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Top questions about vaginal cancer

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on November 9, 2022.

Vaginal cancer is a rare type of cancer that forms anywhere in the vagina or birth canal (the tube that extends from the cervix to the vulva and connects the uterus with the outside of the body). According to the American Cancer Society (ACS), only 1 to 2 percent of all cancers that develop in the female genital tract are vaginal cancers.

What’s the difference between vaginal cancer and vulvar cancer?

While both are cancers of the female reproductive system, vaginal and vulvar cancer are different in origin. Vaginal cancer starts in the passageway that connects the bottom of the uterus and the vaginal opening, while. vulvar cancer begins in the outer area surrounding the vaginal opening.

What are the vaginal cancer symptoms?

Vaginal cancer typically doesn’t cause symptoms in the early stages, but symptoms will develop as the disease progresses. Signs of vaginal cancer may include:

  • Vaginal bleeding outside of menstruation
  • Unusual vaginal discharge
  • Painful sex
  • General pelvic pain
  • A new lump in the vagina
  • Painful urination
  • Constipation

Some of the common signs of vaginal cancer are nonspecific and may be indicative of a different condition.

What are the vaginal cancer risk factors?

Several factors may increase the risk of developing vaginal cancer, including:

  • Older age: While patients may develop the disease at any age, those over the age of 60 are at higher risk.
  • Smoking cigarettes: People who use tobacco are two times more likely to develop vaginal cancer than those who don’t.
  • Drinking alcohol: Alcohol consumption may impact vaginal cancer risk, although the evidence isn’t conclusive.
  • HPV infection: The human papillomavirus (HPV) may increase the risk of developing vaginal cancer.
  • Exposure to DES in the womb: DES is a drug that was used to help prevent miscarriage starting in the 1940s and then banned from use in pregnant women in the 1970s. Those exposed to DES in the womb may have an increased risk of developing a specific type of vaginal cancer called clear cell adenocarcinoma.
  • Adenosis: Vaginal adenosis occurs when areas of the vaginal lining develop glandular cells, a type of cell that isn’t normally found inside the vagina. Vaginal adenosis is common, occurring in around 40 percent of menstruating women. Adenosis may increase the risk of developing a type of vaginal cancer called clear cell carcinoma. However, this form is extremely rare.
  • Cervical cancer: Having cervical cancer or cervical precancer (cervical dysplasia or cervical intraepithelial neoplasia) increases the risk of getting vaginal squamous cell cancer.

Can the HPV vaccine help prevent vaginal cancer?

Some cases of vaginal cancer are linked to certain HPV infections. Getting vaccinated against the virus may help prevent infection from the types of HPV most strongly associated with cancer. By preventing high-risk HPV infections, the HPV vaccine may also help offer protection from developing vaginal cancer and other HPV-linked cancers, such as cancers of the:

How is vaginal cancer diagnosed?

Vaginal cancer is diagnosed using a series of exams and tests, including:

Pelvic exam: A pelvic exam is performed to check for abnormalities or signs of disease in the genital tract, such as the vagina, cervix and uterus. During a pelvic exam, the doctor will insert a device called a speculum into the vagina. The speculum keeps the vaginal passageway open, allowing the clinician to examine the inside of the vagina and cervix. The doctor or nurse will also insert a gloved finger inside the vagina to assess the size and shape of the uterus and ovaries. Further testing may be recommended if the pelvic exam indicates an abnormality.

Pap test: A Pap test is often performed during a pelvic exam. For the Pap test, the clinician will insert a small instrument inside the speculum and gently collect a sample of cells from the vaginal walls and cervix. The cells are then analyzed under a microscope to determine they’re cancerous. If a Pap test reveals abnormal findings, the doctor will likely recommend additional tests.

Colposcopy: A colposcopy is very similar to a pelvic exam but allows the doctor or nurse to get a more comprehensive view of the vaginal area. Both procedures involve using a speculum to keep the vaginal walls open, but during a colposcopy, the doctor will view the inside of the vagina through a lighted and magnified lens called a colposcope, allowing the doctor to get a detailed look inside the vagina and cervix.

Biopsy: While abnormal findings from a pelvic exam or colposcopy may indicate vaginal cancer, the only way to definitively diagnose the disease is through a biopsy. A biopsy is a procedure that involves removing a small tissue sample from the vagina and analyzing it in a laboratory for signs of cancerous cells.

Cystoscopy: This procedure enables doctors to look inside the bladder to determine whether vaginal cancer has spread to the bladder. Cystoscopy isn’t used as an initial diagnostic test for vaginal cancer, but it may be recommended if a vaginal tumor is large or located near the bladder. During the procedure, a cystoscope (thin, lighted tube with a camera) is inserted into the urethra and up to the bladder. Sedatives are given before the procedure to make the patient comfortable.

