Vaginal cancer

Vaginal cancer is a rare type of cancer.

Introduction

Vaginal cancer is a rare type of cancer. There are around 260 new cases of vaginal cancer diagnosed in the UK each year.

The most common symptom of vaginal cancer is painless bleeding from the vagina. See your doctor if you experience any of the following symptoms:

  • You experience any abnormal vaginal bleeding, such as bleeding between periods or bleeding after sex.
  • You experience vaginal bleeding and you have already had the menopause.
  • Your usual pattern of periods has changed, such as having irregular periods or heavier periods than usual.
  • You experience problems with urination, such as pain when urinating.

While it is highly unlikely that any of these symptoms are due to vaginal cancer, they will still need to be investigated by your doctor.

Read more about the symptoms of vaginal cancer.

Treating vaginal cancer

Vaginal cancer can be treated with a combination of radiotherapy, surgery and chemotherapy. Read more about treating vaginal cancer.

Your chances of making a recovery depend on how far advanced your cancer is when it is diagnosed. Vaginal cancer is given stages from 1 to 4, with stage 1 being the least advanced and stage 4 meaning that the cancer has spread beyond your pelvis. Read more about diagnosing vaginal cancer.

Around 9 out of 10 women with stage 1 vaginal cancer live for more than five years after being diagnosed. For women with stage 4 vaginal cancer, around a fifth live for more than five years.

The outlook for vaginal cancer is also slightly better for women who are under 60 when the cancer is diagnosed, and for those who have good health overall.

Read more about vaginal cancer statistics from Cancer Research UK.

Who’s at risk?

The exact causes of vaginal cancer are unknown, but possible risk factors include:

  • smoking
  • your age - 7 out of 10 cases of vaginal cancer are in women over 60
  • being infected with a particularly persistent type of the human papilloma virus (HPV)

Since September 2008 there has been a national programme to vaccinate girls aged 12 to 13 against HPV. Read more about the HPV vaccination, including who can have it and how it is given.

Read more about the causes of vaginal cancer and preventing vaginal cancer.

Types of vaginal cancer

There are two main types of vaginal cancer:

  • primary vaginal cancer, where the cancer begins inside the vagina
  • secondary vaginal cancer, where the cancer begins in another part of the body (usually the reproductive system), such as the cervix (neck of the womb) and then spreads to the vagina

The rest of this topic will focus on primary vaginal cancer. Read more about cervical cancer, ovarian cancer and cancer of the womb.

Primary vaginal cancer

There are three main types of primary vaginal cancer, depending on the type of cells that the cancer begins in.

Squamous cell carcinoma is the most common type of vaginal cancer, accounting for more than 9 out of 10 cases.

Adenocarcinoma accounts for around 1 in 10 cases of vaginal cancer. A very rare type of adenocarcinoma, called clear cell adenocarcinoma, can sometimes affect teenagers and women in their twenties.

Melanoma is also rare and accounts for around 3 in 100 cases of vaginal cancer.

Want to know more?

  • Macmillan: Vaginal cancer
  • Cancer Research UK: Vaginal cancer

Symptoms

The most common symptom of vaginal cancer is vaginal bleeding. Bleeding often occurs during or after sexual intercourse and may be accompanied by pain.

If you still have regular periods (you are pre-menopausal), the bleeding may happen in between your normal periods. You may also notice that your period is much heavier than usual. Read more about periods.

Some women with vaginal cancer also experience vaginal bleeding after sexual intercourse.

Less common symptoms of vaginal cancer include:

  • pain when urinating (dysuria)
  • a sudden, urgent need to urinate
  • blood in your urine
  • pain during sexual intercourse
  • pelvic pain
  • smelly or bloody vaginal discharge
  • an itch in your vagina
  • a lump in your vagina

When to see your doctor

It's important to see your doctor if:

  • You experience vaginal bleeding and you have already had the menopause.
  • Your usual pattern of periods has changed, such as having irregular or heavier periods than usual.
  • You have persistent, abnormal vaginal bleeding, particularly persistent bleeding that is associated with sexual intercourse.
  • You have abnormal vaginal discharge.
  • You experience problems with urination, such as pain when urinating.

While it is highly unlikely that these symptoms are due to vaginal cancer, they still need to be investigated by your doctor.

Causes

The exact cause of vaginal cancer is unknown but there are risk factors that increase your chances of getting it, including HPV, smoking and your age.

How does cancer begin?

Cancer begins with a change in the structure of DNA, which is found in all human cells. DNA provides cells with a basic set of instructions, such as when to grow and when to reproduce.

