Cancers that start in the vagina (primary vaginal cancer) are rare. This information is about two types – squamous cell and adenocarcinoma. If you need information about other types, contact us free on 0808 808 00 00.
The most common symptoms are:
If you have symptoms, it is important to see your doctor. You may have tests to examine inside the vagina or to collect some cells for tests. If the tests show cancer, you may have further tests before you have treatment.
Treatment may include radiotherapy, chemotherapy or surgery. You may have only one of these. Or you may have a combination of treatments. This depends on:
If being able to get pregnant is still important to you, this may also affect your treatment plan.
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. It is 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 cancers that start in the vagina.
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 the glandular cells in the vagina. These normally make liquid to lubricate the vagina. It usually affects women under 30. But it can affect older women too.
Other rare types of vaginal cancer include:
If you would like more information on any of these, contact our cancer support specialists free on 0808 808 00 00, Monday to Friday, 9am to 8pm.
Certain things called risk factors may increase the risk of developing vaginal cancer. Having a risk factor does not mean you will get cancer. And not having a risk factor does not mean that you will not get it. Below are the main risk factors for vaginal cancer.
Vaginal cancer is more common in women over the age of 60.
The main risk factor for vaginal cancer is infection with the human papilloma virus (HPV). But most people who get HPV will not get vaginal cancer.
HPV is very common and most people are infected with it at some point. It can be passed on through any type of sexual contact with a man or a woman.
Usually the body’s immune system gets rid of the virus naturally. There are no symptoms and often the virus does not cause damage. Most people will never know they had it.
In some people, the immune system does not clear the infection and the virus stays in the body. We do not know exactly why that is. If the virus stays in the vagina, it can start to cause changes in the cells that line the vagina. Rarely, usually over many years, these changes develop into vaginal cancer.
Vaginal cancer is not infectious. You cannot catch it or pass it on to other people.
Your immune system helps protect your body from infection and illness. If the immune system is not working well, it is less likely to get rid of infections like HPV.
VAIN is the name for pre-cancerous changes in cells lining the vagina. It can develop if HPV remains in the vagina for a long time.
If VAIN is not treated, it may develop into vaginal cancer in a small number of women.
Women who have had cervical cancer or pre-cancerous changes in the cervix (CIN) at least 5 years ago have an increased risk of developing vaginal cancer. This is likely to be related to HPV, which is the main cause of cervical cancer and CIN. But most women who have had cervical cancer or CIN will never develop vaginal cancer.
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 very 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 has not 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 yearly 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 is important to see your doctor.
Usually you start by seeing your GP. They will refer you to 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 usually examines the inside of your vagina (internal examination) to check for any lumps or swellings. You also 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 should not be painful, but it may be uncomfortable. If you have questions or worries about having an internal examination, let the nurse or doctor know. They can answer any questions you have and explain ways they can make it easier for you.
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 doctor gently puts an instrument called a speculum into your vagina. This keeps the vagina open, so the doctor can see any lump or swelling.
The doctor may also do an internal examination of your back passage (rectum). They will also feel your groin to check for swollen lymph nodes (sometimes called lymph glands).
This is the same test that is used for cervical screening. It checks for 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 test uses a microscope called a colposcope to look closely at your vagina. You usually have it done at a hospital outpatient clinic.
A specialist doctor or nurse will do the colposcopy. To get ready for the test, you undress from the waist down. You then lie on your back on an examination couch or chair with foot or leg supports.
The nurse or doctor puts an instrument called a speculum into your vagina. This holds the vagina open so that they can see more clearly. They put a liquid on the vagina to show any abnormal areas. Then they shine a light onto the vagina and examine it through the colposcope. The colposcope is on a stand outside your body, between your legs or feet.
The doctor or nurse may take a small sample (biopsy) of cells from the vagina. These will be sent to a laboratory to be examined.
A colposcopy takes about 15 minutes. It is not usually painful. But if a biopsy is taken, you may feel some discomfort.
This is an examination of the vagina and cervix under a general anaesthetic. It allows your doctor to examine you thoroughly without it being uncomfortable. They may remove small samples of tissue (biopsies). Your doctor may also look into your bladder and the lower end of your large bowel (the colon and rectum) to see if the cancer has spread.
You may have some slight bleeding for a couple of days after an EUA. Your doctor or nurse can tell you more about the examination and what to expect afterwards.
If the tests show you have 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. This will help your doctors plan the most appropriate treatment for you. 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 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.
An MRI scan 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.
Waiting for test results can be a difficult time. It may take from a few days to a couple of weeks for the results of your tests to be ready. You may find it helpful to talk with your partner, family or a close friend.
Your specialist nurse can also provide support. You can also talk things over with one of our cancer support specialists on 0808 808 00 00.
The stage of a cancer describes how far it has grown from where it started and if it has spread. Your cancer doctor will tell you the stage of the cancer when they have all your test results. Knowing the stage of the cancer helps your doctors advise you on the most appropriate treatment.
