Vaginal cancer is a rare type of cancer that starts in the vagina. It accounts for about 1 percent of female genital cancers, estimates the National Cancer Institute.
There are several main types of vaginal cancer, including:
- Squamous cell. This type of cancer starts in the vaginal lining and develops slowly. It accounts for approximately 75 percent of vaginal cancers, according to the University of Texas.
- Adenocarcinoma. This type of cancer starts in the vaginal gland cells. It’s most common in women over 50. It’s the second-most common type of vaginal cancer.
- Melanoma. As with the more common skin cancer type of melanoma, this type of cancer starts in the cells that give skin color.
- Sarcoma. This type of cancer accounts for only about 4 percent of vaginal cancers. It starts in the vaginal walls.
In early stages, vaginal cancer treatment has a high success rate.
The most common symptom of vaginal cancer is abnormal vaginal bleeding. This includes bleeding after menopause, bleeding during or after sex, and bleeding in between menstruation. Other symptoms include:
- watery vaginal discharge
- painful or frequent urination
- pelvic pain, especially during sex
- fistulas, in later-stage cancer
In some cases, vaginal cancer has no symptoms. In these cases, it may be discovered during a routine pelvic exam.
Causes of vaginal cancer include:
- Human papilloma virus (HPV). This sexually transmitted infection is the most common cause of vaginal cancer.
- Previous cervical cancer. HPV often causes cervical cancer as well.
- In-utero exposure to diethylstilbestrol (DES). This medication used to be given to pregnant women to prevent miscarriage. However, doctors stopped prescribing it in the 1970s. Vaginal cancer caused by DES is now extremely rare.
Risk factors for vaginal cancer include:
- having had a previous hysterectomy, whether it was for a benign or malignant mass
- smoking, which doubles the risk of vaginal cancer
- being older than 60
- having HIV
- early exposure to HPV through sexual activity
First, your doctor will take your medical history to find out more about your symptoms and possible risk factors. They’ll then do a pelvic exam to look for possible causes of your symptoms. They’ll also do a Pap smear to check for any abnormal cells in your vaginal area.
If the Pap smear shows any abnormal cells, your doctor will do a colposcopy. This is a procedure where your doctor uses a magnifying instrument called a colposcope to examine your vaginal walls and cervix to see where the abnormal cells are.
This procedure is similar to a usual pelvic exam: You’ll be in stirrups, and your doctor will use a speculum. Once your doctor knows where the abnormal cells are, they’ll take a biopsy to see if the cells are cancerous.
If the cells are cancerous, your doctor will most likely do an MRI, CT scan, or PET scan to see if the cancer has spread to other parts of the body.
Vaginal cancer stages tell you how far the cancer has spread. There are four main stages, plus one precancerous stage of vaginal cancer:
- Vaginal intraepithelial neoplasia (VAIN). VAIN is a type of precancer. There are abnormal cells in the vaginal lining, but they’re not growing or spreading yet. VAIN isn’t cancer.
- Stage 1. Cancer is only in the vaginal wall.
- Stage 2. Cancer has spread to the tissue next to the vagina but hasn’t yet spread to the pelvic wall.
- Stage 3. Cancer has spread further into the pelvis and pelvic wall. It might’ve also spread to nearby lymph nodes.
- Stage 4. Stage 4 is divided into two substages:
- In stage 4A, cancer has spread to the bladder, rectum, or both.
- In stage 4B, cancer has spread further throughout the body to organs, such as the lungs, liver, or more distant lymph nodes.
If the cancer is stage 1 and in the upper third of the vagina, you might have surgery to remove the tumor and a small area of healthy tissue around it. This is usually followed by radiotherapy.
Radiotherapy is the most commonly used treatment in all stages of vaginal cancer. In some cases, you might have chemotherapy to support the radiotherapy. However, there’s little evidence for the benefit of chemotherapy for vaginal cancer.
If you’ve already received radiotherapy in the vaginal area, your doctor will likely recommend surgery. This is because each part of the body can only undergo a certain amount of radiation. Depending on the size, location, and margins of your tumor, your doctor might remove:
- only the tumor and a small area of healthy tissue around it
- part or all of the vagina
- most of your reproductive or pelvic organs
Stage 4B cancer is generally not curable, but treatment can relieve symptoms. If this is the case, your doctor might recommend radiotherapy or chemotherapy. It might also be possible to enroll in a clinical trial to help test new treatments.
Overall, the American Cancer Society estimates vaginal cancer has a five-year survival rate of 47 percent. Survival rates differ greatly by stage. For stage 1 cancers, there’s a five-year survival rate of 75 percent. Stage 4 has a survival rate of 15 to 50 percent. Survival rates also depend on how far the cancer has spread and where it has spread to.
Certain factors can affect survival rate, too. For example, women over 60 have lower survival rates. Women with symptomatic vaginal cancer upon diagnosis and those with tumors in the middle or the lower third of the vagina also have lower survival rates.
While you may not be able to get your risk of vaginal cancer to zero, there are steps you can take to help reduce your risk. These include:
- Take steps to lower your risk of HPV. This includes using condoms whenever you have any type of sex (vaginal, oral, or anal) and getting the HPV vaccine. To find out more about the HPV vaccine, talk to your doctor.
- If you currently smoke, quit. Smoking is the major lifestyle risk factor for vaginal cancer and other cancers. Quit today.
- Drink only in moderation. There’s some evidence that heavy drinking increases your risk of vaginal cancer.
- Get regular pelvic exams and Pap smears. This will help your doctor find precancers before they turn into vaginal cancers or find vaginal cancer early, before it spreads or causes serious symptoms.