A change in the DNA's structure (genetic mutation) alters these instructions so that the cells carry on growing and reproducing uncontrollably. This produces a lump of tissue (a tumour).

How does cancer spread?

Left untreated, cancer can quickly grow and spread to other parts of your body, such as your bones and organs. The cancer can either be spread through the bloodstream or lymphatic system.

The lymphatic system is a network of channels and glands called lymph nodes, which are distributed throughout your body. They remove unwanted bacteria from your body and are part of your immune system (the body’s defence system).

Increased risk

Evidence suggests that certain risk factors can increase your likelihood of developing vaginal cancer.

Human papilloma virus (HPV)

Human papilloma virus (HPV) is the name given to a family of viruses that affect the skin and the moist membranes that line the body, such as those in the cervix, anus, mouth and throat. HPV is spread during sexual intercourse, including anal and oral sex.

There are many different types of HPV and up to 8 out of 10 people are infected with HPV at some time during their lives. In most cases the virus does not cause any harm and you will not go on to develop vaginal cancer.

However, HPV is present in more than two thirds of women with vaginal cancer, which suggests that HPV may increase your risk of developing vaginal cancer.

HPV is known to cause changes in the cells of the cervix, which can lead to cervical cancer. It is thought that the virus could have a similar effect on the cells of the vagina.

HPV-16 is the type of HPV that is most strongly linked to vaginal cancer. The HPV vaccination, which is offered to girls aged 12 to 13, protects against this type of HPV.

Read more about the HPV vaccination.

Diethylstilbestrol

The medicine diethylstilbestrol is another known risk factor for vaginal cancer. It can cause a type of vaginal cancer called clear cell adenocarcinoma.

Diethylstilbestrol was widely prescribed for pregnant women from 1938 to 1971. At the time, it was thought (wrongly) that diethylstilbestrol could help reduce the risk of miscarriage.

In 1971, researchers discovered a link between diethylstilbestrol and cancer in the children of the women given the medicine. The use of diethylstilbestrol in pregnant women was banned.

The risk of vaginal cancer associated with using diethylstilbestrol is small. As it is now around 40 years since diethylstilbestrol was banned, clear cell adenocarcinoma is very rare.

Other possible risk factors

Other possible risk factors for vaginal cancer include:

  • a previous history of cervical intra-epithelial neoplasia (CIN) – non-cancerous cells that can sometimes become cancerous
  • smoking
  • a history of reproductive cancers, such as cervical cancer or vulval cancer
  • your age – 7 out of 10 cases of vaginal cancer occur in women who are over 60
  • having HIV

Diagnosis

Before diagnosing vaginal cancer, your doctor will ask you about your symptoms and the pattern of your vaginal bleeding. They may refer you for blood tests to rule out other causes of vaginal bleeding, such as infection.

Referral to a gynaecologist

If your doctor cannot find an obvious cause of your symptoms, they will probably refer you to a gynaecologist for further testing. A gynaecologist is a specialist in treating conditions of the female reproductive system.

If you are referred to a gynaecologist, further tests could include:

  • an internal vaginal examination to look for any unusual lumps or swellings
  • using a special instrument (colposcope) that acts like a magnifying glass to study your vagina in greater detail – this is called a colposcopy

Read more about colposcopies, including how they are performed and what the results mean.

If testing reveals that there may be abnormal tissue inside your vagina, a small sample of the tissue will be removed and checked under a microscope for cancerous cells. This is known as a biopsy.

Further testing

If the results of the biopsy suggest that you have cancer, and there is a risk that the cancer may have spread, you will probably require further testing to assess how widespread the cancer is.

These tests may include:

Follow the links to find out more about these procedures.

Staging

Healthcare professionals use a staging system to describe how far vaginal cancer has advanced.

  • Stage 1: the cancer is contained inside the vagina.
  • Stage 2: the cancer is beginning to spread through the walls of the vagina towards the pelvis.
  • Stage 3: the cancer has spread into your pelvis and may have spread to nearby lymph nodes.
  • Stage 4a: the cancer has spread beyond your vagina and into organs such as your bladder or back passage (rectum).
  • **Stage 4b: the cancer has spread into organs further away, such as the lungs.

In stage 1 vaginal cancer, it may be possible to achieve a cure using radiotherapy alone. As well as or instead of radiotherapy, you may also have a section of your vagina removed.

In stages 2, 3 and 4a vaginal cancer, a combination of radiotherapy, chemotherapy and surgery may be required to get rid of the cancer.

In stage 4b vaginal cancer, a cure is not usually possible. However, radiotherapy and chemotherapy can relieve the symptoms and slow down the spread of cancer.

