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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more|.
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This information is about vaginal cancer.
The vagina is a muscular tube that extends from the opening of the womb (cervix) to the folds of skin (vulva) between a woman's legs.
It allows blood from periods (menstruation) to pass out of the body, and is the passageway through which babies are born.
The vagina and surrounding organs View a large copy of the vagina and surrounding organs image|
Cancers affecting the vagina are rare. Fewer than 300 women are diagnosed with this type of cancer in the UK each year.
Vaginal cancer can start in the vagina itself (primary vaginal cancer) or spread into the vagina from another part of the body (secondary vaginal cancer).
There are two main types of primary vaginal cancers and they are named after the cells from which they develop:
The most common type of vaginal cancer is called squamous cell. This is usually found in the upper part of the vagina, and most commonly affects women between the aged 50–70.
This type of vaginal cancer usually affects women under 20, but may occasionally occur in other age groups.
Other very rare types of vaginal cancer include melanoma, small cell carcinoma, sarcoma, and lymphoma.
Secondary cancers in the vagina are more common than primary vaginal cancer, and usually come from the neck of the womb (cervix|), the lining of the womb (endometrium|) or from nearby organs such as the bladder| or bowel|.
This information is about primary vaginal cancer. Our cancer support specialists can give you further information about secondary cancers in the vagina
As with many cancers, the exact cause of most vaginal cancers is unknown, but research into this is ongoing. Cancer of the vagina is not infectious and so can't be passed on to other people.
Women who have had genital warts caused by the human papilloma virus (HPV)| may have a slightly higher risk of developing vaginal cancer.
Women who have had radiotherapy| to the pelvic area may also have a slightly increased risk.
A hormone drug called diethylstilbestrol| (DES) has been identified as a cause of a particular type of adenocarcinoma of the vagina. Between 1940 and 1970, DES was prescribed to pregnant women to try to prevent miscarriages. The female children of women who took DES during pregnancy have an increased risk of developing a type of adenocarcinoma of the vagina called clear cell adenocarcinoma (CCA), although it is very rare. Daughters of women who took DES should have annual check-ups to detect early signs of CCA.
Although DES and some other female hormones (oestrogens) can be safely used to treat some other medical conditions, DES is no longer used during pregnancy.
The most common symptoms of vaginal cancer are a blood-stained vaginal discharge, bleeding after sexual intercourse and pain. Problems with passing urine (such as blood in the urine, the need to pass urine frequently, and the need to pass urine at night) can be a symptom of vaginal cancer. You may also have some pain in the back passage (rectum).
Usually, you will begin by seeing your GP, who will refer you to a specialist doctor for tests and for expert advice and treatment. The following tests are commonly used to diagnose vaginal cancers:
At the hospital, the specialist doctor will do a full pelvic examination. They will examine the inside of your vagina to check for any lumps or swellings. The doctor will also feel your groin and pelvic area to check for any swollen lymph nodes and may also check your back passage (rectum).
You may have a liquid-based cytology test| to see if there are any abnormalities in the cells of the cervix.
The person taking the liquid-based cytology or smear test should explain the procedure and you should feel able to ask questions at any time. Once you are lying comfortably on the couch, the doctor or nurse will gently insert an instrument called a speculum into the vagina, to keep it open while the smear is taken.
A special brush or small disposable spatula is then used to take a sample of cells from the cervix. The cells are then either put into a small container of preservative or placed on a glass slide and sent to the laboratory for examination under a microscope.
This is an examination of the vagina using a colposcope, which is a small, low-powered microscope. The colposcope acts like a magnifying glass so the doctor or specialist nurse can see the whole vagina in more detail.
The doctor will use a speculum in the same way as in the screening test, to hold the vagina open. The vagina may then be painted with a liquid that makes any abnormal areas show up more clearly. Colposcopy is usually carried out in the hospital outpatient department and takes about 10-15 minutes. It isn't usually painful but may be slightly uncomfortable.
