Vaginal Cancer

Vaginal cancer happens when cancerous cells grow in your vagina.

A woman’s vagina -- her birth canal -- is a channel that goes from the opening of her uterus to the outside of her body. Many kinds of cancer can spread to the vagina from somewhere else, but cancer that starts here is rare. There are about 6,000 new cases in the U.S. each year.

Vaginal Cancer Types

There are a few main types of vaginal cancer:

Squamous cell carcinoma . This is by far the more common. It happens when cancer forms in the flat, thin cells that line your vagina. This type spreads slowly and tends to stay close to where it starts, but it can move into other places like your liver, lungs, or bones. Older women are most likely to get this form. Nearly half of all new cases are in women ages 60 and up.

Adenocarcinoma . This type starts in glandular cells in the lining of your vagina, which make mucus and other fluids. It’s more likely to spread to other areas, including your lungs and the lymph nodes (small organs that filter out harmful things in your body) in your groin.

Clear cell carcinoma . This is an even rarer form of adenocarcinoma. It often affects women whose mothers took a hormone called diethylstilbestrol (DES) in the early months of pregnancy. Between 1938 and 1971, doctors often prescribed this medication to prevent miscarriage and other problems.

Even more rarely, vaginal cancer can form in connective tissue or muscle cells (sarcoma) or in cells that make pigments (melanoma).

Vaginal Cancer Causes and Risk Factors

Some cases of vaginal cancer don’t have a clear cause. But most are linked to infection with the human papillomavirus, or HPV. This is the most common sexually transmitted disease (STD). An HPV infection most often goes away on its own, but if it lingers, it can lead to cervical and vaginal cancer.

You also might be more likely to get vaginal cancer if you:

  • Are 60 or older
  • Were exposed to DES
  • Drink alcohol
  • Have cervical cancer or precancerous lesions
  • Have HIV
  • Smoke
  • Have unusual cells in your vagina called vaginal intraepithelial neoplasia

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Vaginal Cancer Symptoms

Vaginal cancer often doesn’t cause symptoms. Your doctor might find it during a routine exam or Pap test.

If you have symptoms, they can include:

  • Unusual bleeding from your vagina
  • Watery or bad-smelling discharge from your vagina
  • Pain in your pelvis
  • Pain when having sex
  • Pain when peeing
  • Peeing more than usual
  • Constipation
  • A lump in your vagina

If you notice any of these things, it doesn’t mean you have vaginal cancer. You could just have an infection. But it’s important to get it checked out.

Vaginal Cancer Diagnosis

If a pelvic exam or a Pap test shows signs of a problem, your doctor may want to take a closer look by doing a colposcopy. They’ll use a lighted magnifying tool called a colposcope to check your vagina and cervix for anything unusual.

They might also take out a bit of tissue so a specialist can look at it under a microscope. This is called a biopsy.

Vaginal Cancer Stages

After your doctor diagnoses vaginal cancer, they’ll do imaging tests and other exams to find out whether it’s spread to other parts of your body. This helps them decide the stage the cancer and how to treat it. The stages are:

  • Stage I: The cancer is only in your vaginal wall.
  • Stage II: It has spread to the tissue around your vagina.
  • Stage III: Cancer is in the wall of your pelvis.
  • Stage IVa: The cancer has reached the lining of your bladder, the lining of your rectum, or another area of your pelvis.
  • Stage IVb: It has spread to farther parts of your body like your lungs or bones.

Vaginal Cancer Treatment

You and your doctor will decide on treatment based on many things, including how close the cancer is to other organs, its stage, whether you’ve had radiation treatment in your pelvic area, and whether you’ve had a hysterectomy to remove your uterus.

Your doctor will probably recommend one or more of these treatments:

Surgery. This is the most common treatment. Your doctor may use a laser to cut out tissue or growths. In some cases, they might remove all or part of your vagina. You may need a hysterectomy to remove your cervix or other organs.

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Many women can have a normal sex life after surgery. But sex can raise your chances of infection, and it can cause bleeding or strain the surgical site. Your doctor will tell you what’s safe to do and when it's safe.

Radiation therapy. This treatment uses high-powered X-rays or other forms of radiation to kill cancer. Your doctor might use a machine that sends X-rays into your body, or they could insert a radioactive substance inside your body, on or near the cancer.

Radiation treatments in your pelvic area can damage your ovaries. That can cause them to stop making estrogen, leading to menopause symptoms like hot flashes and vaginal dryness. If you’ve been through menopause, you probably won’t have these problems.

This type of therapy also can irritate healthy tissue. Your vagina might get swollen and tender. Sex may be painful.

Chemotherapy (“ chemo ”). This uses medication to kill or stop the growth of cancer cells. You might take the medication by mouth or get it injected into a vein (intravenous or IV). In some cases, your doctor might give you a chemo in lotion or cream form.

You may lose your sex drive or have side effects like nausea, hair loss, and changes in body weight. These will improve or go away after treatment.

Vaginal Cancer Prognosis

Your recovery depends on many things. The most crucial is the stage at which your doctor found your cancer. At the earliest stages, doctors can often cure vaginal cancer.

Five-year survival rates are around 67% for women at stages I and II. This means that 5 years after they were diagnosed or treated, 67% of women are still alive. It's about 47% for all stages combined.

Your age, your overall health, whether your cancer is new or has come back, and whether it caused symptoms also play a role in recovery.

Vaginal Cancer Prevention

The best way to protect yourself is to avoid getting HPV. The FDA has approved the Gardasil 9 vaccine to prevent HPV-related diseases, including the seven most common types of HPV that cause cancer. The vaccine is for people ages 9 to 45. Younger patients need fewer shots for full protection.

Certain lifestyle changes can also help reduce your risk of vaginal cancer:

  • Wait to have sex until your late teen years or beyond.
  • Don’t have sex with more than one partner.
  • Don’t have sex with someone who has more than one partner.
  • Use condoms during sex.
  • Get regular Pap exams.
  • If you smoke, stop. If you don’t smoke, don’t start.
WebMD Medical Reference Reviewed by Laura J. Martin, MD on January 19, 2020

Sources

SOURCES:

National Cancer Institute: “Vaginal Cancer Treatment.”

American Society of Clinical Oncology: “Vaginal Cancer: Risk Factors and Prevention.”

CDC: “Vaginal and Vulvar Cancers.”

American Cancer Society: “Vaginal Cancer.”

Mayo Clinic: “Cancer Treatment for Women: Possible Sexual Side Effects.”

FDA.gov: "FDA approves expanded use of Gardasil 9 to include individuals 27 through 45 years old."

Merck.com: "Gardasil 9."

American Cancer Society: “Key Statistics for Vaginal Cancer,” “Survival Rates for Vaginal Cancer.”

Mayo Clinic: “Vaginal cancer.”

Johns Hopkins Medicine: “Vaginal Cancer.”

UpToDate: “Vaginal cancer.”

Obstetrics and Gynecology: “Factors Affecting Risk of Mortality in Women With Vaginal Cancer.”

Merck & Co.: “Gardasil 9 Prescribing Information.”

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