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What Is Vaginal Cancer?
Vaginal cancer is a cancer that starts in the vagina. There are several types of vaginal cancer, but the most common is squamous cell carcinoma, a cancer that starts in a layer of cells in the lining of the vagina.
Vaginal Cancer Prognosis and Survival Rates
Vaginal cancer prognosis depends on the type of cancer and the stage at which it is diagnosed.
Vaginal cancer is a rare cancer, accounting for 1% to 2% of cancers in the female genital tract. It occurs primarily in older women; 67 is the average age of those diagnosed.
According to the Centers for Disease Control, in the U.S. in 2020 (the latest year for which data is available), 1,272 women were diagnosed with vaginal cancer and 423 women died from the disease.
The five-year survival rate for vaginal cancer is 51%.
Why Come to CU Cancer Center for Vaginal Cancer
With a 12-doctor team, the gynecologic oncologists at the CU Cancer Center are one of the largest groups of physicians dedicated to women’s cancer care in the United States.
As the only National Cancer Institute-designated Comprehensive Cancer Center in Colorado and one of only four in the Rocky Mountain region, the University of Colorado Cancer Center has doctors who provide cutting-edge, patient-centered vaginal cancer care and researchers focused on diagnostic and treatment innovations.
There are numerous vaginal cancer clinical trials being conducted by CU Cancer Center members at any time. These trials offer patients options to traditional vaginal cancer treatment and can result in remission or increased life spans.
Types of Vaginal Cancer
There are a few main types of vaginal cancer, each named for the type of cell in which it forms.
- Squamous cell carcinomas are the most common form of vaginal cancer, accounting for 70% of all vaginal cancers. This cancer is slow forming and begins in the flat squamous cells in the lining of the vagina.
- Adenocarcinomas, which make up about 15% of vaginal cancers, start in the gland cells. Women over 50 are more likely to be diagnosed with this cancer type, but younger women may get this if they were exposed to diethylstilbestrol (DES) in their mother’s womb.
- Melanoma is a type of cancer that most often forms on sun-exposed parts of the body but can also form in pigment-producing cells called melanocytes that are found in the vagina and other parts of the body.
- Sarcomas begin in cells in muscles, bones, and connective tissue.
Vaginal pre-cancer, or VAIN, is a condition where some of the cells in the vagina look abnormal and may become cancerous over time. Women who have had a hysterectomy (a surgery to remove the uterus) or were previously treated for cervical cancer are more likely to have VAIN.
Risk Factors for Vaginal Cancer
Vaginal cancer has multiple risk factors: behaviors or conditions that increase a person’s chances of getting a disease such as cancer. Risk factors for vaginal cancer include:
- Age (vaginal cancer is largely found in women 40 and older, and nearly half of cases are diagnosed in women who are 70 or older).
- Use of the hormone drug diethylstilbestrol, or DES.
- Human papillomavirus (HPV).
- Cervical cancer.
- Smoking.
- Drinking alcohol.
- Human immunodeficiency virus (HIV).
Symptoms of Vaginal Cancer
Vaginal cancer can usually be treated successfully if it is diagnosed before the cancer has spread to distant parts of the body. Patients with early-stage vaginal cancer may not experience symptoms, but those with later stages of the disease may.
Symptoms of vaginal cancer include:
- Abnormal vaginal bleeding or spotting, especially after sex.
- Pain or a lump or mass in the pelvis.
- Pain during sex.
- Abnormal vaginal discharge.
- Frequent or painful urination.
- Constipation.
- Pain in the pelvis or lower belly.
- Back pain.
- Swelling in the legs.
Screening for Vaginal Cancer
Screening is used to look for cancer before a person shows any symptoms of the disease. Regular HPV and Pap tests can help to detect vaginal cancer.
Diagnosing Vaginal Cancer
Based on a patient’s symptoms and after an initial physical examination, a doctor may order certain tests to determine whether the patient has vaginal cancer. Though testing procedures can vary based on the type of vaginal cancer the doctor is looking
for, common screenings for vaginal cancer include:
- Colposcopy: A colposcope is like a microscope with a light on the end of it. During a colposcopy, the walls of the vagina are spread open with a speculum, and the doctor uses the colposcope to examine the tissues in the vagina. The
colposcope stays outside the vagina.
- Biopsy: During a biopsy, a doctor extracts a sample of tissue from the vagina. These are sent to a laboratory for analysis by a pathologist to determine whether the cells in the sample are cancerous.
- Magnetic resonance imaging (MRI): An MRI uses radio waves and magnetic fields to produce detailed images of the body.
- Computed tomography (CT or CAT) scan: A CT scan uses x-rays to take detailed images of the body and can help determine if cancer has spread to other organs or come back after treatment. A CT-guided needle biopsy uses
a CT scan to help a doctor guide a biopsy needle into a suspected tumor.
- Positron emission tomography (PET) scan: A slightly radioactive form of sugar is injected into the blood, where it is taken in by cells in the body. Since cancer cells grow faster than normal cells, they take in larger amounts of
the sugar. Doctors use PET scans to look for possible areas of cancer spread, and to determine if suspicious areas seen in other imaging tests are cancer or not.
- Endoscopic tests: Some tests for vaginal cancer involve the use of an endoscope, a tubelike instrument with a camera on the end of it. These include a proctosigmoidoscopy, which checks for the spread of cancer to the rectum and colon, and a cystoscopy, which checks for spread to the bladder.
Stages of Vaginal Cancer
After diagnosing the presence of vaginal cancer, the doctor will identify the stage of the disease. The stage is determined by several factors, including where exactly the disease formed, how extensive it is, and whether and how much it has spread.