Lymphadenectomy: Also referred to as a lymph node dissection, this procedure is used to remove lymph nodes from the pelvic or groin region and check lymph node tissue under a microscope to determine whether the cancer has spread.

What are the vaginal cancer stages?

After a vaginal cancer diagnosis, the next step is determine the cancer’s stage. Cancers are assigned a stage based on how far the disease has spread. Assessing the extent of spread and determining the stage helps doctors determine a treatment plan and estimate the prognosis or severity of the condition.

The systems used to classify cancer stages may depend on the type of cancer. Vaginal cancer is staged based on the TNM system, which measures three important factors:

  • T (tumor): The size of the original tumor
  • N (node): Whether it’s spread to nearby lymph nodes
  • M (metastasis): Whether it’s spread to distant parts of the body

Each factor is assigned a number based on how advanced the cancer is. Then, the cancer is given an overall stage based on its specific TNM combination. The stages of vaginal cancer range from 0 to 4. The more severe or progressed the cancer is, the higher the stage:

  • Stage 0: In stage 0, precancerous cells are found in the vagina’s lining. The cells aren’t cancerous but abnormal and may turn into cancer. This precancerous condition is called vaginal intraepithelial neoplasia (VAIN).
  • Stage 1: Cancer is limited to the vaginal wall.
  • Stage 2: Cancer has grown through the vaginal wall and into the tissue on the outside of the vagina.
  • Stage 3: Cancer has spread to the pelvic wall.
  • Stage 4 (divided into two sub-stages):
    • Stage 4A: Cancer may have grown outside the pelvic wall into nearby areas or spread to the bladder or rectal lining.
    • Stage 4B: Cancer has spread to distant parts of the body.

Which vaginal cancer treatments are available?

Surgery: The standard approach to treating vaginal cancer is surgery. Several different types of surgeries may be used, and the doctor may recommend a particular type based on various factors, including the stage of cancer and the patient’s personal preferences. Doctors may use different approaches for the same surgery, depending on the circumstances. For example, some surgeons may use robotic systems to assist with surgery, enabling them to perform the procedure less invasively with smaller surgical incisions. Some common surgical approaches for treating vaginal cancer include:

  • Wide local excision: Surgical removal of the tumor and some surrounding tissue using a scalpel
  • Vaginectomy: Surgical removal of all or part of the vagina, which is sometimes reconstructed with skin taken from another area of your body
  • Total hysterectomy: Surgical removal of the uterus and cervix
  • Lymph node dissection/lymphadenectomy: Surgical removal of certain lymph nodes, which may be analyzed in a lab to determine and measure cancer spread
  • Pelvic exenteration: Surgical removal of the rectum, bladder, cervix, vagina, ovaries, the lower portion of the colon and nearby lymph nodes

Radiation therapy: This therapy may help treat vaginal cancer using high-energy radiation sources like X-rays to slow or stop cancer growth. Radiation therapy may be used after surgery to destroy remaining cancer cells, or as a palliative treatment to shrink a tumor and reduce symptoms. The two types of radiation therapy used to treat vaginal cancer are:

  • External radiation therapy, using an external machine to deliver radiation waves to the tumor
  • Internal radiation therapy, which inserts a radioactive device near the tumor

Chemotherapy: This treatment uses drugs to help treat the cancer by destroying cancer cells or preventing their growth. Chemotherapy for vaginal cancer may be delivered by:

  • Systemic chemotherapy: Drugs are administered orally or injected into the bloodstream to attack cancer cells throughout the body.
  • Regional chemotherapy: Drugs are placed directly inside the area where the cancer is located.
  • Topical chemotherapy: Drugs are packaged in a cream or lotion applied directly to the cancerous area.

Targeted therapy: This treatment is designed to specifically attack cancer cells. A form of chemotherapy (drug therapy), targeted therapy uses medicines made to hunt for features unique to cancer-specific cells (like enzymes, proteins or gene mutations that may affect cancer’s growth) to help destroy the cells and/or work in conjunction with other cancer treatments, such as chemotherapy, radiation therapy or surgery.

Immunotherapy: These substances—either produced naturally in the body or synthesized in a lab—may be used to empower the immune system to fight off cancer. Immunotherapy isn’t a common treatment option for vaginal cancer but is being studied in clinical trials. For example, the immunotherapy imiquimod is currently under investigation to evaluate its potential as a topical treatment for vaginal lesions.

Will vaginal cancer treatment affect my sex life?

