Radiation therapy is the most common treatment for vaginal cancer. It’s often used in combination with surgical excision and chemotherapy.
“The exact treatment used for vaginal cancer will primarily depend on its stage at presentation or diagnosis,” said Shannon A. Tomita, MD, a gynecologic oncologist with Atlantic Health System in New Jersey.
Doctors often treat early stage vaginal cancers with surgical excision, though they may use radiation if surgery is not feasible due to the size or location of the tumor, she explained.
Meanwhile, “more advanced-stage disease is typically treated with chemotherapy, radiation, or a combination of the two,” she said. Doctors may also use lymphadenectomy, targeted drug therapy, and immunotherapy.
As is the case with radiation treatment for other types of cancer, radiation therapy for vaginal cancer involves directing high energy rays at the cancer cells in order to kill them.
External beam radiation
External beam radiation involves directing rays directly at the tumor from outside the body, much like an X-ray.
Doctors generally use external beam radiation alongside internal radiation therapy (for stage 1) or internal radiation and chemotherapy (for stages 2, 3, and 4).
Internal radiation therapy
Also known as intracavitary brachytherapy, internal radiation therapy involves placing radioactive material inside the vaginal canal.
There are a few different types:
- Low dose rate (LDR) brachytherapy: This an inpatient procedure that involves placing a radioactive material in a container and then leaving it inside the vagina for 1 to 2 days.
- High dose rate (HDR) brachytherapy: This is an outpatient procedure that involves placing a higher dose of radioactive material in a container and leaving it inside the vagina for just a few hours.
- Interstitial radiation: While less common, this type of internal radiation therapy involves placing radioactive material inside needles that are then used to prick the tumor and nearby tissues.
Surgery is most often used in cases with early stage diagnosis. Doctors may treat later stage vaginal cancer with surgery if radiation is not successful.
There are a few different types of surgeries used to treat vaginal cancer, but all involve the removal of cancerous tissue.
Local excision
Also known as wide excision, this type of surgery involves removing the cancerous masses and the edges of surrounding tissue.
Trachelectomy
Squamous cell carcinoma, which accounts for about 90% of all vaginal cancers, starts in the part of the vaginal canal closest to the cervix. As such, treating squamous cell carcinoma sometimes involves removing the cervix.
When the surgeon removes the cervix but leaves the uterus in place, it’s known as a trachelectomy. This type of surgery for vaginal cancer is rare, as most cases require the removal of additional reproductive organs.
Hysterectomy
A hysterectomy is any surgery that involves removal of the uterus, which can be done through the vagina or the abdomen.
There are a few different types of hysterectomies that might be used in vaginal cancer treatment, depending on where the cancer has spread:
- Total hysterectomy: Total hysterectomy is the name for the surgery that involves the removal of the cervix as well as the uterus and any portion of the vaginal canal tissues where disease is present.
- Radical hysterectomy: When surgeons remove the uterus, cervix, lymph nodes, and all the connective tissues around the uterus, the surgery is called a radical hysterectomy.
- Bilateral salpingo-oophorectomy: When the cancer has spread to the fallopian tubes and those also require removal, the procedure is called either a bilateral salpingo-oophorectomy (BSO) or total abdominal hysterectomy bilateral salpingo-oophorectomy (TAHBSO).
Lymphadenectomy
It’s common for vaginal cancer to spread to the lymph nodes in the groin and pelvic area. In fact, diseased lymph nodes near the vagina are a diagnostic indicator for stage 3 and 4 vaginal cancer.
Surgeons may remove these lymph nodes through a procedure called a lymphadenectomy or lymph node dissection as a way to check for cancer spread and properly stage vaginal cancer.
This can help your care team develop a treatment plan that best suits your individual needs.
Pelvic exenteration
Pelvic exenteration is a major operation that doctors only use to treat vaginal cancer in rare instances where the cancer has returned or previous treatment methods have not been successful.
This tactic involves removal of vaginal tissues and the lymph nodes in the pelvis, plus one or more of the following organs:
- colon
- rectum
- bladder
- uterus
- cervix
In the event that surgeons remove the rectum or bladder, additional surgeries will be necessary to allow you to urinate and excrete.
Laser ablationThis outpatient treatment is used for “precancer,” or the presence of abnormal vaginal or cervical cells.
It involves directing a high energy ray at the abnormal cells in order to dissolve them. The goal of laser surgery is to kill cells that could later develop into cancer.
Targeted drug therapy is a treatment option that works overtime to destroy cancer cells or stall their growth. It works by
Antibody-drug conjugates
Antibody-drug conjugates (ADC) are intravenous options administered every 3 weeks. These drugs contain a monoclonal antibody that attaches to the proteins in cancer cells.
The drugs in chemotherapy are attracted to these drugs. Thus, when used together, the two help the chemo find the cancer cells.
RET inhibitors
A small percentage of vaginal cancer tumors occur due to a mutation in something called the RET (rearranged during transfection) gene, which causes them to make an abnormal form of RET protein. This abnormal protein form supports tumor growth.
RET inhibitors are oral medications that work specifically on the RET gene to rectify the protein issue and thus stop tumor growth.
NTRK inhibitors
Some vaginal cancers are occur due to a mutation in one or more of the NTRK (neurotrophic tyrosine receptor kinase) genes.
These mutations cause the body to make an abnormal form of TRK proteins, which leads to abnormal cell growth and cancer.
NTRK inhibitors are oral medications that contain an ingredient that disables the TRK protein, thus leading to slowed or stopped vaginal cancer growth.
Chemotherapy involves either killing the cancer cells or injuring them in such a way that they cannot continue to divide and grow.
This option can be applied topically, taken orally, or administered intravenously. Oral or intravenous delivery is the preferred method for vaginal cancer that has spread to other parts of the body.
Broadly speaking, immunotherapy works by making your immune system more reactive. This can help your immune system learn to identify cancerous cells and destroy them on its own.
The main form of immunotherapy used is an intravenous drug called immune checkpoint inhibitors.
Immune checkpoint inhibitors increase the odds that the immune system will attack cancer cells that went undetected by the immune system when those cells were turned on.
There are several different treatments that can be used for vaginal cancer, often with high success rates.
However, it’s easiest to cure the disease when doctors catch it at its earliest stages, said Damian P. Alagia, MD, the senior medical director for advanced diagnostics and women’s health at Quest Diagnostics.
So if you are experiencing any unusual vaginal symptoms or have questions about vaginal cancer, consult a healthcare professional.
Gabrielle Kassel (she/her) is a queer sex educator and wellness journalist who is committed to helping people feel the best they can in their bodies. In addition to Healthline, her work has appeared in publications such as Shape, Cosmopolitan, Well+Good, Health, Self, Women’s Health, Greatist, and more! In her free time, Gabrielle can be found coaching CrossFit, reviewing pleasure products, hiking with her border collie, or recording episodes of the podcast she co-hosts called Bad In Bed. Follow her on Instagram @Gabriellekassel.