Vaginal Cancer

Types of vaginal cancer

Most cancers found in the vagina have actually spread from elsewhere, such as the cervix, uterus, vulva or bowel. Primary vaginal cancer is diagnosed only when it starts in the vagina.

Causes and risk factors

• HPV infection: persistent infection with high-risk HPV types, mainly HPV 16, causes most squamous cell vaginal cancers.
• Vaginal intraepithelial neoplasia (VaIN): precancerous changes that can progress to cancer.
• History of cervical cancer or cervical precancer.
• Age over 60.
• Smoking.
• HIV infection and other causes of a weakened immune system.
• DES exposure before birth for clear cell adenocarcinoma (women born between about 1940 and 1971 whose mothers took DES).
• Previous pelvic radiation.

Symptoms

Early vaginal cancer may cause no symptoms. When present:

• Abnormal vaginal bleeding, especially after menopause or after sex
• Watery, bloody or foul-smelling discharge
• A lump or mass in the vagina
• Pain during sex
• Pelvic pain
• Painful or frequent urination, or blood in the urine
• Constipation or rectal pain in more advanced disease
• Leg swelling from lymph node involvement

These symptoms are more often caused by less serious conditions such as vaginal atrophy or infections, but they should always be checked.

Diagnosis

• Pelvic exam, including a careful look at all vaginal walls with a speculum
• Pap and HPV tests
• Colposcopy: magnified examination of the vagina, often after applying a solution that highlights abnormal areas
• Biopsy: confirms cancer and type
• Imaging for staging: MRI of the pelvis, CT or PET-CT
• Cystoscopy or proctoscopy if the bladder or rectum may be involved

Stages

Treatment

Treatment depends on stage, location, size and type, and is planned by a gynecologic oncology team.

• Radiation therapy: the main treatment for most vaginal cancers, combining external beam radiation with internal radiation (brachytherapy) placed in or near the tumor.
• Chemoradiation: chemotherapy, usually cisplatin, given with radiation for more advanced stages.
• Surgery: for small, early cancers in the upper vagina, sometimes removing part of the vagina and nearby tissue. Extensive surgery is reserved for selected cases or recurrence.
• Treatments for advanced disease: chemotherapy, immunotherapy and clinical trials.
• Vaginal reconstruction after major surgery.
• Supportive care: vaginal dilators after radiation to prevent narrowing, sexual health support, and management of bowel and bladder effects.

Outlook

Outcomes depend mainly on stage. Early-stage vaginal cancer has a good chance of cure, while survival falls with more advanced spread. Your team can give the most relevant estimate. Follow-up visits continue for several years to check for recurrence and manage treatment side effects.

Prevention

• HPV vaccination prevents infection with the HPV types that cause most vaginal cancers. It is recommended routinely at ages 11 to 12, and can be given through age 26, and for some adults up to 45 after discussion with a clinician.
• Regular cervical screening, and continued vaginal screening for people with a history of cervical precancer or cancer, even after hysterectomy.
• Do not smoke.
• Practice safer sex to reduce HPV exposure.

Frequently asked questions

What are the first signs of vaginal cancer?

The most common early sign is abnormal vaginal bleeding, especially after menopause or after sex. Others include watery or bloody discharge, a lump in the vagina, pain during sex and pelvic pain. Many early cancers cause no symptoms and are found during routine exams.

What causes vaginal cancer?

Most vaginal cancers are caused by long-term infection with high-risk human papillomavirus (HPV). Other risk factors include older age, smoking, a history of cervical precancer or cancer, a weakened immune system, and, for one rare type, exposure to DES before birth.

How is vaginal cancer treated?

Most vaginal cancers are treated with radiation therapy, combining external radiation and internal radiation (brachytherapy), often with chemotherapy. Small, early tumors may be treated with surgery. Advanced cancers may receive chemotherapy, immunotherapy or clinical trial treatments.

Can the HPV vaccine prevent vaginal cancer?

Yes. The HPV vaccine protects against the high-risk HPV types that cause most vaginal, cervical, vulvar and anal cancers. It works best when given before exposure to HPV, ideally at ages 11 to 12, but is recommended up to age 26.