View All Pages

Vaginal Cancer - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Vaginal Cancer. To see other pages, use the menu on the side of your screen. Think of that menu as a roadmap to this full guide.

About the vagina

The vagina or birth canal is the opening through which menstrual fluid leaves a woman’s body and babies are born. It is connected to the cervix, which is the opening of the uterus or womb, and the vulva (folds of skin around its opening).

Usually, the vagina is in a collapsed position with its walls touching. The walls have many folds that allow the vagina to open and expand during sexual intercourse and vaginal childbirth. The vaginal lining is kept moist by mucus released from glands in the cervix.

The vaginal walls have a thin layer of cells called the epithelium, which contains cells called squamous epithelial cells. The vaginal wall, underneath the epithelium, is made up of connective tissue, involuntary muscle tissue, lymph vessels, and nerves.

About vaginal cancer

Vaginal cancer is an uncommon cancer of the female reproductive system. Vaginal cancer begins when normal cells in the vagina change and grow uncontrollably, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can spread to other parts of the body. A benign tumor means the tumor will not spread. There are four types of vaginal cancer:

Squamous cell carcinoma. Squamous cell carcinoma can develop in the cells lining the vagina, most often in the area closest to the cervix. Squamous cell carcinoma makes up 85% to 90% of vaginal cancers. It develops slowly through a precancerous condition (changes in cells that may, but do not always, become cancer) called vaginal intraepithelial neoplasia or VAIN.

Adenocarcinoma. Adenocarcinoma begins in the vaginal gland tissue. It makes up about 5% to 10% of vaginal cancers.

Clear cell adenocarcinoma. This cancer occurs in women whose mothers took the drug diethylstilbestrol (DES) during pregnancy between the late 1940s and 1971. It is estimated that one woman out of 1,000 women exposed to DES will develop vaginal cancer.

Melanoma. Melanoma can also begin on the skin of the vagina or other internal organs. Melanoma is usually found on skin exposed to the sun and often appears as a dark-colored tumor on the lower or outer parts of the vagina. Learn more about melanoma.

To continue reading this guide, use the menu on the side of your screen to select another section.  

Vaginal Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will find information about how many women learn they have vaginal cancer each year and some general survival information. Remember, survival rates depend on several factors. To see other pages, use the menu on the side of your screen.

Vaginal cancer is uncommon. Only 1% of women with a cancer of the reproductive system have vaginal cancer. This year, an estimated 3,170 women in the United States will be diagnosed with vaginal cancer. It is estimated that 880 deaths from this disease will occur this year.

The overall five-year survival rate is the percentage of women who survive at least five years after the cancer is detected, excluding those who die from other diseases. For vaginal cancer, it varies based on different factors, including the stage (or extent) of the disease at the time it is diagnosed. If cancer is found at the earliest stage before it has spread (stage I; see Stages), the five-year survival rate is 84%. If the cancer not spread outside the vagina (stage II), the five-year survival rate is 75%. If it is found once the cancer has spread outside of the vaginal wall (Stage III or IV), the five-year survival rate is 57%.

Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of women with this type of cancer in the United States, but the actual risk for a particular individual may differ. It is not possible to tell a woman how long she will live with vaginal cancer. Because the survival statistics are measured in multi-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer.  Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts & Figures 2014 and the ACS website.

To continue reading this guide, use the menu on the side of your screen to select another section.  

Vaginal Cancer - Medical Illustrations

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will find a basic drawing about the main body parts affected by this disease. To see other pages, use the menu on the side of your screen.

Women's Cancers Anatomy

Larger image

To continue reading this guide, use the menu on the side of your screen to select another section.  

Vaginal Cancer - Risk Factors and Prevention

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. To see other pages in this guide, use the colored boxes on the right side of your screen, or click “Next” at the bottom.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors may raise a woman's risk of developing vaginal cancer:

Age. Squamous cell carcinoma most often occurs in women between 50 and 70 years old; approximately half of women with vaginal cancer are older than 60.

Human papillomavirus (HPV). Research indicates that infection with this virus is a risk factor for vaginal cancer. HPV is most commonly passed from person to person during sexual activity. There are different types, or strains, of HPV, and some strains are more strongly linked with certain types of cancers. Many types of cancer caused by HPV are associated with precancerous conditions that develop before the cancer. HPV vaccines protect against specific strains of the virus. Learn more about HPV and cancer.

Smoking. Smoking may increase a woman’s risk of developing vaginal cancer.

Diethylstilbestrol (DES). Women whose mothers took this drug during their pregnancy between the late 1940s and 1971 have an increased risk of clear cell adenocarcinoma. The average age of diagnosis is 19. Because most women of mothers who took DES are now between 40 and 70, the number of cases has declined. However, the long-term risks of DES exposure are not known.

