Vaginal cancer

It’s rare for cancers to start in the vagina. They usually start in the cervix or womb, and grow into the vagina. There are different types of vaginal cancer. This information is about squamous cell cancer and adenocarcinoma of the vagina that are treated in the same way.

The cause of vaginal cancer isn’t known. But factors including increasing age, radiotherapy to the pelvis, and exposure to HPV or a drug called Diethylstilbestrol (DES) can increase your risk of developing it.

Symptoms of vaginal cancer include:

  • blood-stained vaginal discharge
  • bleeding after the menopause, between periods or after sex
  • pain when passing urine, needing to pass urine often or blood in the urine
  • pain in the pelvic area
  • constipation or feeling you need to pass a bowel motion even though you just have (tenesmus)
  • swollen legs.

Vaginal cancer is diagnosed with tests including: internal pelvic examination, liquid based cytology, a colonoscopy or a biopsy. If the tests show cancer, you may have further tests to see if it has begun to spread.

Radiotherapy and surgery are common treatments for vaginal cancer. Chemotherapy can also be given to treat vaginal cancer that has spread. Some women have chemotherapy and radiotherapy. Treatment for vaginal cancer may affect your fertility (ability to have children).

The vagina

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 your periods (menstruation) to drain out of the body, and it’s also the passageway through which babies are born (the birth canal).

The vagina and surrounding organs
The vagina and surrounding organs

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What is vaginal cancer?

Cancers that start in the vagina (primary vaginal cancer) are rare. Fewer than 300 women are diagnosed with this type of cancer in the UK each year.

It is more common for cancer to start in an area close by, such as the cervix or womb, and grow into the vagina. This information is only about primary vaginal cancer.


Types of vaginal cancer

There are different types of vaginal cancer. This information is only about squamous cell cancer and adenocarcinoma of the vagina. They are both treated in a similar way.

Squamous cell

This is the most common type of vaginal cancer. It starts in squamous cells that line the vagina. It usually starts in the upper part of the vagina. It mainly affects women over the age of 60.

Adenocarcinoma

This is rare. It starts in glandular cells. They make liquid to lubricate the vagina. It usually affects women under 30, but it can happen in older women.

Other rare types of vaginal cancer include melanoma, small cell carcinoma, sarcoma, lymphoma and clear cell cancers. If you would like more information on any of these, contact our cancer support specialists free on 0808 808 00 00, Monday–Friday, 9am–8pm.


Causes and risk factors of vaginal cancer

The exact cause of vaginal cancers is unknown, but research into this is ongoing. Cancer of the vagina is not infectious and can't be passed on to other people.

Certain things called risk factors may increase the risk of developing vaginal cancer. This doesn’t mean that if you have one or more of these risk factors you will develop vaginal cancer. The main risk factors are:

Age

Squamous cell vaginal cancer is more common in older women.

HPV (human papilloma virus)

HPV is a common virus that most sexually active women will have been exposed to.

Most women who get HPV don’t know they’ve had it. Their immune system| gets rid of it before it causes any problems. But in some women this doesn’t happen. And the HPV may cause changes in cells in the vagina or cervix. When the vagina is affected, doctors call it vaginal intra-epithelial neoplasia (VAIN). If the cervix is affected, doctors call it cervical intra-epithelial neoplasia (CIN).

VAIN or CIN can both slightly increase the risk of vaginal cancer. The cell changes are not cancer, but if they are left untreated for many years, they may develop into cancer. Because of this, the cell changes in VAIN and CIN are called pre-cancerous changes. Women who have genital warts, which are caused by HPV, have a slightly increased risk of VAIN and CIN.

Radiotherapy to the pelvis

Women who have had radiotherapy to the pelvis may have a very slightly increased risk of vaginal cancer.

Diethylstilbestrol (DES)

This is a risk factor for a rare type of vaginal cancer called clear cell adenocarcinoma (CCA). Your risk is increased if your mother was prescribed the drug DES when she was pregnant with you. DES is a hormone drug that used to be given to prevent miscarriages. But it hasn’t been used for a long time. Doctors prescribed it to some pregnant women between 1940 and 1970. Most women whose mothers took this drug will never develop vaginal cancer. But daughters of women who took DES should have annual check-ups to detect early signs of CCA.


Signs and symptoms of vaginal cancer

The most common symptoms of vaginal cancer are:

  • blood-stained vaginal discharge
  • bleeding after menopause, between periods or after sex
  • pain when passing urine, needing to pass urine often or blood in the urine
  • pain in the pelvic area
  • constipation or feeling you need to pass a bowel motion even though you just have (tenesmus)
  • swelling in your legs.

These symptoms can be caused by many other conditions. But if you notice any of them it’s important to see your doctor to have them checked.


How vaginal cancer is diagnosed

Usually you begin by seeing your GP. They will refer you to see a specialist doctor (gynaecologist) at the hospital.

