On this page: What is vaginal cancer? | What are the symptoms? | How common is it? | What are the risks? | Diagnosis | Staging | Prognosis | Which health professionals will I see? | Treatment | Key points
This section has information about the symptoms, causes, diagnosis and treatment of primary cancer of the vagina.
There are two types of vaginal cancer: cancer that starts in the vagina (primary cancer) and cancer that has spread to the vagina (secondary cancer). There are several types of primary vaginal cancer. However, two main types make up about 85% of all cases:
This is the most common type of cancer, affecting cells covering the surface of the vagina. It usually grows slowly over many years.
A type of cancer that begins in the glandular cells lining the vagina. This type is more likely to spread to the lungs and lymph nodes.
Other cancers, such as melanoma or sarcoma, can also affect the vagina, but this is rare.
Secondary cancer in the vagina is more common than primary vaginal cancer. This means the cancer has spread from another part of the body. The cancer may spread from the cervix (the neck of the uterus), uterus (the womb), vulva, or nearby organs such as the bladder or bowel.
There are often no obvious symptoms of vaginal cancer. The cancer is sometimes found through a routine Pap smear (see diagnosis below).
You may have one or more of the following symptoms:
Some women also have bladder and bowel problems. You may have blood in your urine or feel the urge to pass urine frequently or during the night. Pain in the rectum can sometimes occur.
If you have any symptoms, make an appointment with your GP.
Cancer of the vagina is one of the rarest types of gynaecological cancer. Each year in Australia, approximately 70 women are diagnosed with vaginal cancer.
Squamous cell carcinoma usually affects women aged 50–70.
Adenocarcinoma is more likely to affect young women under 25, but it can also occur in other age groups.
The exact cause of vaginal cancer is unknown, but factors that increase the risk include:
This is a precancerous condition of the vagina that is sometimes caused by human papillomavirus (HPV). VAIN often doesn’t cause symptoms, and many women are diagnosed while having tests for other reasons. It means that the cells in the inner lining of the vagina are abnormal and they may develop into cancer after many years. However, not all women with VAIN develop cancer.
This condition causes abnormal cells to form in the tissue of the vagina. This is usually the result of DES exposure (see opposite).
Sometimes known as the wart virus, HPV is a common sexually transmitted infection. There are many different types of HPV and only some increase the risk of developing vaginal cancer. Most women with HPV do not develop cancer of the vagina.
Cigarette smoking doubles the risk of developing vaginal cancer. This may be because smoking can make the immune system work less effectively.
If you have had radiotherapy to the pelvis for another reason, you are at a slightly higher risk of vaginal cancer. This complication is very rare.
Cancer of the vagina is more likely to be diagnosed in women who have had cervical cancer or early cervical cell changes that were considered to be precancerous.
This synthetic hormone drug has
been identified as a cause of a particular type of vaginal cancer.
Between 1938 and 1971 – and occasionally beyond – DES was
prescribed to pregnant women to prevent miscarriages. It is no
longer prescribed to pregnant women in Australia.
The female children of women who took DES (called DES daughters) have an increased risk of developing a range of health problems, including vaginal adenocarcinoma.
About one in 1000 DES daughters develop adenocarcinoma, particularly a type called clear cell carcinoma. This incidence of DES-related adenocarcinoma is highest for women who were exposed during the first three months of their mother’s pregnancy. The risk appears to be highest for those in their teenage years and early twenties. However, older women have also been diagnosed. If you are concerned about this risk, see your GP. They may recommend you have an annual gynaecological check-up.
Vaginal cancer is not infectious and it can’t be passed to other people through sexual contact. It is not caused by an inherited faulty gene and can’t be passed on to children. For more information on the risk factors, call Cancer Council 13 11 20.
If you have any of the symptoms listed above, your doctor will ask to do a physical examination of your groin and pelvic area. If the area is painful or sensitive, you may be given a local anaesthetic to numb it during the examination.
If you feel embarrassed or scared about having a physical examination, let your doctor know. If you wish, you can also ask for someone else, such as a nurse or your partner, to be present.
The doctor may also arrange some of the following tests.
You may have a Pap smear (Pap test) to check the cells inside the vagina and cervix.
During this test, you will lie on a table with your knees up and apart. The doctor will gently insert an instrument with smooth, curved sides (speculum) into your vagina. A lubricant is used to guide the speculum. The sides of the speculum spread the vaginal walls apart so the doctor can see your vagina and cervix. The doctor uses a small instrument, such as a brush or swab, to remove some cells from the surface of the cervix. The tissue sample is sent to a lab, where it is checked for abnormalities.
The results of the Pap smear may show that you have early cell changes in the lining of the vagina. This condition is called vaginal intraepithelial neoplasia or VAIN, see above.
The doctor will do an internal examination to look at your vagina, cervix and vulva. This is called a colposcopy. You will be advised not to have sex or put anything into your vagina (e.g. tampons, medicine) for 24 hours before a colposcopy.