Cervical cancer. Women who have had cervical cancer or cervical precancerous conditions have an increased risk of vaginal cancer.

Previous radiation therapy. Women who have had radiation therapy in the vaginal area have an increased risk of vaginal cancer.

Hysterectomy. Women who have had a hysterectomy, which is the removal of part or all of the uterus, have an increased risk of vaginal cancer.

Pessary use. Long-term vaginal irritation from using a pessary can increase a woman’s risk of vaginal cancer. A pessary is a device used to keep a sagging uterus in place.

Prevention and Early Detection

All women should have an annual gynecologic examination. During this exam, the doctor will take a family medical history and perform a general physical examination of the pelvis, during which the doctor will feel a woman’s uterus, vagina, cervix, and other reproductive organs to check for any unusual changes. Regular pelvic examinations can help detect cancer or precancerous conditions at an early stage.

In addition, research has shown that certain factors can help prevent vaginal cancer:

  • Delaying first sexual intercourse until the late teens or older
  • Avoiding sexual intercourse with multiple partners
  • Avoiding sexual intercourse with someone who has had many partners
  • Practicing safe sex, including condom use, although condoms cannot fully protect against HPV
  • Having regular Pap tests (see Diagnosis) to find and treat precancerous conditions
  • Not starting to smoke
  • Quitting smoking, if a smoker

Gardasil, a vaccine used to prevent cervical cancer for girls and women between ages 9 and 26, is also approved to prevent vaginal cancer. Gardasil helps prevent infection from the four most common strains or types of HPV. The vaccine does not protect people who are already infected with HPV.

Research continues to look into what factors cause this type of cancer and what women can do to lower their personal risk. There is no proven way to completely prevent this disease, but there may be steps you can take to lower your cancer risk. Talk with your doctor if you have concerns about your personal risk of developing this type of cancer.

To continue reading this guide, use the menu on the side of your screen to select another section.  

Vaginal Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu on the side of your screen.

Precancerous conditions, such as VAIN (see Overview), and early-stage vaginal cancer do not often cause symptoms in the early stages, but cancer in later stages can cause symptoms. However, many cases of VAIN and early vaginal cancer can be found through regular gynecologic examinations or Pap tests (see Diagnosis).

Women with vaginal cancer may experience the following symptoms or signs. Sometimes, women with vaginal cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer.

The most common symptom of vaginal cancer is abnormal vaginal bleeding. Vaginal bleeding during or after menopause is not normal and is a sign of a problem. Other symptoms of vaginal cancer include:

  • Abnormal vaginal discharge
  • Difficulty or pain when urinating
  • Pain during sexual intercourse
  • Pain in the pelvic area (the lower part of the abdomen between the hip bones)
  • Pain in the back or legs
  • Swelling in the legs

If you are concerned about one or more of the symptoms or signs on this list, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section helps explain what tests and scans may be needed to learn more about the cause of the symptoms. Use the menu on the side of your screen to select Diagnosis, or you can select another section, to continue reading this guide.  

Vaginal Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages in this guide, use the menu on the side of your screen.

Doctors use many tests to diagnose cancer and find out if it has spread to another part of the body, called metastasis. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has spread. This list describes options for diagnosing this type of cancer, and not all tests listed will be used for every woman. Your doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition
  • Type of cancer suspected
  • Signs and symptoms
  • Previous test results

In addition to a physical examination, the following tests may be used to diagnose vaginal cancer:

Pelvic examination. The doctor feels the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum to check for any unusual changes.

Pap test. The doctor gently scrapes the outside of the cervix and vagina and takes a sample of cells for testing. During the test, a woman will usually feel some pressure as the doctor takes the sample of the cells, but there is usually no pain.

Colposcopy. The doctor may do a colposcopy to check the vagina and cervix for any abnormalities. A colposcope is a special instrument that magnifies the cells of the cervix and vagina, similar to a microscope. The colposcope gives the doctor a lighted, magnified view of the tissues of the vagina and the cervix. The colposcope is not inserted into the woman’s body and the examination is not painful, can be done in the doctor’s office, and has no side effects. This examination can be performed on pregnant women.

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed during the biopsy is analyzed by a pathologist. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. The type of biopsy performed will depend on the location of the tissue being biopsied.

If the biopsy indicates that a woman has vaginal cancer, the doctor will refer her to a gynecologic oncologist, a doctor who specializes in treating this type of cancer. The specialist may suggest imaging tests to see if the cancer has spread beyond the vagina.