Vaginal cancers are usually staged using a number system. A number between 1 and 4 is given to the tumour, depending on:
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.
Grading refers to the appearance of the cancer cells under the microscope. It gives an idea of how quickly the cancer may develop:
The treatment you have will depend on different factors. These include:
If you are a younger woman, preserving your fertility may be a factor in treatment decisions.
Your cancer doctor and nurse will explain the treatment options and their benefits and disadvantages. It is 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 you.
Radiotherapy is the most commonly used treatment for vaginal cancer. Some women have surgery to remove the cancer. Chemotherapy may be given with radiotherapy. Chemotherapy may be given on its own if the cancer has spread to other parts of the body.
Radiotherapy treats cancer using high-energy rays (radiation). It destroys the cancer cells, while doing as little harm as possible to normal cells. It can be given from outside the body (external radiotherapy) or from inside the body (internal radiotherapy). You may have external radiotherapy followed by internal radiotherapy.
External radiotherapy uses a machine called a linear accelerator. It is similar to a large x-ray machine. A radiographer gives you the treatment in the radiotherapy department at the hospital. You have it as an outpatient once a day from Monday to Friday, with a rest at the weekend. Each session of treatment takes a few minutes. It usually takes about 5 to 6 weeks to have the full course of treatment.
External radiotherapy is painless. It will not make you radioactive and it is safe for you to be around other people. This includes children and pregnant women. Before your first radiotherapy treatment, you will have a CT scan of the area to be treated. Your cancer doctor will use the scan to help plan your radiotherapy.
Internal radiotherapy is used to give an extra dose of radiation to the tumour after external radiotherapy. This can be done in two ways:
This treatment may be used for cancers in the lower part of the vagina. During an operation, the doctor places radioactive needles, tubes or seeds into the cancer. These then release a dose of radiation to the surrounding area.
The doctor gently inserts an applicator (similar to a plastic tampon) into the 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.
Radiotherapy is often given with chemotherapy (see below). Doctors call this chemoradiation. The chemotherapy drugs make the cancer cells more sensitive to radiotherapy. The combination of treatments can be more effective than radiotherapy on its own.
The chemotherapy drug most commonly used is cisplatin. You usually have it once a week throughout your radiotherapy.
The side effects of chemoradiation are similar to radiotherapy side effects. But they can be more severe. Your cancer doctor, radiographer or specialist nurse can give you more information.
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 slowly over a few weeks.
Sometimes certain side effects do not completely go away. Or sometimes new side effects develop months or years after radiotherapy. These are called late effects of pelvic radiotherapy.
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. If you want help or advice on how to stop, talk to your cancer doctor, your GP or a specialist nurse.
During treatment, you may have some of the side effects explained here. It is important to tell your radiographer, cancer doctor or specialist nurse about any side effects you have.
Radiotherapy to the pelvis affects the ovaries. If you are still having periods, radiotherapy will cause an early menopause. This will usually happen 2 to 3 months after the treatment starts. If you are already close to the menopause, it may happen sooner.
If your periods have stopped this does not always mean that you will not get pregnant. You should continue to use contraception to prevent pregnancy. Your cancer doctor or specialist nurse can give you more information.
Your healthcare team will discuss the menopause with you before your treatment starts. They can also give you information about treatments to manage menopausal symptoms, such as hormone replacement therapy (HRT).
Before radiotherapy, some women have an operation to move their ovaries higher up, out of the radiotherapy site. This is called ovarian transposition. The aim is to protect the ovaries and prevent an early menopause. The ovaries can be moved using laparoscopic (keyhole) surgery. Ovarian transposition is not always successful at protecting the ovaries. Some women will still have an early menopause.
The skin in the area being treated sometimes gets dry and irritated. Avoid using perfumed soaps or body wash during treatment, as they could irritate the skin. You will be given advice on looking after your skin. Your doctor can prescribe cream to soothe it if it becomes sore.
You may lose some of your pubic hair. After treatment, it will usually grow back, but may be thinner than it was before.
Tiredness is a common side effect and may continue for months after treatment is over. During treatment, you will need to rest more than usual, especially if you have to travel a long way for treatment each day. But it is good to do gentle exercise when you feel able to, such as walking. Once your treatment is over, slowly increase your activity and try to balance rest periods with exercise such as walking. This will help build up your energy levels.
Radiotherapy can irritate the bladder. You may feel like you need to pass urine more often. You may also have a burning feeling when you pass urine. Your doctor can prescribe medicines to make passing urine more comfortable. Try drinking at least 2 litres (3½ pints) of water or other fluids each day to help with the symptoms.
Radiotherapy to the pelvis may irritate your bowel and cause tummy (abdominal) cramps. If you have cramps, tell your doctor, nurse or radiographer. They can give you medication to help.