During this procedure, you will lie on your back on an examination table with your buttocks near the end of the table, your legs separated and your feet on footrests. The doctor will insert an instrument called a speculum into the vagina, and will look though a microscope called a colposcope to examine the vaginal canal. The colposcope is not put into your body, but the doctor looks through it from the outside. The doctor will place a vinegar-like liquid into your vagina, which makes it easier to see abnormal cells through the colposcope.
Your doctor may take a tissue sample (biopsy) during the colposcopy. The tissue is sent to a laboratory where a specialist called a pathologist examines the cells under a microscope. The pathologist will be able to check for cell abnormalities.
You may feel uncomfortable during the colposcopy. Some women are advised to take pain relief, such as ibuprofen, about an hour before the procedure to ease cramping and discomfort. Talk to your doctor about this before the test.
"I felt uncomfortable for a few days after the colposcopy but a hot water bottle and mild pain-killers helped." – Gina
If the tests described above show that you have vaginal cancer, further tests may be necessary to find out whether cancer cells have spread:
This checks the number of cells in your blood, and how well your kidneys and liver are working.
The doctor uses a slender tube with a lens and a light (cystoscope) to look into the urethra and bladder. This is done under general anaesthetic.
A painless scan of your lungs.
A computerised tomography scan. This scan takes three-dimensional x-rays of the inside of your body.
A magnetic resonance imaging scan. You will lie on the treatment table inside a cylinder that uses a magnetic field to create pictures of your body. Some women feel claustrophobic during this scan. Tell your medical team if you feel anxious, as they may be able to help you relax.
Before a CT or MRI scan, you may be given an injection or asked to drink a liquid called a contrast to make the images on the computer appear clearer. Some people are allergic to the iodine in the contrast liquid, so tell the doctor if you have any allergies.
Based on the results of the diagnostic tests, your doctor will tell you the stage of the cancer.
Staging is a way to describe the size of the cancer and whether it has spread beyond its original site. Your doctor may also tell you the grade of the cancer cells. This gives you an idea of how quickly the cancer may develop.
A low-grade (grade 1) cancer means that the cells are slow growing and less likely to spread. High-grade (grade 3) cells look more abnormal and are more likely to grow and spread quickly.
Knowing the stage and grade of the cancer helps your medical team decide on the most appropriate treatment.
||Cancer is found only in the vagina.|
||Cancer has begun to spread through the vaginal wall, but it has not spread into the walls of the pelvis.|
||Cancer has spread to the pelvis. It may also be in the lymph nodes close to the vagina.|
||Cancer has spread beyond the vagina and surrounding area into the lining of the bladder or bowel. The cancer may also have spread to other parts of the body.|
Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for any doctor to predict the exact course of your disease. Instead, your doctor can give you an idea about common issues that affect women with cancer of the vagina.
Some women with cancer of the vagina may want to know the prognosis for women in similar situations, while others may not find the numbers helpful, or may even not want to know them. Do what feels right for you.
In most cases, the earlier vaginal cancer is diagnosed, the better the chances of successful treatment and cure.
Test results, the type of vaginal cancer you have, the rate and depth of tumour growth, how well you respond to treatment, and other factors such as age, fitness and medical history are all important in assessing your prognosis.
Your GP (general practitioner) will probably arrange the first tests to assess your symptoms. You will then be referred to a gynaecological oncologist.
You will be cared for by a range of health professionals who specialise in different aspects of your treatment. This is called a multidisciplinary team or MDT.
|gynaecological oncologist||a surgeon who specialises in
treating gynaecological cancers,
such as cancer of the vagina
||prescribes and coordinates the course of radiotherapy
||prescribes and coordinates the course of chemotherapy
||provides support throughout
treatment and liaises with other
||administer treatment and
provide support and assistance
through all stages of your
treatment, including recovery
|dietitian||recommends the best eating
plan to follow when you are in
treatment and recovery
||helps you deal with physical or
emotional issues affecting your
||advises you on support services
||assist you with getting back to
|counsellor, psychologist||provide emotional support and help manage anxiety and depression|
Treatment depends on a number of factors including your general health and the stage, grade and type of cancer you have. Treatment may involve radiotherapy, surgery and chemotherapy. You may have one of these treatments or a combination.
Radiotherapy is the treatment of cancer using high-energy x-rays to kill or destroy cancer cells. It is a common treatment for women with cancer of the vagina. Some women are treated with a combination of radiotherapy and chemotherapy (see below). It can also be used to control symptoms of advanced cancer.
Radiotherapy can be delivered in two ways: externally or internally. Most women with vaginal cancer have both types of radiotherapy. Your radiation oncologist will recommend the type of treatment most suitable for you.
External radiotherapy, also called external beam radiotherapy or EBRT, means that radiotherapy beams are directed at the cancer from outside the body. You will lie on a treatment table and under the machine that delivers radiation.
External radiotherapy will not make you radioactive. It is safe for you to be with other people, including children, after your treatment sessions are over and when you are at home.
External radiotherapy is usually given as a series of 10–15 minute daily treatments, Monday to Friday, over 4–6 weeks. The exact number of sessions you have will depend on the type and size of the cancer.
Radiotherapy to the vagina is a painless treatment, but it can cause side effects. The side effects you experience depend on your radiotherapy dose and the length of your treatment.