Read more about how vaginal cancer is treated.

Want to know more?

Macmillan: Staging and grading of vaginal cancer

Treatment

Treatment for vaginal cancer will depend on how advanced the cancer is. Possible treatments include radiotherapy, chemotherapy and surgery.

If your doctor gives you an urgent referral because they think you have cancer, you have the right to be seen by a specialist within two weeks.

Cancer treatment team

You will have multi-disciplinary teams (MDTs) involved in treating your vaginal cancer.

If you have vaginal cancer, you may see several or all of these professionals as part of your treatment.

Deciding what treatment is best for you can be difficult. Your cancer team will make recommendations, but the final decision will be yours.

Before going to hospital to discuss your treatment options, you may find it useful to write a list of questions to ask the specialist. For example, you may want to find out the advantages and disadvantages of particular treatments.

Radiotherapy

There are several ways radiotherapy can be used to treat vaginal cancer. It can be used:

  • as an initial treatment to cure the cancer
  • in combination with chemotherapy (chemoradiation)
  • after surgery to prevent the cancer from returning
  • to control symptoms when a cure is not possible (palliative radiotherapy)

There are two ways radiotherapy for vaginal cancer can be given, as follows:

  • a machine beams high-energy rays at your vagina and pelvis (external radiotherapy or brachytherapy)
  • a small radioactive device, which looks like a tampon and is known as a source, is inserted into your vagina (internal radiotherapy)

The type of radiotherapy you receive depends on where the cancer is in your body. For example, internal radiotherapy may be used if the cancer is in the lining of your vagina, and external radiotherapy may be used if the cancer is deeper in the tissues of the vagina. Many women receive a combination of internal and external radiotherapy.

External radiotherapy is usually given in short daily sessions from Monday to Friday, with a break at the weekend.

High dose rate brachytherapy involves a series of brief internal treatments, and low dose rate takes 24 hours for one treatment.

While it kills cancerous cells, radiotherapy can also affect healthy tissue and has a number of side effects, including:

  • sore, red skin (like sunburn)
  • vaginal discharge
  • pain while passing urine
  • loss of taste
  • loss of appetite
  • tiredness
  • feeling sick (nausea)

Read more about radiotherapy, including how it is performed and other side effects.

Effects on sex

Having radiotherapy may cause you to lose interest in sex, particularly if you have other side effects such as tiredness or nausea, or if you are anxious about your condition or treatment.

Radiotherapy to the vaginal area can cause scar tissue to form in your vagina. Scar tissue is less stretchy than normal tissue and can lead to your vagina being narrower. It may be possible to treat this using a vaginal dilator, which is a device that is inserted into your vagina to help prevent it narrowing. A recent study into vaginal dilators found there was little research into the benefits of using them after radiotherapy. It is possible that using vaginal dilators while you are still healing may cause more damage to your vagina. You should discuss the risks and benefits of vaginal dilators with your treatment team.

Having sex regularly after your treatment can also help prevent your vagina narrowing.

If you experience vaginal dryness or pain when having sex, you can use lubricants, or ask your treatment team to prescribe appropriate medication.

Menopause and fertility

If you have external radiotherapy to your pelvis, you may experience an early menopause (if you have not had the menopause already).

If you have an early menopause, you will no longer be able to have children (infertility). This is often very upsetting, particularly for younger women who want to have a family. Before your treatment, your treatment team will discuss all the options and available support with you.

Surgery

There are four different types of surgery used to treat vaginal cancer:

  • removing the upper section of your vagina (partial vaginectomy)
  • removing all of your vagina (radical vaginectomy)
  • removing all of your vagina, your womb, ovaries and fallopian tubes, and nearby lymph nodes (radical vaginectomy and radical hysterectomy)
  • removing all of your vagina and surrounding tissue, including your bladder and/or rectum (back passage) (pelvic exenteration)

Partial vaginectomy

A partial vaginectomy can be used to treat stage 1 vaginal cancer, where radiotherapy has failed to remove the cancer or where a woman prefers to have surgery rather than radiotherapy because she still wants to have children.

Your surgeon will remove the cancerous section of the vagina as well as some surrounding healthy tissue, just in case a small number of cancerous cells have spread.

Your surgeon will repair the defect in the vaginal wall, which means you will be able to have normal sexual intercourse after you have recovered from the operation.

Radical vaginectomy

A radical vaginectomy is used to treat cases of advanced stage 1 and stage 2 vaginal cancer. The surgeon will remove most, or all, of your vagina.