X-ray. An x-ray is a way to create a picture of the structures inside of the body using a small amount of radiation.

Endoscopy. This test allows the doctor to see inside the body with a thin, lighted, flexible tube called an endoscope. The person may be sedated as the tube is inserted through the mouth, anus, vagina, urethra, or a small surgical opening. Sedation is giving medication to become more relaxed, calm, or sleepy.

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow.

Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging.

The next section helps explain the different stages for this type of cancer. Use the menu on the side of your screen to select Stages, or you can select another section, to continue reading this guide.

Vaginal Cancer - Stages

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

One tool that doctors use to describe the stage is the TNM system. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:

  • How large is the primary tumor and where is it located? (Tumor, T)
  • Has the tumor spread to the lymph nodes? (Node, N)
  • Has the cancer metastasized to other parts of the body? (Metastasis, M)

The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Here are more details on each part of the TNM system for vaginal cancer:

Tumor. Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information is listed below.

TX: The primary tumor cannot be evaluated.

T0: There is no evidence of cancer in the vagina.

Tis: The tumor is carcinoma in situ, an early cancer found only in one layer of cells that has not spread to nearby tissue.

T1: The tumor is in the vagina and has not spread through the vaginal wall or to other parts of the body.

T2: The tumor has spread through the vaginal wall and surrounding tissue, but not to the walls of the pelvis.

T3: The tumor has spread to the pelvic wall.

T4: The tumor has spread to the bladder, rectum, or other areas of the body.

Node. The “N” in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the pelvis and groin are called regional lymph nodes. Depending on the exact location of the tumor (upper third, middle third, or lower third of the vagina), the lymph nodes near the hips or upper thighs may also be involved. Lymph nodes in other parts of the body are called distant lymph nodes.

NX: The lymph nodes cannot be evaluated.

N0: Cancer has not spread to the regional lymph nodes.

N1: Cancer has spread to the regional lymph nodes.

Distant metastasis. The "M" in the TNM system indicates whether the cancer has spread to other parts of the body.

MX: Metastasis cannot be evaluated.

M0: The cancer has not spread to other parts of the body.

M1: The cancer has spread to another part of the body.

Grading

Grade. Doctors also describe this type of cancer by its grade (G), which describes how much cancer cells look like healthy cells when viewed under a microscope. The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the cancer looks similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the cancerous tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor. The cancer’s grade can help the doctor predict how quickly the cancer will spread. In general, the lower the tumor’s grade, the better the prognosis.

GX: The tumor grade cannot be evaluated.

G1: The tumor cells are well differentiated (contain many healthy-looking cells).

G2: The tumor cells are moderately differentiated (more cells appear abnormal than healthy).

G3: The tumor cells are poorly differentiated (most of the cells appear abnormal).

G4: The tumor cells are undifferentiated (the cells barely resemble healthy cells).

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, M, and G classifications.

Stage 0: The tumor is called carcinoma in situ. In other words, the cancer is found only in the first layer of cells lining the vagina, not in the deeper tissue (Tis, N0, M0).

Stage I: The tumor has not spread through the vaginal wall or to other parts of the body (T1, N0, M0).

Stage II: The tumor has spread through the vaginal wall, but not to the walls of the pelvis (T2, N0, M0).

Stage III: Vaginal cancer is called stage III in either of these conditions:

  • Cancer has spread to the lymph nodes in the pelvis (T1, T2, or T3; N1, M0).
  • Cancer has spread to the pelvic wall (except the bladder), but not the lymph nodes (T3, N0, M0).

Stage IVA: Cancer has spread to the bladder, rectum, or beyond the pelvis. The lymph nodes may or may not be involved (T4, any N, M0).

Stage IVB: Any cancer that has spread to a distant part of the body (any T, any N, M1).

Recurrent: Recurrent cancer is cancer that has come back after treatment. If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010) published by Springer-Verlag New York, www.cancerstaging.net.

Information about the cancer’s stage will help the doctor recommend a treatment plan.  The next section helps explain the treatment options for this type of cancer. Use the menu on the side of your screen to select Treatment Options, or you can select another section, to continue reading this guide.  

Vaginal Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will learn about the different ways doctors use to treat women with this type of cancer. To see other pages, use the menu on the side of your screen.

This section outlines treatments that are the standard of care (the best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new approach to treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Clinical trials may test such approaches as a new drug, a new combination of standard treatments, or new doses of current therapies. Your doctor can help you review all treatment options. For more information, see the Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team.

Descriptions of the most common treatment options for vaginal cancer are listed below. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Vaginal cancer is most often treated with one or a combination of treatments: surgery, radiation therapy, and/or chemotherapy. Learn more about making treatment decisions.