A small sample of tissue will be taken from any abnormal areas. This sample will be examined under a microscope.
The above tests may show early cell changes in the vagina known as vaginal intra-epithelial neoplasia| (VAIN). This is sometimes referred to as carcinoma-in‑situ. VAIN is not cancer, and therefore the treatment for this condition is not the same as for cancer.
If the above tests show that you have a vaginal cancer, further tests may be necessary to find out whether or not any cancer cells have spread. The results of these tests will help the specialist to decide on the best type of treatment for you. Cancer can spread in the body, either in the bloodstream or through the lymphatic system. The lymphatic system is part of the body's defence against infection and disease. The system is made up of a network of lymph nodes (also called lymph glands) that are linked by fine ducts containing lymph fluid. You may have:
These are necessary to assess your general health and to check whether the cancer has spread to the lungs.
A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body. The scan is painless and takes 10–30 minutes. CT scans use a small amount of radiation, which will be very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.
You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. For a few minutes, this may make you feel hot all over. If you are allergic to iodine or have asthma you could have a more serious reaction to the injection, so it is important to let your doctor know beforehand.
This test is similar to a CT scan but uses magnetism instead of x-rays to build up a detailed picture of areas of your body. Before the scan you may be asked to complete and sign a checklist. This is to make sure that it’s safe for you to have an MRI scan.
Before having the scan, you’ll be asked to remove any metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm. This is called a contrast medium and can help the images from the scan to show up more clearly.
During the test you will be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. It’s also noisy, but you’ll be given earplugs or headphones. You'll be able to hear, and speak to, the person operating the scanner.
The stage of a cancer is a term used to describe its size and whether or not it has spread. Knowing the particular type, and the stage, of the cancer helps the doctors to decide on the most appropriate treatment for you.
The most commonly used staging system is called the TNM system:
The T, N and M will often have numbers attached to describe the detail. For example, a T1 tumour may be very small and just in one layer of tissue, whereas a T4 tumour may be a larger size and spread through several layers of tissue.
The exact details of the T, N and M will depend on the type of cancer.
In addition to TNM staging system, you’ll probably hear the doctors use a number staging system. There are usually three or four number stages for each cancer type.
Stage 1 describes a cancer at an early stage when it's usually small in size and hasn’t spread, whereas stage 4 describes cancer at a more advanced stage when it has usually spread to other parts of the body. Stages 2 and 3 are in-between these stages.
The number stages are made up of different combinations of the TNM stages. So a stage 1 cancer may be described as either T1, N0, M0 or T2, N0, M0.
Number stages may also be further subdivided to give more detailed information about tumour size and spread. For example, a stage 3 cancer may be subdivided into stage 3a, stage 3b and stage 3c. A stage 3b cancer may differ from a stage 3a cancer in either the tumour size or if the cancer has spread to lymph nodes.
In the last few years, staging systems have become increasingly complex and they now describe the size and spread of different types of cancer in much greater detail. This can be very helpful in planning the details of treatment or predicting outcomes.
However, doctors will often use a much simpler approach when talking about staging. They might use words like ‘early’ or ‘local’ if the cancer hasn't spread, ‘locally advanced’ if it has begun to spread into surrounding tissues or nearby lymph nodes, or ‘advanced’ or ‘widespread’ if it has spread to other parts of the body. Your doctors can give you more information about the stage of your particular cancer.
Grading refers to the appearance of the cancer cells under the microscope and gives an idea of how quickly the cancer may develop. Low-grade means that the cancer cells look very like normal cells, they are usually slow-growing and they are less likely to spread. In high-grade tumours the cells look very abnormal, are likely to grow more quickly, and are more likely to spread.
The treatment for vaginal cancer depends on a number of factors, including your age, general health and the stage, grade, and type of cancer.
Radiotherapy, surgery and chemotherapy may be used to treat vaginal cancer. You may have one, or a combination, of these treatments.
