This information is about vaginal cancer, or cancer of the vagina, which is a rare type of 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.
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).
Primary vaginal cancer
There are two main types of primary vaginal cancer, 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 aged 50–70.
This type of vaginal cancer usually affects women under 20, but may occasionally occur in older women.
Other very rare types of vaginal cancer include melanoma, small cell carcinoma, sarcoma, and lymphoma.
Secondary vaginal cancer
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.
Causes and risk factors of vaginal cancer
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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 very 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 some 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 other medical conditions, DES is no longer used during pregnancy.
Signs and symptoms of vaginal cancer
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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. Women may also have some pain in the back passage (rectum).
How vaginal cancer is diagnosed
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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.
Internal vaginal examination
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 or smear 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. A liquid is then applied to the vagina that makes any abnormal areas show up more clearly. A 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.
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.
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. You may have any of the following.
Chest x-ray and blood tests
These are necessary to assess your general health and to check whether the cancer has spread to the lungs.
CT (computerised tomography) scan
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 this beforehand.
MRI (magnetic resonance imaging) scan
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’ll be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It’s 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.
Staging and grading of vaginal cancer
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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 stage of a cancer helps the doctors decide on the most appropriate treatment for you.
Vaginal cancers are usually staged using a combination of the FIGO and AJCC (TNM) classifications. A number between 0 and 4 is given to the tumour, depending on its growth in the vagina and surrounding tissues, and whether it has spread to lymph nodes or other organs.
Stage 1 describes a cancer at an early stage, when it is usually small and hasn’t spread. 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 between these stages.
Other terms used
You may hear other terms used to describe cancer:
‘Early’ or ‘local’ may be used to describe a cancer that hasn’t spread
‘Locally advanced’ describes a cancer that has begun to spread into surrounding tissues or nearby lymph nodes
‘Local recurrence’ means the cancer has come back in the same area after treatment
‘Secondary’, ‘advanced’, ‘widespread’ or ‘metastatic’ means the cancer has spread to other parts of the body.
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 similar to normal cells. They are usually slow-growing and 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.
Treatment of vaginal cancer
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The treatment for vaginal cancer depends on a number of factors, including your 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’s important to ask the specialist to explain things again if there’s anything you don’t understand.
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 team of radiographers.
The dose needed will depend on the exact type of cancer and whether or not it has spread into surrounding tissue. Therefore 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'll be asked to visit the radiotherapy department for treatment every weekday for 4-6 weeks. Each treatment takes a few minutes and is painless. You may be asked to have a full bladder for treatment.
Some women may be given chemotherapy once a week during radiotherapy treatment.
Internal radiotherapy (brachytherapy)
This type of radiotherapy is used to give an extra dose of radiation to the tumour. It also limits the exposure of normal tissue to radiation. An applicator (similar to a plastic tampon) containing a radioactive substance is inserted into your vagina. It is connected to a machine which sends radiation into the applicator. The treatment may last several minutes or a few hours, depending on the equipment used. Having the applicator inserted into the vagina should be no more uncomfortable than having an internal pelvic examination. You will not be radioactive after the treatment and can continue with your normal activities.
If your cancer specialist recommends internal radiotherapy for you, the staff in the radiotherapy department will explain what will happen and show you the equipment beforehand.
Sometimes, as well as the applicator, 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.
Side effects of radiotherapy
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 Smokefree, that offer advice and support.
Short-term side effects of radiotherapy
It's 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 to drink plenty of fluids and maintain a healthy diet during your treatment. If you have diarrhoea that is not being well controlled, let your doctor know so that anti-diarrhoea medicines can be prescribed.
Radiotherapy can make you 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.
In younger people who have not yet experienced the menopause, radiotherapy for vaginal cancer affects the ovaries and brings on the menopause. This is usually happens three months after treatment starts and means that you will 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 be protected from menopausal symptoms by taking HRT (hormone replacement treatment), which is available as tablets or skin patches. Your gynaecologist or oncologist can start these during the radiotherapy treatment, or shortly after it has ended. They will choose the correct replacement hormones and dosage for you. Unfortunately though, they can’t stop you from becoming infertile. We have some information about dealing with infertility, which you may find helpful.
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.
It is important to get as much rest as you can if you’re having radiotherapy, especially if you have to travel a long way for treatment each day.
Possible long-term side effects of radiotherapy
Improvements in the planning of treatment, and the way in which the radiotherapy is given, have made long-term effects much less likely.
In a small number of people, the bowel or bladder may be permanently affected by the radiotherapy. If this happens, the increased bowel motions and diarrhoea may continue, or you may need to pass urine more often than before.
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 can 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 the 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 nodes 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 and support you need.
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. Chemotherapy for vaginal cancer 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 also sometimes given with radiotherapy and occasionally before surgery.
Will treatment for vaginal cancer affect my sex life?
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How your sex life is physically affected will depend on 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 or masturbation.
If you are having radiotherapy, the side effects may make sexual intercourse uncomfortable and undesirable. 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 a shortening and narrowing of the vagina. 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 (if you’re in one) 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 family or friends, while others prefer to seek help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is there if you need it. Our cancer support specialists can give you information about counselling in your area.
College of Sexual and Relationship Therapists (COSRT)
COSRT offers counselling and psychotherapy. Can give details of local counsellors.
Gynae C is a national helpline offering support to women with gynaecological cancer.
This information has been compiled using information from a number of reliable sources, including:
Raghavan, et al. The Textbook of Uncommon Cancers. 3rd edition. 2006. Wiley.
Souhami, et al Oxford Textbook of Oncology. 2nd edition. 2001. Oxford University Press.
Tobias, Hochauser. Cancer and its management. 6th edition. 2010. Wiley Blackwell.
UpToDate. Vaginal cancer. www.uptodate.com (accessed September 2012).
Thanks to Dr Susan Lalondrelle, Consultant Clinical Oncologist, and the people affected by cancer who reviewed this edition. Reviewing information is just one of the ways you could help when you join our Cancer Voices network.