You may need to open your bowels more often and you may have diarrhoea. Drink plenty of fluids if you have diarrhoea. Your doctor may also prescribe medication to help manage it. Your doctor, nurse or radiographer may suggest you follow a low-fibre diet. This means avoiding:
during treatment and for a few weeks after it.
External radiotherapy can reduce the number of blood cells your body makes. This is more likely to happen if you are having chemoradiation. If your number of white blood cells is low, you are more prone to infection and may need antibiotics. If your number of blood-clotting cells (platelets) is low, you may bleed or bruise more easily. If your number of red blood cells is low, you may feel tired and you may need a blood transfusion. Your hospital team will arrange for you to have regular blood tests if needed.
You may have a light vaginal discharge after treatment has finished. If it continues or becomes heavy, tell your clinical oncologist or specialist nurse.
Radiotherapy to the pelvic area can sometimes cause late effects. These are side effects that do not go away, or that develop months or years later. If these happen, there are lots of ways they can be managed or treated.
Radiotherapy can make your vagina narrower and less stretchy. The vaginal walls may be dry and thin, and can stick together. This can make penetrative sex and internal examinations uncomfortable.
Your hospital team may recommend you use vaginal dilators to help reduce these effects on your vagina. Dilators are tampon-shaped plastic tubes of different sizes, which you use with a lubricant.
Although dilators are commonly used, there is not strong evidence about how effective they are. Your specialist nurse or doctor will explain the best way to use them.
This can feel uncomfortable. Creams, gels, lubricants or pessaries (small pellets that are put inside the vagina) can help.
There are lots of products you can try. You can buy them in chemists or online. Or your doctor can prescribe them.
Vaginal moisturisers work by drawing moisture into the vaginal tissue. You apply them regularly. You can also use lubricants when you have sex to make it feel more comfortable and pleasurable. Lubricants can be water-based, silicone-based or oil-based. You can buy vaginal moisturisers and lubricants from chemists, some supermarkets or online.
Vaginal dryness can make you more likely to get infections, such as thrush. Let your doctor know if you have symptoms such as itching or soreness.
After pelvic radiotherapy, the blood vessels in the lining of the vagina can become fragile. This means they can bleed more easily, especially after sex. Bleeding may also be caused by the vaginal tissue sticking together, or scar tissue causing the vagina to narrow.
If you have any bleeding, always let your cancer doctor or nurse know. They will examine you and explain whether it is likely to be caused by the radiotherapy. If the bleeding is minor, once you know the cause you may find that it does not trouble you much.
After radiotherapy, some women may have permanent changes to their bowel or bladder.
If your bowel or bladder are affected, you may have to go the toilet more often or more urgently than usual.
The blood vessels in the bowel and bladder can be more fragile. This can cause blood in your urine or poo. If you have bleeding, always tell your cancer doctor or GP so that it can be checked.
Pelvic radiotherapy may increase the risk of swelling in one or both legs. This is called lymphoedema. It is not common, but the risk is higher if you have surgery to remove the lymph nodes as well as radiotherapy. You can reduce the risk of lymphoedema by:
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 gives 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 disappear after treatment has finished.
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 of chemotherapy include:
Let your doctor or nurse know about any side effects you have.
Surgery is usually only used for small stage 1 cancers and for cancers that were not cured by radiotherapy. The type of operation you have will depend on:
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. This is usually 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. Depending on the amount removed, this may make your vagina shorter. The vagina is naturally stretchy, so this may not be noticeable to you. But if you have difficulties with penetrative sex, talk to your specialist nurse or surgeon. They can discuss what may help.
Some women may need to have the upper part of the vagina removed (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. They sometimes do this at the same time as the vaginectomy. Sometimes it is better to do this as a second operation at a later date. Having a vaginal reconstruction means you will still be able to have penetrative sex.
If the cancer has spread into surrounding tissue, your surgeon may need to remove other organs as well as the vagina. They may advise removing
This surgery can be done in different ways:
Your surgeon will talk to you about the type of surgery you will have.
Occasionally, if the cancer has spread to other organs in the pelvis, the surgeon may advise more major surgery. This involves removing part of the bowel or the bladder, or both, 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 anywhere else. You also need to be well enough to cope with it.
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. Your nurse will give you elastic stockings (TED stockings) to help prevent blood clots in the legs. They may ask you to wear them for a few weeks after you go home. You may also have daily injections of a blood-thinning drug.
It is normal to have some pain or discomfort for a few days. The nurses will make sure you have regular painkillers. If the pain is not controlled, let your doctor or nurse know. They can change your painkillers or increase the dose.
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.
How your sex life is affected will depend on the treatment you have. If you have vaginal reconstruction, the new vagina will not make fluid to lubricate itself. You will need to use vaginal lubricants before 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 prevent this. Your doctor can prescribe creams to treat vaginal dryness.
You may not feel like having sex for a while. If you have a partner, you may both need time to get used to any changes. You can still share your feelings for each other through cuddling, massage, kissing and stroking. After treatment, you may find that your sex life slowly 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.
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