer genitals and then inserts two fingers into the vagina while pressing on your belly with the other hand. This allows the doctor to check your uterus, ovaries, and other organs. A device called a speculum is inserted into the vagina to open it so the doctor can look for changes in the vagina and cervix.[11][12]
A Pap test is usually done during the pelvic exam. This test can sometimes find abnormal cells that started in the vagina.[12]
Colposcopy is an exam that uses a special lighted magnifying instrument to look closely at the vagina. The instrument is not inserted into the vagina, but it helps the doctor see the surface of the vagina more clearly to look for any changes that might be cancerous.[11]
A biopsy is the only way to know for certain if you have cancer. During this procedure, the doctor removes a small sample of tissue from the vagina. This is often done during a pelvic exam or colposcopy. The tissue sample is sent to a laboratory where it is examined under a microscope to check for cancer cells.[11][12]
If cancer is found, your healthcare team may recommend additional tests to find out how far the cancer has spread. These tests help determine the cancer’s stage, which indicates the size of the cancer and whether it has spread beyond the vagina. Knowing the stage helps doctors plan the best treatment and understand how likely the cancer is to be cured.[11]
Treatment options
Treatment for vaginal cancer depends on the type and stage of cancer, as well as your overall health and personal preferences. The main goal may be to cure the cancer, control its growth, or relieve symptoms.[13][17]
Radiation therapy is the main treatment for vaginal cancer. This treatment uses high-energy rays, such as X-rays, to kill cancer cells. Radiation can be delivered from outside the body, where beams are directed at the cancer from a machine. It can also be delivered from inside the body through brachytherapy, where radioactive devices are placed inside or near the vagina. Radiation is often combined with low-dose chemotherapy to make it more effective.[11][13][14]
Surgery may be used for vaginal cancer that is found early or if radiation has not worked. Different types of surgery may be needed depending on where the cancer is and how large it is. For small, early-stage cancers, only part of the vagina may be removed. For larger cancers, all of the vagina may need to be removed, and sometimes nearby organs such as the uterus, cervix, bladder, or rectum must be removed as well.[13][14]
If your vagina is removed, your surgeon may offer vaginal reconstruction. This surgery uses skin and muscle from other parts of your body to create a new vagina, which may allow you to have vaginal sex again after you recover. You can discuss the risks and benefits of this procedure with your surgeon.[14]
Chemotherapy uses strong medicines to destroy cancer cells, shrink tumors, and prevent cancer from spreading. These drugs can be given by mouth, through a vein, or by injection. Sometimes chemotherapy is given directly to a specific area, such as the spinal column or an organ. Chemotherapy is often used together with radiation therapy to improve results.[13][14]
Immunotherapy helps your body’s own defense system fight cancer. Certain drugs called immune checkpoint inhibitors can block cancer cells from hiding from your immune system.[13]
If precancerous cells are found before they turn into cancer, they can be removed using laser ablation or treated with medicated creams applied directly to the affected area.[13]
After treatment, you will need regular follow-up visits with your healthcare team. These check-ups help detect any problems or signs that the cancer has come back. You will usually be seen every few months for the first few years.[14]
Prevention and screening
There is no sure way to prevent vaginal cancer, but some steps can reduce your risk.[2]
Getting vaccinated against HPV can help prevent infection with the types of HPV that cause vaginal cancer. The HPV vaccine is most effective when given before a person becomes sexually active.[4]
Regular cervical screening, including Pap tests and pelvic exams, can help find abnormal cells before they turn into cancer. Many cases of vaginal cancer are found and prevented through cervical screening.[10]
Not smoking or quitting smoking if you do smoke can reduce your risk, since smoking doubles the risk of vaginal cancer.[2]
There are currently no regular screening tests specifically for vaginal cancer. However, routine pelvic exams may help find vaginal cancer early, when it is small and before it has spread. Early detection gives you the best chance of successful treatment.[2]