Vaginal cancer treatment may affect the patient’s sex life. The specific sexual impacts of treatment depend on the therapies received. Some of the potential concerns include:

Vaginal changes

Vaginal removal/reconstruction: If all or part of the vagina is removed, vaginal reconstruction may be considered to recover the patient’s ability to have sexual intercourse. Reconstructed vaginas are created using tissue from another part of the body. Penetration will likely feel different after vaginal reconstruction. The patient may need to use a dilator to stretch the vaginal passageway and allow for more comfortable penetration. Artificial lubrication may also be important, since the tissue used to rebuild the vagina may not produce natural lubrication.

Vaginal dryness: Vaginal dryness may result from several different vaginal cancer therapies, including radiation therapy, vaginal removal/reconstruction, surgical removal of the ovaries and chemotherapy (if it leads to early menopause). Moisturizers and lubricants may be recommended to help reduce dryness and painful sex.

Vaginal narrowing: Many cancer treatments may also cause vaginal narrowing, including surgery in or around the vagina and radiation therapy. Vaginal dilators may be recommended to help prevent the vagina from narrowing.

Early menopause: Some vaginal cancer treatments may affect the body’s production of hormones, potentially resulting in early menopause. Surgeries that remove both ovaries result in permanent and immediate menopause because, without the ovaries, the production of the hormone estrogen drops. Radiation therapy, chemotherapy and surgical removal of one ovary may also lead to early menopause in some cases, although it may not be permanent. Menopause may cause a wide range of symptoms and sexual changes, including vaginal pain and reduced sexual desire. In some cases, women may be able to take hormones to help reduce menopause symptoms. However, hormone replacement therapy isn’t safe for everyone and may come with risks that should be discussed with a doctor.

How can I preserve quality of life during vaginal cancer treatment?

Going through the process of vaginal cancer treatment may be physically and emotionally taxing. The various therapies may cause lifestyle changes and come with adverse effects beyond the symptoms of the cancer itself. It’s important to consider emotional well-being throughout the journey because mental health is important.

Some therapies may force significant life changes. For example, certain surgeries may make it difficult to have sexual intercourse or bear children in the future. Before deciding on a treatment plan, it’s essential to have extensive conversations about treatment options and how they will affect lifestyle habits and other considerations. Doctors should walk patients through the potential outcomes associated with their options so they can make informed decisions about the road ahead.

It’s also important to have a plan in place for care during treatment. It may help to speak to family and friends about fears and needs, and the patient may wish to form connections with others who are also fighting cancer, like Cancer Fighters. Other providers may help the patient maintain healthy habits during treatment. The health care team may be able suggest supportive care providers such as a:

  • Nutritionist
  • Sex therapist
  • Physical therapist
  • Mental health provider

Will vaginal cancer or its treatment impact fertility?

Vaginal cancer and its treatments may affect fertility or the ability to get pregnant.

The cancer itself may cause infertility if it disrupts the normal workings of the reproductive system. For example, vaginal tumors may cause damage to important organs like the ovaries and uterus, or block the process through which an egg becomes fertilized and implanted in the uterus.

The treatments for vaginal cancer may also affect fertility. Some therapies may cause complete infertility, while others may reduce the chances of getting pregnant, including:

  • Surgery to remove both ovaries: The patient will be unable to get pregnant.
  • Hysterectomy (surgery to remove the uterus): Pregnancy after a hysterectomy is not possible without a womb to carry the baby.
  • Surgery that involves removing one ovary: When only one ovary is removed and the other is left behind, pregnancy is still possible, though fertility may be limited.
  • Vaginectomy (surgery to remove all or part of the vagina): Pregnancy is still possible after a vaginectomy.
  • Radiation therapy: This therapy in the pelvic area may damage the reproductive organs such as the ovaries, often resulting in infertility.
  • Chemotherapy: Some chemotherapy drugs, especially at high doses, may cause infertility or make it difficult to get pregnant.

It’s important to talk about fertility preferences with the health care team so appropriate treatment options can be considered.

What type of doctor should I see if I have vaginal cancer?

Vaginal cancer is a rare disease and should be treated by an experienced medical professional with expertise in treating cancers of the female reproductive system. These experts are called gynecologic oncologists, and they are specifically trained to treat cancer in the female genital tract, including:

What is the vaginal cancer survival rate?

The National Cancer Institute (NCI) collects data on cancer patients to calculate estimated survival rates as a part of its Surveillance, Epidemiology and End Results (SEER) program. These datasets are categorized by type and stage of cancer. Survival statistics are often explained as five-year relative survival rates, which tell the likelihood that a person with a specific cancer will survive for at least five years after diagnosis compared to those without cancer.

While survival rates may provide helpful context, it’s important to remember each patient is different. These numbers reflect the average outcomes of patients in the past, and treatment options continue to improve over time.