Women with vaginal cancer may have concerns about if or how their treatment may affect their sexual function and fertility (ability to have children), and these topics should be discussed with the health care team before treatment begins.

Surgery

Surgery is the primary treatment for vaginal cancer. A surgical oncologist is a doctor who specializes in treating cancer using surgery. Surgery is the removal of the tumor and surrounding tissue during an operation. The type of surgery used depends on the stage of the cancer and other factors. Surgical options for vaginal cancer include:

Laser surgery. Laser surgery is the use of a focused beam of light that burns the cancer off the skin. It can be used to remove precancerous cells or a tumor. Additional tissue surrounding the tumor (called a margin) also may be removed to be certain that all cancer has been destroyed.

Excision. This is the surgical removal of the tumor and some of the surrounding healthy tissue. Vaginal repair using skin from other parts of the woman's body may be necessary.

Vaginectomy. This is the removal of the vagina, which may include the pelvic lymph nodes. Often, a reconstructive surgeon can create a new vagina with grafts of tissue from other parts of the woman’s body. The woman will be able to have sexual intercourse, but she will need to use a lubrication aid.

Radical hysterectomy. If the cancer has spread to other parts of the woman’s reproductive system, the uterus, ovaries, and fallopian tubes, as well as lymph nodes may be removed.

Learn more about cancer surgery.

Coping with vaginal surgery

Many women experience a range of feelings after vaginal surgery, such as loss, sadness, or anxiety. Some women may feel that they have lost their identity as women. Others have questions about whether sexual intercourse can continue after surgery.

Before surgery, it is important to ask the surgeon about the procedure, the possible side effects, and when sexual intercourse can resume. Women should talk with their doctors about finding additional information or support in coping with this surgery. Learn more about coping with gynecologic surgery and emotional and physical concerns.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. Radiation therapy may be used alone or after surgery. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. One method is intracavity radiation therapy, in which tiny tubes of a radioactive substance are placed in the vagina for one to two days. The woman must stay in bed during this time. Another method is interstitial radiation therapy, in which radioactive material is injected directly into the tumor.

Side effects depend on the dose used, the area targeted, and the type of radiation therapy (internal or external). General side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most of these side effects go away soon after treatment is finished. Specific side effects may include the narrowing of the vagina, damage to healthy vaginal tissue, and irritation of the intestines. The vagina may shorten and narrow so much that sexual intercourse is not possible. To prevent this, the vagina may need to be stretched with a plastic tube called a vaginal dilator several times a week.

Learn more about radiation therapy. For more information about radiation therapy for gynecologic cancers, see the American Society for Therapeutic Radiology and Oncology's pamphlet, Radiation Therapy for Gynecologic Cancers.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. The goal of chemotherapy can be to destroy cancer remaining after surgery, slow tumor growth, or reduce side effects. A patient may receive one drug at a time or combinations of different drugs at the same time.

Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Although chemotherapy can be given orally (by mouth), most drugs are given intravenously (IV) for vaginal cancer. IV chemotherapy is either injected directly into a vein or through a catheter, a thin tube temporarily put into a large vein to make injections easier. Intravaginal chemotherapy (drugs that are put directly into the vagina) may be used to treat early-stage vaginal cancer.

The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. Other potential side effects include the inability to become pregnant and symptoms of premature menopause. Learn more about sexual and reproductive health concerns.

Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care can help a person at any stage of illness. People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, and radiation therapy. Talk with your doctor about the goals of each treatment in the treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and supportive care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it is addressed as quickly as possible. Learn more about palliative care

Treatment options by stage

Stage 0

  • Surgery to remove all or part of the vagina
  • Internal radiation therapy
  • Laser surgery
  • Intravaginal chemotherapy

Stage I (squamous carcinoma)

  • Internal radiation therapy with/without external-beam radiation therapy
  • Removal of the tumor with possible radiation therapy
  • Removal of the vagina with/without lymph nodes

Stage I (adenocarcinoma)

  • Radical hysterectomy with the removal of the lymph nodes and possible radiation therapy
  • Internal radiation therapy with/without external-beam radiation therapy
  • Removal of the tumor and lymph nodes followed by internal radiation therapy

Stage II

  • Combined internal radiation therapy and external-beam radiation therapy
  • Surgery, followed by possible radiation therapy

Stage III

  • Combined internal radiation therapy and external-beam radiation therapy
  • Surgery, followed by possible radiation therapy

Stage IVA

  • Combined internal radiation therapy and external-beam radiation therapy
  • Surgery, followed by possible radiation therapy

Stage IVB

  • Radiation therapy
  • Chemotherapy

Metastatic vaginal cancer

If cancer has spread to another location in the body, it is called metastatic cancer. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about seeking a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials.