A plastic surgeon may be able to make a new vagina using skin, muscle and tissue taken from another part of your body, usually one of your thighs or buttocks.

There are a number of different vaginal reconstruction techniques, although it is not always possible to create a fully functioning vagina.

Radical hysterectomy

A radical hysterectomy is often performed at the same time as a radical vaginectomy (see above).

During a radical hysterectomy, all of the reproductive system is removed, including the womb, fallopian tubes, ovaries and nearby lymph nodes.

Read more about hysterectomies, including how to prepare for the operation and your recovery.

Pelvic exenteration

Pelvic exenteration is used to treat recurrent or advanced cases of vaginal cancer. It is major surgery, so you will need to be in good health before the procedure can be performed.

If you no longer have a bladder, you will need another way to pass urine. One solution is for your surgeon to make a hole (stoma) in your abdomen. A bag is then attached to the stoma so that urine can be passed into it. The bag is known as a urostomy bag.

Similarly, as you may no longer have a rectum, you will need a way to pass stools (faeces) out of your digestive system. Another stoma can be made and attached to a collection bag, known as a colostomy bag. Read more about colostomies.

It may be possible to reconstruct your rectum and attach it to the remaining section of your bowel once this has healed. In this case, you will only need a temporary colostomy.

As pelvic exenteration is major surgery, it may take you several months to fully recover from the operation.

Chemotherapy

Chemotherapy is usually used in combination with radiotherapy or to control symptoms when a cure is not possible (called palliative chemotherapy).

Chemotherapy is usually given by injection (called intravenous chemotherapy).

Like radiotherapy, the powerful cancer-killing medicines used in chemotherapy can also damage healthy tissue and cause a range of side effects. Side effects of chemotherapy include:

  • nausea
  • vomiting
  • hair loss (see below)
  • fatigue

During chemotherapy, hair loss may or may not occur depending on the type of medications used.

Chemotherapy can also weaken your immune system, making you more vulnerable to infection. However, the side effects should stop once treatment has finished.

Read more about chemotherapy, including how it is performed and more about the possible side effects.

Clinical trials

As vaginal cancer is rare, you may be asked to take part in a clinical trial. Clinical trials are an important way for healthcare professionals to learn more about the best way to treat specific conditions.

Most clinical trials involve comparing a new treatment with an existing treatment to determine whether the new treatment is more or less effective.

If you do receive a new treatment, there is no guarantee that it will be more effective than an existing one.

You can find out whether there are currently any [clinical trials for vaginal cancer] or ask your care team if there are clinical trials in your area. Your care team can explain the advantages and disadvantages of taking part.

Read more about [clinical trials and medical research], including how they are regulated and how to take part.

Want to know more?

  • Macmillan - treatment for vaginal cancer
  • Cancer Research UK - treating vaginal cancer

Complications

Treatment for vaginal cancer can have a significant emotional impact, particularly in women who have not yet reached the menopause and need to have radiotherapy or a hysterectomy.

Both these treatments trigger an early menopause, which means that many women find out they will never be able to have children. This can be particularly traumatic for women who are very young when the cancer develops.

The removal of some or all of the vagina can be traumatic for pre- and post-menopausal women alike, and many women feel less "womanly" than they did before.

It is not uncommon to feel a sense of loss and bereavement after treatment and, in some women, this may trigger depression.

Getting support

Talking to other women who have had similar treatment can give you emotional support and reassurance. Your doctor or the hospital staff may be able to recommend a suitable local support group or charities may provide some:

  • Macmillan Cancer Support has information about groups you can join

The Hysterectomy Association provides hysterectomy support services, including a one-to-one telephone support line, counselling and "preparing for hysterectomy" workshops.

Prevention

There is a strong link between certain types of human papilloma virus (HPV) and the development of abnormalities that may develop into vaginal cancer.

HPV vaccination

There is now a vaccine that provides protection against the two strains of HPV that are thought to be responsible for most cases of vaginal cancer. HPV vaccination also protects against cervical cancer, which is far more common than vaginal cancer.

Girls should be offered the HPV vaccine as part of their routine childhood vaccination programme. The vaccine should be given to girls who are 12 to 13 years old, with three doses given over six months.

Read more about the HPV vaccination.

Safe sex

The HPV vaccine will not provide complete protection against HPV but it will help to reduce the risk of transmission. HPV is spread through intimate contact, such as unprotected penetrative sex, so using a condom is the best way to avoid it.

Before having sex with someone new, it is a good idea for you both to be tested for sexually transmitted infections (STIs) at a sexual health clinic. All tests are free and confidential.

Read more about STIs and sexual health clinics.

Content supplied by NHS Choices