Internal radiotherapy, also called brachytherapy, is a way of delivering radiotherapy directly to the tumour from the inside of your body. You may have this after finishing a course of external radiotherapy.
A thin, temporary radioactive applicator, shaped like a tampon, will be put into your vagina. Some women are given a general anaesthetic and have other small probes inserted near the cancer. You will have to lie still while this is in place. You will receive treatment through the applicator or probes – either as low-dose or high-dose treatment (see below).
For both types of brachytherapy, the tissue around the applicator will become swollen. This usually settles by the time it is removed, but the treated area will feel sore afterwards. The pain should ease over a couple of weeks. Your doctor can prescribe pain-killers to help relieve the discomfort.
To find out about side effects see below. For further information about radiotherapy and its side effects, call Cancer Council 13 11 20.
The most common effects occur during or soon after radiotherapy, but will vary depending on the dose and length of your treatment:
Radiotherapy can shorten and narrow the vagina, which may make sex and follow-up pelvic examinations uncomfortable or difficult.
You may have slight bleeding or discharge from the vagina once the radiotherapy has ended. If this continues or becomes heavy, let your doctor or nurse know.
You may lose your pubic hair. For some women, this can be permanent.
Radiotherapy can temporarily cause inflammation to the lining of the bladder (cystitis) and loose stools (diarrhoea). A longer-term side effect may be blood in your urine or stools.
Radiation to the groin can increase the risk of swelling in the legs.
If you have cancer of the vagina and have radiotherapy to the pelvis, your ovaries may stop producing hormones and you may go through menopause. During menopause, your periods will stop and you may have symptoms such as hot flushes, dry or itchy skin, mood swings, or loss of libido (interest in sex).
The cancer may need to be removed with an operation.
The surgeon will try to remove all of the cancer along with some surrounding healthy tissue, called a margin. This helps reduce the risk of the cancer coming back. Some lymph nodes in your pelvis may also be removed.
There are a number of different operations for cancer of the vagina. The type of surgery you have depends on the size and position of the cancer.
The affected part of the vagina is removed.
The entire vagina is removed. In some cases, a plastic (reconstructive) surgeon can make a new vagina using skin and muscle from other parts of your body. This is called vaginoplasty or vaginal reconstruction, and it may be done to improve the appearance of your genitals.
Some women also need to have a radical hysterectomy. This means the uterus and cervix are removed. Your gynaecological oncologist will let you know whether it is also necessary to remove your ovaries and fallopian tubes (salpingo oophorectomy). If you have this type of surgery, it will cause menopause. See managing side effects for ways to manage menopause.
You will be given medication to reduce any pain. Tell your doctor or nurses if you are uncomfortable so they can adjust the dose.
A tube called a catheter will drain urine and will help keep your wound clean and dry. This will be removed within a few days.
You will be encouraged to start moving around as soon as possible after your operation. While you are in hospital, you may wear leg compression garments and be given injections of medication to prevent blood clots forming (thrombosis). The nurse or a physiotherapist can help you do regular gentle leg exercises to prevent thrombosis, as well as deep breathing exercises to prevent a chest infection.
Depending on the amount of tissue removed, the remaining or reconstructed vagina may be stretched so that you may still be able to have sexual intercourse. However, scar tissue in your vagina can cause pain and you may not be able to have an orgasm through penetration. Surgery to the vagina does not affect the clitoris, so it is still possible to have an orgasm through direct stimulation, oral sex and masturbation.
The length of your hospital stay and the side effects that you experience will depend on the type of surgery you have. Most women are in hospital for a few days to a week.
When you return home, you will need to take it easy. You may not be able to lift anything heavy or drive for 6–8 weeks.
Chemotherapy uses cytotoxic drugs to kill or slow the growth of cancer cells. This treatment is usually given if the cancer is advanced or if it returns after treatment. Chemotherapy is usually given with surgery or radiotherapy.
Drugs are sometimes given as tablets or, more commonly, by injection into a vein (intravenously). You will usually have a treatment session, followed by a break. Treatment can often be given to you during visits to a hospital or clinic as an outpatient, but sometimes you may spend a few days in hospital.
Most people have some side effects from chemotherapy. There are many different types of chemotherapy drugs and the side effects vary depending on the drugs used. However, these can usually be controlled with medication.
Common problems include feeling sick (nausea), tiredness, hair loss and a reduced resistance to infections. Chemotherapy may also increase any skin soreness caused by radiotherapy.
Some people find that they are able to lead a fairly normal life during their treatment, while others become very tired and need to take things more slowly. Do as much as you feel you can, and try not to overdo it. For more information, call 13 11 20 for a free booklet about chemotherapy and its side effects.
Palliative treatment helps to improve quality of life by reducing symptoms of cancer when it is no longer possible to cure the disease. It is particularly important for people with advanced cancer, but it’s not just for end of life care and it can be used at different stages of cancer.
Often treatment is concerned with pain relief. You may be given radiotherapy, chemotherapy or other medication. However, palliative treatment can also involve the management of other physical and emotional issues.
You can call Cancer Council 13 11 20 for free booklets about palliative care and advanced cancer.