Before starting treatment, you should be given a chance to ask your cancer specialist any questions you have about the treatments being considered. It is important to ask the specialist to explain things more than once if there is anything you do not understand, however insignificant it may seem.
For many women with vaginal cancer, radiotherapy| is the most suitable treatment. In some younger women, radiotherapy may be combined with chemotherapy, which is known as chemoradiation .
Radiotherapy treats cancer by using high‑energy rays (radiation) that destroy the cancer cells, while doing as little harm as possible to normal cells. It is given in the radiotherapy department at the hospital.
Your treatment will be planned by a doctor who is a specialist in radiotherapy treatment (a clinical oncologist or radiotherapist). They will be able to discuss the treatment with you and answer any questions you may have. The treatment will be given by a radiographer.
The dose needed will depend on the exact type of cancer and whether or not it has spread into surrounding tissue, so you may find that you are having a different radiotherapy treatment from other women you meet at the hospital. Some women have both external and internal radiotherapy treatment.
Beams of radiation are directed at the cancer from outside the body, a bit like having an x-ray. While having external radiotherapy, you will be asked to visit the radiotherapy department for treatment every weekday for 4-6 weeks. Each treatment takes several minutes and is painless.
Some women may be given chemotherapy once a week during the radiotherapy treatment.
An applicator (similar to a tampon) containing a radioactive substance is inserted into your vagina. The treatment may last several minutes or a few hours, depending on the equipment used.
If your cancer specialist recommends internal radiotherapy for you, you may find it helpful to ask the staff in the radiotherapy department to explain what will happen and to show you the equipment beforehand.
Sometimes, as well as the applicator, tiny radioactive needles may be placed into the area surrounding the vagina. If these are needed, they are put in under general anaesthetic and are removed once the treatment ends.
Radiotherapy for vaginal cancer can cause short-term and long-term side effects. The most common effects happen during, or soon after, treatment. The side effects occur because, as well as destroying cancer cells, radiotherapy can also damage the healthy cells nearby.
Stopping smoking during and after radiotherapy is very worthwhile. It can help reduce both short- and long-term side effects, particularly those that affect the skin.
It can be very difficult to stop smoking or even cut down at such a stressful time. If you want help or advice, you can talk to your doctor or specialist nurse. There are also useful organisations, such as QUIT|, that offer advice and support.
It is not unusual for the skin in the treatment area to become red and sore. This can be uncomfortable, especially when you are passing urine. Your specialist can prescribe painkillers and creams, which will help to ease this.
You may have a slight discharge from the vagina once the treatment has finished. If it continues for more than a few weeks or becomes heavy, it is important to let your doctor or nurse know.
Radiotherapy to the pelvic area can cause side effects such as tiredness|, diarrhoea| and a burning sensation when passing urine (cystitis). These side effects can be mild or more troublesome, depending on the strength of the radiotherapy dose and the length of your treatment. Your oncologist will be able to tell you what to expect.
Most of these side effects can be treated with medicines and your oncologist will be able to help you. Side effects should gradually disappear after your treatment.
It is important that you drink plenty of fluids and maintain a healthy diet| during your treatment. If you have diarrhoea that is not controlled, let your doctor know so that anti-diarrhoea medicines can be prescribed.
You may feel sick|, but this is rare. If you don't feel like eating, you can replace meals with nutritious high-calorie drinks, which are available from most chemists and can be prescribed by your GP. It may help to talk to a dietitian.
Unfortunately, radiotherapy for vaginal cancer affects the ovaries and this brings on the menopause, usually about three months after treatment starts. You will therefore become infertile|. The menopause means that your periods will stop and you will have menopausal side effects such as hot flushes, dry skin and possibly loss of concentration. You can discuss the menopause further with your doctor.
Some women become less interested in sex and notice that their vagina is dry. Sometimes, radiotherapy causes a narrowing of the vagina, which can make sexual intercourse uncomfortable. See below for advice on how to deal with the effects on your sex life.