The specialist doctor will ask about your symptoms and any other illnesses or health problems you have had. They may arrange for you to have some of the following tests.

Internal pelvic examination

The doctor will usually examine the inside of your vagina (internal examination) to check for any lumps or swellings. You can have a nurse with you during your examination. Let them know if you feel anxious or if it is very uncomfortable for you. An internal examination shouldn’t be painful but may be uncomfortable. You can ask for a female doctor to examine you if you prefer.

You lie on a couch, with your feet drawn up and knees apart. The doctor places one or two gloved fingers into your vagina. They press on your lower tummy area (pelvis) at the same time to feel for anything unusual in that area. The specialist may also do an internal examination of your back passage (rectum).

The doctor will also feel your groin to check for swollen lymph nodes (sometimes called glands).

Taking a sample of cells from the cervix

This is the same test that is used for cervical screening. The test is called a liquid-based cytology test. It is used to see whether there are any abnormal cells in the cervix. The nurse or doctor will explain the procedure.

The doctor or nurse gently puts an instrument called a speculum into your vagina to keep it open. They use a special brush to take a sample of cells from the cervix. This is sent to the laboratory and examined under a microscope.

Colposcopy

This is a test to look at the vagina. It is done with a colposcope, which is a type of microscope with a light. It acts like a magnifying glass. This means the doctor or specialist nurse can see the vagina in more detail.

The doctor or nurse uses a speculum in the same way as in a cervical smear test, to hold the vagina open. They apply a liquid to the vagina to make any abnormal areas show up more clearly.

You usually have a colposcopy in the hospital outpatient department. The test takes about 10–15 minutes. It isn't usually painful, but may be slightly uncomfortable.

Biopsy

During a colposcopy, the doctor may take a small sample of tissue (biopsy) from any area that looks abnormal. The biopsy will be examined under a microscope.


Further tests for vaginal cancer

If the above tests show vaginal cancer, you will have further tests. Most of these are done to find out whether the cancer has spread to the pelvis or to other parts of the body. Your doctor or specialist nurse will explain more about the tests you need.

Blood tests

You have blood tests to check your general health.

Chest x-ray

You may have a chest x-ray to check your lungs are healthy.


Staging and grading of vaginal cancer

Staging

The stage of a cancer describes how far it has grown from where it started and if it has spread. Knowing the stage of the cancer helps your doctors advise you 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 (sometimes called glands) or other organs.

Lymph nodes are part of the lymphatic system, which helps protect the body against infection and disease. There are groups of lymph nodes throughout the body. They are linked by fine tubes containing lymph fluid.

  • Stage 1 The cancer is only in the vagina.
  • Stage 2 The cancer has grown through the wall of the vagina but no further.
  • Stage 3 The cancer has spread into the wall of the pelvis. It may or may not have spread to nearby lymph nodes.
    Or, the cancer is in the vagina. It may or may not have grown through the vaginal wall but has spread to lymph nodes nearby.

Stage 4 is divided into:

  • Stage 4A The cancer has grown into organs nearby, such as the bladder or the back passage (rectum), and may or may not have spread to any lymph nodes
  • Stage 4B Cancer has spread to further away organs in the body, such as the lungs. This is called secondary or metastatic cancer.

Grading

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 the cancer cells look very similar to normal cells. They are usually slow-growing and less likely to spread. In high-grade tumours, the cells look very abnormal. They are likely to grow more quickly.


Treatment for vaginal cancer

The treatment you have will depend on different factors. This includes the stage of the cancer, where it is in the vagina and your general health. If you are a younger woman, preserving your fertility may be a factor in treatment decisions.

Your specialist doctor and nurse will explain the treatment options and their advantages and disadvantages. It’s important to ask them any questions you have and to let them know if you need more information. You and your doctor can then decide on the best treatment plan for your situation.

Radiotherapy is a common treatment for vaginal cancer. Surgery to remove the cancer is also used. Some women have chemotherapy along with radiotherapy. Chemotherapy can also be given to treat vaginal cancer that has spread to other parts of the body.

You may have one, or a combination, of these treatments.


Radiotherapy for vaginal cancer

Radiotherapy treats cancer using high-energy rays (radiation). They destroy the cancer cells, while doing as little harm as possible to normal cells. It can be given from outside the body (external) or from inside the body (internal radiotherapy). Some women have both external and internal radiotherapy treatment.

Many women with vaginal cancer are treated with radiotherapy. You may have radiotherapy:

  • as a treatment on its own
  • after surgery to reduce the risk of the cancer coming back
  • if the cancer was not completely removed with surgery.

Some women have radiotherapy combined with chemotherapy. This is called chemoradiation. Chemotherapy is usually given once a week during radiotherapy treatment. Having chemotherapy at the same time may make radiotherapy work better. There are more side effects with chemoradiation so you have to be well enough to cope with this treatment.

