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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:
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 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).
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.
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.
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.
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.
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:
Squamous cell vaginal cancer is more common in older women.
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.
Women who have had radiotherapy to the pelvis may have a very slightly increased risk of vaginal cancer.
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.
The most common symptoms of vaginal cancer are:
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.
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.
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).
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.
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.
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.
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.
You have blood tests to check your general health.
You may have a chest x-ray to check your lungs are healthy.
A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. The scan takes 10 to 30 minutes and is painless. It uses a small amount of radiation, which is 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. This may make you feel hot all over for a few minutes. It is important to let your doctor know if you are allergic to iodine or have asthma, because you could have a more serious reaction to the injection.
You will probably be able to go home as soon as the scan is over.
This test uses magnetism to build up a detailed picture of areas of your body. The scanner is a powerful magnet so you may be asked to complete and sign a checklist to make sure it is safe for you. The checklist asks about any metal implants you may have, such as a pacemaker, surgical clips or bone pins, etc.
You should also tell your doctor if you have ever worked with metal or in the metal industry as very tiny fragments of metal can sometimes lodge in the body. If you do have any metal in your body, it is likely that you will not be able to have an MRI scan. In this situation, another type of scan can be used. Before the scan, you will be asked to remove any metal belongings including jewellery.
Some people are given an injection of dye into a vein in the arm, which does not usually cause discomfort. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test, you will 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. It is also noisy, but you will be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.
This is a combination of a CT scan, which takes a series of x-rays to build up a three-dimensional picture, and a positron emission tomography (PET) scan. A PET scan uses low-dose radiation to measure the activity of cells in different parts of the body.
PET-CT scans give more detailed information about the part of the body being scanned. You may have to travel to a specialist centre to have one. You cannot eat for six hours before the scan, although you may be able to drink. A mildly radioactive substance is injected into a vein, usually in your arm. The radiation dose used is very small. You will wait for at least an hour before you have the scan. It usually takes 30 to 90 minutes. You should be able to go home after the scan.
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 4 is divided into:
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.
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 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:
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.
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 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.
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.
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.
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.
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.
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.
If you are having problems, ask your nurse or radiographer for advice. Let them know if your side effects don’t improve.
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:
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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 is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells.
It may be given:
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.
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.
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.
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.
Our online community is also a good place to meet people who may be in a similar situation.
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