You can be protected from menopausal symptoms by taking HRT (hormone replacement treatment) with tablets or skin patches. Your gynaecologist can start these during the radiotherapy treatment, or shortly after it has ended. They will choose the correct replacement hormones and dosage for you.
It is important to get as much rest as you can, especially if you have to travel a long way for treatment each day.
The blood vessels in the bowel and bladder can become more fragile after radiotherapy treatment, and this can cause blood to appear in the urine or bowel movements (faeces). It may be many months or years before these side effects occur.
Radiotherapy can also cause small, fragile blood vessels to develop in the vagina, which can lead to slight vaginal bleeding.
The skin of vagina can become drier and lose some of its elasticity. Some women may have a discharge or may be more prone to developing infections.
If you notice any bleeding or discharge, it is important to let your doctor know, so that tests can be done and you can be given the appropriate treatment.
Some people also find that the radiotherapy affects the lymph glands in the pelvic area and can cause swelling of the legs. This is called lymphoedema| and is more likely if you have had surgery as well as radiotherapy.
We have more information about the possible side effects of pelvic radiotherapy.|
Sometimes, the cancer needs to be removed in an operation. The type of surgery| you will have depends on the size and position of the cancer.
It may be possible to have an operation to remove the cancer, together with some of the surrounding normal tissue. Depending on the amount removed, the remaining vaginal tissue may be able to stretch so that you can still have sexual intercourse.
Some women may need to have a larger operation that removes the whole of the vagina (vaginectomy). Sometimes it is possible to make a new vagina (vaginal reconstruction) using tissue from other parts of the body. The doctors and nurses caring for you will make sure that you receive the information you need and will support you.
It may also be necessary to remove the womb (uterus), cervix, ovaries, and fallopian tubes. This operation is called a radical hysterectomy|. During this operation some of the lymph nodes in the pelvis may also be removed.
Chemotherapy| is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. They work by disrupting the growth and division of the cells. The chemotherapy is usually given directly into a vein (intravenously).
Chemotherapy is mainly used to treat advanced vaginal cancers, or cancer that has returned after initial treatment. It is now also sometimes given with radiotherapy and occasionally before surgery.
How your sex life| is physically affected will depend upon the treatment you have. If you have to have your cervix and uterus removed, and have a vaginal reconstruction, it may not be possible to have a vaginal orgasm. However, surgery to the vagina does not affect the clitoris so it will be possible to have an orgasm through oral sex and masturbation.
If you are having radiotherapy, the side effects may make sexual intercourse uncomfortable and undesirable both to you and your partner. Although you may not feel like having sexual intercourse, you and your partner can continue to share your feelings for each other, and be intimate and close in other ways, such as cuddling, massage, kissing, and stroking.
Radiotherapy causes shortening and narrowing of the vagina, and to prevent this you will be advised by your doctor or gynaecology nurse to use a dilator (a plastic or glass tube) each day during and for some time after the treatment. The dilator is gently inserted into the vagina to keep it open.
You may find it hard to believe that you need this sort of treatment. Most women feel shocked and upset by the idea of having treatment to the most intimate and private parts of their body. You may experience a wide variety of emotions| including anger, fear and resentment.
When these strong feelings are combined with the trauma of surgery, as well as all the emotions that go with having a cancer diagnosis, you may find the normal closeness of your relationship is also affected. Sharing your feelings may help bring you and your partner closer together.
Everyone has their own way of coping with difficult situations. Some people find it helpful to talk to friends or family, while others prefer to seek help from people who are less involved with their situation, such as a specialist nurse or counsellor. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is available if you need it. It is important to give yourself and your partner time to deal with the emotions and feelings that cancer can cause.
COSRT| offers counselling and psychotherapy. Can give details of local counsellors.
DES| gives support and information to women exposed to DES.
Gynae C| is a national helpline offering support to women with gynaecological cancer.
This section has been compiled using information from a number of reliable sources including:
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.