A cancer doctor who is an expert in treating cancer with radiotherapy (a clinical oncologist) will plan your treatment. They will talk it over with you and answer any questions you have.

External radiotherapy

With external radiotherapy, high-energy x-rays are directed from a machine to the area of the cancer.

It is normally given as a series of short, daily treatments in the hospital radiotherapy department. You have the treatment from Monday–Friday, with a rest at the weekend. Your course may last 4–6 weeks. Radiotherapy isn’t painful, but you have to lie still for a few minutes while it is given.

You will have a CT scan of the area to be treated before your first radiotherapy treatment. Your cancer doctor will use the scan to help them plan your radiotherapy.

Internal radiotherapy (brachytherapy)

Internal radiotherapy is used to give an extra dose of radiation to the tumour after external radiotherapy. The doctor gently inserts an applicator (similar to a plastic tampon) 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.

The staff in the radiotherapy department will explain what will happen. They will show you the equipment before you have treatment.

Side effects of radiotherapy

Your cancer doctor, nurse or radiographer will tell you about the likely side effects of pelvic radiotherapy. They can give you advice on how to manage them and tell you about the treatments that can help.

Most side effects are temporary. They may get worse for a couple of weeks after treatment. After this, side effects usually improve gradually over a few weeks.

Sometimes certain side effects don’t completely go away. Or sometimes, new side effects develop months or years after radiotherapy. These are called late effects.

The side effects of radiotherapy are made worse by smoking. Stopping smoking helps reduce both immediate and late side effects, particularly those that affect the skin. It can be difficult to stop smoking at such a stressful time. If you want help or advice on how to stop, talk to your clinical oncologist, GP or a specialist nurse.

We have more information on giving up smoking that we can send you.

During treatment, you may have some of the side effects explained here. It’s important to tell your radiographer, cancer doctor or specialist nurse about any side effects you have.

Tiredness

Pace yourself so you don’t overdo it and take regular rests. Try to balance this with some physical activity, such as regular short walks. This will help build up your energy levels.

Effects on the skin

Your skin in the treatment area may redden or get darker, and become dry, flaky and itchy. Towards the end of treatment, it may become moist and sore. Your radiographer or nurse will check your skin regularly. Tell them if your skin is sore or you notice any other changes. They can prescribe a cream or dressings to help. They can also prescribe painkillers, if needed.

Pelvic radiotherapy may make the hair around your genital area fall out. It usually grows back a few weeks after radiotherapy is finished.

You may have a slight discharge from the vagina after treatment has finished. It is important to let your doctor or nurse know if it continues for more than a few weeks, or becomes heavy.

Effects on the bowel

Diarrhoea is a common side effect. Your doctor can prescribe drugs to control this. It’s important to drink 2–3 litres of fluid a day if you have diarrhoea.

Effect on the bladder

You may feel you need to pass urine often and have a burning sensation when you pass urine (cystitis). Drinking plenty of fluids will help. Try to avoid or cut down on drinks containing caffeine or alcohol.

Let them know if your side effects don’t improve. If you are having problems, ask your nurse or radiographer for advice.

Early menopause

In younger women, pelvic radiotherapy stops the ovaries working and causes an early menopause. Your periods stop and you may have menopausal side effects, such as:

  • hot flushes and sweats
  • vaginal dryness
  • lower sex drive
  • mood swings and poor concentration.

You can usually have hormonal replacement therapy (HRT) to replace the hormones your ovaries are no longer producing. This can improve some menopausal symptoms. If HRT is not suitable for you or if you don’t want to have it, there are other ways to manage menopausal symptoms.

Your specialist nurse can give you advice about managing menopausal symptoms. The Daisy Network is an organisation for women who have had an early menopause. It also provides information. The menopause means your ovaries are no longer producing eggs. This means you will not be able to get pregnant (become infertile). This can be difficult to cope with and some women may need counselling. Let your nurse know if you find this hard to deal with.

Effects on the vagina

Radiotherapy to the pelvis can make the vagina narrower, less stretchy and drier. Your nurse may recommend you use vaginal dilators (tampon shaped plastic tube) with a lubricant. This is to try to prevent the vagina from narrowing. Your nurse will explain how to use them. Using a dilator regularly may make having sex after treatment easier. It can also make it easier to have internal examinations.

There are lots of vaginal lubricants and creams that help with vaginal dryness. Your doctor can also prescribe hormone creams to help with dryness and vaginal narrowing.

Possible late side effects of radiotherapy

These are side effects that don’t go away, or that develop months or years later. Newer ways of giving radiotherapy are designed help to reduce the chance of developing late effects. Your cancer doctor or nurse can give you more information.