According to SEER data, the overall five-year relative survival rate across every stage of vaginal cancer is 49 percent, based on data from vaginal cancer patients diagnosed between 2011 and 2017. This rate suggests that, on average, a patient with vaginal cancer is nearly half as likely as people without the disease to survive five years or longer after being diagnosed.

Survival rates are also calculated according to the stage of vaginal cancer. However, SEER uses three general stages for every type of cancer. Below are the three SEER stages for vaginal cancer and their five-year relative survival rates:

  • Localized, the cancer hasn’t spread beyond where it started: 66 percent
  • Regional, the cancer has spread to nearby lymph nodes: 54 percent
  • Distant, the cancer has spread to distant body parts: 24 percent

Questions to ask the doctor about vaginal cancer

Receiving a vaginal cancer diagnosis may be overwhelming. Throughout the process of diagnosis and treatment, patients will review lots of new information and make tough decisions.

The patient is in the driver’s seat when making these decisions. Being well-informed and having a strong understanding of available treatment options and the associated risks is necessary before starting treatment. The care team needs to know the patient’s preferences, concerns and doubts to craft an individualized treatment plan. Here are some questions to ask the oncologist or cancer care team:

  • How do you know I have vaginal cancer? What did the tests reveal that indicated cancer?
  • What other tests will I need?
  • Do I need to consult with another doctor or specialist? Could you refer me to one?
  • What kind of vaginal cancer do I have?
  • Has the cancer spread?
  • What is the stage of the cancer? And what does it mean to have that stage of cancer?
  • How serious is the diagnosis? What are the survival rates for this diagnosis?
  • What are my treatment options? Which treatments do you recommend for me and why?
  • How much experience do you have treating vaginal cancer? How many patients with vaginal cancer have you treated?
  • What are the risks, benefits and side effects of each of the treatment options recommended?
  • Will these treatment options affect my ability to have children in the future? Are there any treatments that don’t affect fertility?
  • Will these treatment options affect my sex life? How?
  • Will I need reconstructive surgery after treatment? What will that process be like?
  • Should I consider enrolling in a clinical trial?
  • How should I prepare for treatment?
  • Are there any providers I should consult to help me prepare for treatment (dietitian, physical therapist, etc.)? Could you refer me to these providers?
  • What will I feel like during treatment?
  • What is recovery like? How long will it take me to recover after treatment?
  • Is it possible for the cancer to return after treatment? What are the chances of a recurrence?

What type of vaginal cancer do I have?

Several different types of cancer may begin in the vagina, although all types are collectively referred to as vaginal cancer. Squamous cell carcinoma is the most common type, accounting for the vast majority of cases (9 out of 10), according to the ACS. These cancers develop in specific cells called squamous cells found in the lining of the vagina.

The second-most common form of vaginal cancer is adenocarcinoma, which grows in gland cells that help keep the vagina moist. Other vaginal cancer types are extremely rare.

The vaginal cancer type is determined through diagnostic tests such as a biopsy. A biopsy involves removing a sample of cancerous or suspicious tissue from the vagina. The sample is then taken to a lab, where doctors analyze it to look for cancer cells. If cancer cells are found, other tests may be used to determine the type of cancer.

Has my vaginal cancer spread?

Vaginal cancer will grow over time. If the cancer isn’t caught early or goes untreated, it may expand beyond the area where it started and spread progressively farther in the body. Vaginal cancer usually begins in the vaginal lining near the cervix. With time, it may extend into and through the vaginal wall and reach neighboring tissues or organs. If cancer cells reach the bloodstream or lymph system, they may travel to other parts of the body. Cancer that spreads from its original location is called metastatic cancer.

Tests to determine whether the cancer has spread may include:

Are my kids at risk of getting vaginal cancer if I had it?

Current research suggests family history isn’t a known risk factor for vaginal cancer. However, patients should discuss with their doctor any concerns about children developing vaginal cancer, what steps can be taken to better understand potential risk, and whether preventative measures should be followed.

What are the side effects of vaginal cancer treatment?

The potential side effects of vaginal cancer therapies may vary widely depending on the specific treatment plan. Common treatment options for vaginal cancer include:

  • Surgery
  • Radiation therapy
  • Chemotherapy
  • Immunotherapy

The side effects of these treatment categories aren’t generalizable because there are many different types of therapies, approaches and dosing options within them. The health care team may provide a more precise list of common and rare side effects to expect with each treatment.

What if I want a second opinion?

After being diagnosed with vaginal cancer and learning of available treatment options, some patients may consider getting a second opinion with another oncologist, who can review the test results and suggested treatment plan, listen to concerns and potentially offer different options. Meeting with another oncologist gives patients the chance to hear a new perspective and may make them feel more informed and confident in their decisions.

Next topic: What are the facts about vaginal cancer?

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