Doctors typically use the TNM system to determine the stage of vaginal cancer. The TNM system assesses the size and extent of the tumor (T) and whether it has ulcerated; whether the cancer has spread to nearby lymph nodes (N); and the presence and extent of metastasis (M) to distant lymph nodes, bones, and organs.
After the TNM assessment, the doctor will assign an overall stage number from I to IV, which can be further broken down based on the size of the original tumor and the extent to which the cancer has spread. In general, the lower the stage the better the prognosis and treatment options.
Vaginal Cancer Stages
Stage IA: Cancer is in the vagina only and is not larger than 2 centimeters. The cancer has not spread to nearby lymph nodes or distant sites in the body.
Stage IB: Cancer is in the vagina only and is larger than 2 centimeters. The cancer has not spread to nearby lymph nodes or distant sites in the body.
Stage IIA: Cancer has grown through the wall of the vagina but has not reached the pelvic wall. The cancer is not larger than 2 centimeters, and it has not spread to nearby lymph nodes or distant sites in the body.
Stage IIB: Cancer has grown through the wall of the vagina but has not reached the pelvic wall. The cancer is larger than 2 centimeters, and it has not spread to nearby lymph nodes or distant sites in the body.
Stage III: Cancer can be any size and may be growing into the pelvic wall. It may also be blocking the flow of urine, causing the kidneys not to work. The cancer may have spread to nearby lymph nodes in the pelvis or groin, but it has not spread to other lymph nodes or distant sites.
Stage IVA: The cancer is growing into the bladder or rectum, or it is growing out of the pelvis. It may have spread to nearby lymph nodes in the pelvis or groin, but it has not spread to other lymph nodes or distant sites.
Stage IVB: The cancer has spread to distant organs such as the liver or lungs. It may also have spread to the bones. It can be any size.
Treatments for Vaginal Cancer
The treatment for vaginal cancer is customized to each patient and depends on the stage at which the patient is diagnosed, and the patient’s general health.
Vaginal cancer care teams may include multiple health care specialists, including primary care providers, gynecologists, gynecologic oncologists, medical oncologists, hematologists, and radiation oncologists, as well as nurse practitioners, physician assistants, nurses, psychologists, social workers, and rehabilitation specialists. CU Cancer Center doctors offer specialized care for patients with vaginal cancer.
Treatments for vaginal cancer include radiation therapy, surgery, and chemotherapy. Patients may receive one or more of these treatments in combination. Some patients may also be eligible to participate in clinical trials — doctor-led research studies of new or experimental procedures or treatments.
Radiation Therapy for Vaginal Cancer
Radiation therapy is the most common treatment for vaginal cancer. It uses high-powered energy to kill cancer cells. A doctor who specializes in radiation therapy to treat cancer is a radiation oncologist. The two main types of radiation therapy used to treat vaginal cancer are external beam radiation and intracavitary brachytherapy. Vaginal cancer is most commonly treated with a combination of both types of radiation therapy.
External-beam radiation therapy (EBRT) is the most common radiation treatment and uses a machine located outside the body to focus a beam of X-rays on the area with the cancer.
Intracavitary brachytherapy, or internal radiation therapy, places radioactive materials inside the body to provide a localized treatment. In the case of vaginal cancer, radioactive materials are placed into a cylinder that is inserted into the vagina. In LDR brachytherapy, the cylinder stays in place for 1–2 days, and the patient must remain in a hospital bed throughout the treatment. In HDR brachytherapy, the cylinder stays in place for a shorter period in an outpatient procedure. Treatments are given 1¬–2 weeks apart.
Surgery for Vaginal Cancer
Surgeries for vaginal cancer include local — or wide — excision, vaginectomy, trachelectomy, and hysterectomy.
Local excision: A local — or wide — excision is a surgery to remove the cancer, along with a nearby rim of normal tissue. This procedure is often used as a treatment for VAIN. For some cancers, surgeons also remove a small number of lymph nodes to check for cancer spread.
Vaginectomy: Vaginectomy is surgery to remove the vagina. In a partial vaginectomy, only part of the vagina is removed, and in a radical vaginectomy, the entire vagina is removed along with the tissue around it.
Trachelectomy: A trachelectomy is surgery to remove the cervix, which is near the upper part of the vagina in which cancer most often starts.
Hysterectomy: In some cases of vaginal cancer, the uterus and cervix must be removed to get rid of all the cancer cells. This surgery is called a hysterectomy.
Chemotherapy for Vaginal Cancer
Chemotherapy uses drugs to kill rapidly growing cancer cells. Drugs are either injected into a vein or taken orally. Chemotherapy may be given along with radiation therapy prior to surgery.
Chemotherapy drugs for vaginal cancer include cisplatin, carboplatin, fluorouracil (5-FU), paclitaxel (Taxol), docetaxel (Taxotere), and irinotecan.
The University of Colorado (CU) Cancer Center partners with UCHealth, Children’s Hospital Colorado, and Rocky Mountain Regional VA to provide clinical care. Please make an appointment with one of our clinical partners to be seen by a CU Cancer Center doctor.
UCHealth Cancer Care - Anschutz Medical Campus
1665 Aurora Court Anschutz Cancer Pavilion
Aurora, CO 80045
720-848-0300
UCHealth Cherry Creek Medical Center
100 Cook Street
Denver, CO 80206
720-848-0000
UCHealth Cancer Center - Highlands Ranch
1500 Park Central Drive
Highlands Ranch, CO 80129
720-516-1100
UCHealth Lone Tree Medical Center
9548 Park Meadows Drive
Lone Tree, CO 80124
720-848-2200
Children's Hospital Colorado:
13123 East 16th Avenue
Aurora, CO 80045
720-777-6740
Rocky Mountain Regional VA Medical Center:
1700 North Wheeling Street
Aurora, CO 80045-7211
303-399-8020
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Information reviewed by Saketh Guntupalli, MD in January 2024.