Bowel and bladder effects

The most common late effects are changes to the bowel and bladder. This may cause you to have loose bowel motions, diarrhoea, or feel you need to pass urine more often than before.

Bleeding

Small blood vessels in the bowel and bladder can become more fragile after radiotherapy. This may cause blood to appear in your urine or bowel motions. You may also have bleeding from small blood vessels in the vagina. Always tell your cancer doctor or nurse straightaway if you have bleeding or discharge from any of these areas.

Lymphoedema

Radiotherapy can affect the lymph nodes in the pelvic area. This may cause swelling of one or occasionally both legs, called lymphoedema. You have more risk of lymphoedema if you had surgery as well as radiotherapy. Your nurse will explain what you can do to reduce the risk of lymphoedema. If you notice any swelling in your legs, contact your nurse or doctor straightaway. Always tell your cancer doctor or nurse if you have new symptoms or side effects that don’t improve.


Surgery for vaginal cancer

Some women have surgery as their main treatment. The type of operation you have will depend on where the cancer is in the vagina and how far it has grown. Before the operation, your surgeon and specialist nurse will explain what it involves. You may need some tests before surgery to make sure you are well enough. You usually have this done at a pre-assessment clinic.

Removing the area of the cancer (local excision)

If the cancer is very small, it may be possible to remove it along with a small area of normal-looking tissue surrounding the cancer.

Removing part or all of the vagina (vaginectomy)

Some women may need to have part of the vagina (partial vaginectomy) or all of the vagina (radical vaginectomy) removed. The surgeon may make a new vagina (vaginal reconstruction) using tissue from other parts of the body. This means you will still be able to have sexual intercourse.

Vaginectomy and hysterectomy

If the cancer has spread into surrounding tissue, you may need other organs removed as well as the vagina. Your surgeon may advise removing the womb, ovaries, fallopian tubes and nearby lymph nodes. This operation is called a radical hysterectomy. We have more information about having a hysterectomy.

Pelvic exenteration

Occasionally, if the cancer has spread to organs close by, the surgeon may advise more major surgery. This involves removing part of the bowel and/or bladder as well as the vagina, womb and ovaries. This is called pelvic exenteration. It is major surgery and is only suitable if there are no signs of cancer elsewhere. You also need to be well enough to cope with it. We have separate information about pelvic exenteration.

After your operation

How long you are in hospital for will depend on the type of operation you have. After your operation, the nurses will encourage you to start moving around as soon as possible. This helps prevent complications such as a blood clot or chest infection. You’ll be given support stockings to help prevent blood clots in the legs. You may be asked to wear them for a few weeks after you go home.

It's normal to have some pain or discomfort for a few days. The nurses will make sure you have regular pain killers. If the pain is not controlled, let your doctor or nurse know so they can change your painkillers.

It takes time to recover from surgery and you may feel tired for several weeks. If you have had a hysterectomy, you will need to avoid heavy lifting for at least 12 weeks. Your doctor or nurse will give you advice about your recovery.


Chemotherapy for vaginal cancer

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells.

It may be given:

  • with radiotherapy (called chemoradiation)
  • to treat vaginal cancer that has spread to other parts of the body
  • occasionally before surgery.

You usually have chemotherapy as an outpatient in a chemotherapy day unit. A nurse will give you the drugs, usually as a drip (infusion) into a vein.

Side effects of chemotherapy

Chemotherapy can cause side effects, but they can often be well controlled with medicines. Your doctor or nurse will explain what to expect and give you advice on how to manage them. Most side effects will usually disappear once your treatment is over.

Chemotherapy can reduce the number of white cells in your blood. This will make you more likely to get an infection. Your doctor or nurse will give you advice about what to do if this happens. If you have any signs of infection, you will be given antibiotics.

Other possible side effects include:

Let your doctor or nurse know about any side effects you have.


Effects of vaginal cancer on your sex life

How your sex life is affected will depend on the treatment you have. If you have your cervix and womb removed and vaginal reconstruction, it may not be possible to have a vaginal orgasm. Surgery to the vagina does not affect the clitoris. This means it will still be possible to have an orgasm in other ways without having penetrative sex.

Radiotherapy causes a shortening and narrowing of the vagina, which can make having penetrative sex uncomfortable. Using a dilator and lubricant as advised by your doctor or specialist nurse can help to keep it open. Your doctor can prescribe creams to treat vaginal dryness.

You may not feel like having sex for a while. There may be a period of adjustment for you and your partner. You can still share your feelings for each other by cuddling, massage, kissing and stroking. After treatment you may find that your sex life gradually improves. If you continue to have difficulties, ask your specialist nurse or doctor for advice. They can refer you for more specialised support if needed.


Your feelings

You may have many different emotions, including anger, resentment, guilt, anxiety and fear. These are all normal reactions and are part of the process many people go through in trying to come to terms with their condition.

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.

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