Cancer of the vagina

Wednesday 1 October, 2014

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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.

What is vaginal cancer?

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:

  • Squamous cell carcinoma (SCC)

    This is the most common type of cancer, affecting cells covering the surface of the vagina. It usually grows slowly over many years.

  • Adenocarcinoma

    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. 

What are the symptoms?

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: 

  • bloody vaginal discharge not related to your menstrual period, which may have an offensive or unusual odour
  • pain during sexual intercourse
  • bleeding after sexual intercourse
  • pain in the pelvic area
  • a lump in the vagina.

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. 

How common is it?

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.

What are the risks?

The exact cause of vaginal cancer is unknown, but factors that increase the risk include:

  • Vaginal intraepithelial neoplasia (VAIN)

    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.

  • Vaginal adenosis

    This condition causes abnormal cells to form in the tissue of the vagina. This is usually the result of DES exposure (see opposite).

  • Human papillomavirus (HPV)

    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.

  • Smoking tobacco

    Cigarette smoking doubles the risk of developing vaginal cancer. This may be because smoking can make the immune system work less effectively.

  • Radiotherapy to the pelvis

    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.

  • History of gynaecological cancer

    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.

  • Diethylstilboestrol (DES)

    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.

Diagnosis

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.

Pap smear

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. 

Colposcopy and biopsy

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
Further tests

If the tests described above show that you have vaginal cancer, further tests may be necessary to find out whether cancer cells have spread:

  • Blood test

    This checks the number of cells in your blood, and how well your kidneys and liver are working.

  • Cystoscopy

    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.

  • Chest x-ray

    A painless scan of your lungs.

  • CT scan

    A computerised tomography scan. This scan takes three-dimensional x-rays of the inside of your body.

  • MRI scan

    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.

Staging vaginal cancer

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. 

Staging  Description
Stage 1
Cancer is found only in the vagina.
Stage 2
Cancer has begun to spread through the vaginal wall, but it has not spread into the walls of the pelvis.
Stage 3
Cancer has spread to the pelvis. It may also be in the lymph nodes close to the vagina.
Stage 4
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

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.

Which health professionals will I see?

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.

Health professional Role
gynaecological oncologist a surgeon who specialises in treating gynaecological cancers, such as cancer of the vagina
radiation oncologist
prescribes and coordinates the course of radiotherapy
medical oncologist
prescribes and coordinates the course of chemotherapy
cancer care coordinator
provides support throughout treatment and liaises with other health professionals
nurses
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
sex counsellor
helps you deal with physical or emotional issues affecting your sexuality
social worker
advises you on support services
physiotherapist, occupational therapist
assist you with getting back to normal activities
 counsellor, psychologist  provide emotional support and help manage anxiety and depression

Treatment

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

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

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

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. 

Types of internal radiotherapy
Low-dose rate (LDR)
  • Treatment is delivered in hospital over 1–5 days.
  • The applicator is inserted into the vagina, and held in place by gauze or stitches. You will be given pain medication so you are more comfortable.
  • A machine delivers the radiation through the applicator.
  • You will need to stay in bed during treatment to keep the applicator from moving. A tube (catheter) in your bladder will drain urine.
  • Family and friends can visit you for short periods, but children and pregnant women won’t be allowed to see you to avoid the chance of them being exposed to radiation.
  • Being alone can be difficult. Ask if you can bring things to do (e.g. books, mobile phone). Discuss your feelings with your medical team.
High-dose rate (HDR)
  • You can have treatment as an inpatient or outpatient.
  • An intense dose can be delivered in a few hours.
  • The applicator is inserted into your vagina. You will be given pain medication to help make you more comfortable.
  • A machine delivers the radiation through the applicator for 10–15 minutes. The applicator is taken out after the dose of radiation is delivered.
  • If several treatment sessions are needed, the applicator will be re-inserted each time, but the doctor may use some techniques to make it easier to get the applicator in the right place.
  • Once the treatment is completed, it will be safe for you to be around other people, including children.
Side effects of radiotherapy

The most common effects occur during or soon after radiotherapy, but will vary depending on the dose and length of your treatment:

  • Narrowing of the vagina

    Radiotherapy can shorten and narrow the vagina, which may make sex and follow-up pelvic examinations uncomfortable or difficult.

  • Bleeding and discharge

    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.

  • Hair loss

    You may lose your pubic hair. For some women, this can be permanent.

  • Bowel and bladder problems

    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.

Lymphoedema

Radiation to the groin can increase the risk of swelling in the legs.

Menopause

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).

Surgery

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.

Types of vaginal surgery

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.

  • Removing part of the vagina (partial vaginectomy)

    The affected part of the vagina is removed.

  • Removing the whole vagina (radical vaginectomy)

    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. 

What to expect after surgery
  • Pain killers

    You will be given medication to reduce any pain. Tell your doctor or nurses if you are uncomfortable so they can adjust the dose.

  • Catheter

    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.

  • Exercise and movement

    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.

  • Sexuality

    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.

Recovery after surgery

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

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.

Side effects of chemotherapy

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

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

Key points

  • The two most common types of primary vaginal cancer are squamous cell carcinoma and adenocarcinoma.
  • Symptoms include discharge, pain during sex, bleeding and a lump in the vagina.
  • Conditions such as vaginal intraepithelial neoplasia (VAIN) can increase your risk. Female children of women who took a drug called diethylstilboestrol (DES) during pregnancy are also at an increased risk.
  • Diagnostic tests may include a Pap smear, an examination of your vagina (colposcopy) and a tissue sample (biopsy).
  • The stage of the cancer describes its size and if it has spread. The grade tells how quickly the cells are growing.
  • Your doctor will talk to you about your prognosis. The earlier vaginal cancer is diagnosed, the better the chances of successful treatment.
  • You may see a range of health professionals, including a gynaecological oncologist.
  • Radiotherapy uses x-rays to destroy cancer cells. Most women have external and internal radiotherapy (brachytherapy). Side effects vary depending on the type of radiotherapy you have.
  • During surgery, the affected part of the vagina is cut out. Other organs may also be removed.
  • Chemotherapy uses drugs to kill cancer cells. It is usually given if the cancer is advanced or if it returns after treatment.
  • Palliative treatment may be given to manage cancer symptoms and improve quality of life. 

Reviewed by: Prof Jonathan Carter, Head Gynaecologic Oncology, Chris O’Brien Lifehouse, Professor of Gynaecological Oncology, University of Sydney, and Head Gynaecologic Oncology, Royal Prince Alfred Hospital, NSW; Ellen Barlow, Gynaecological Oncology Clinical Nurse Consultant, Gynaecological Cancer Centre, The Royal Hospital for Women, NSW; Jason Bonifacio, Practice Manager/ Chief Radiation Therapist, St Vincent’s Clinic, Radiation Oncology Associates and Genesis Cancer Care, NSW; Wendy Cram, Consumer; Kim Hobbs, Social Worker, Gynaecology Oncology, Westmead Hospital, and Chair COSA Social Work Group, NSW; Lyndal Moore, Consumer; Pauline Tanner, Cancer Nurse Coordinator, Gynaecological Cancer, WA Cancer and Palliative Care Network, WA.
Updated: 01 Oct, 2014