Stage IV vaginal cancer is the most advanced stage of the disease. At this stage, the cancer has spread beyond the vagina to the bladder, rectum, lymph nodes of the pelvis, or other organs, such as the bones or lungs. The symptoms of advanced vaginal cancer can include:

  • Unusual vaginal bleeding
  • Abnormal vaginal discharge
  • Difficulty or pain when urinating
  • Pain during sexual intercourse
  • Pain in the pelvic area
  • Pain in the back or legs
  • Nausea and vomiting
  • Abnormal bowel function

Women with vaginal cancer that has spread to the bladder and rectum may receive internal radiation therapy and external-beam radiation therapy, and/or surgery. Supportive care will also be important to help relieve symptoms and side effects.

If the woman's bladder is removed (called a cystectomy), a small piece of intestine will be attached to the abdominal wall, allowing her to periodically drain urine by placing a slim, hollow tube into a surgically created opening. A plastic bag worn at the front of the stomach can be used for continual draining.

If the rectum or part of the colon is removed, a woman with vaginal cancer many need to have a colostomy. This is a surgical opening, or stoma, through which the colon is connected to the abdominal surface to provide a pathway for waste to exit the body; such waste is collected in a pouch worn by the patient. Learn more about colostomies.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called “no evidence of disease” or NED. 

A remission can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding the risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence, including whether the cancer’s stage has changed. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above such as surgery, chemotherapy, and radiation therapy but they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Surgery may be performed to remove the cervix, uterus, lower colon, rectum, and/or bladder, depending on where the recurrence began and the type of surgery previously performed. Radiation therapy and/or chemotherapy may also be used for treatment.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

If treatment fails

Recovery from cancer is not always possible. If treatment is not successful, the disease may be called advanced or terminal cancer.

This diagnosis is stressful, and this is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than six months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help cope with the loss. Learn more about grief and loss.

The next section helps explain clinical trials, which are research studies. Use the menu on the side of your screen to select About Clinical Trials, or you can select another section, to continue reading this guide.  

Vaginal Cancer - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu on the side of your screen.

Doctors and scientists are always looking for better ways to treat patients with vaginal cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.  

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and manage the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that studies are the only way to make progress in treating vaginal cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with vaginal cancer.

Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

For specific topics being studied for vaginal cancer, learn more in the Latest Research section.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends. 

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

The next section helps explain the areas of research going on today about this type of cancer. Use the menu on the side of your screen to select Latest Research, or you can select another section, to continue reading this guide.  

Vaginal Cancer - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. To see other pages, use the menu on the side of your screen.

Doctors are working to learn more about vaginal cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

HPV research. Researchers are working to learn more about the link between HPV and vaginal cancer.

Enhanced surgical and radiation techniques. Advances are being made in surgery and radiation therapy to increase cure rates and reduce treatment side effects. This includes vaginal reconstructive surgery after advanced surgery to treat the cancer.

New chemotherapy. Researchers continue to investigate new drugs and new combinations of existing treatments for vaginal cancer, such as combining chemotherapy with radiation therapy.

Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current vaginal cancer treatments in order to improve patients’ comfort and quality of life.

To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases now.

The next section addresses how to cope with the symptoms of the disease or the side effects of its treatment. Use the menu on the side of your screen to select Coping with Side Effects, or you can select another section, to continue reading this guide.  

Vaginal Cancer - Coping with Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Fear of treatment side effects is common after a diagnosis of cancer, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative or supportive care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

Common side effects from each treatment option for vaginal cancer are described in detail within the Treatment Options section. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Side effects depend on a variety of factors, including the cancer’s stage, the length and dosage of treatment(s), and your overall health.

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them. And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with vaginal cancer. Learn more about caregiving.

In addition to physical side effects, there may be emotional and social effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team, such as a social worker, who can help with coping strategies, including concerns about managing the cost of your cancer care

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the After Treatment section or talking with your doctor.

The next section helps explain medical tests and check-ups needed after finishing cancer treatment. Use the menu on the side of your screen to select After Treatment, or you can select another section, to continue reading this guide.  

Vaginal Cancer - After Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will read about your medical care after cancer treatment is finished and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

After treatment for vaginal cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. Although there are no specific guidelines, women should visit their doctors regularly for physical and pelvic examinations and a Pap test. Follow-up care is essential for women who have finished vaginal cancer treatment. The doctor may also recommend other tests, including x-rays, CT scans, ultrasound studies, or MRI scans. Tell your doctor about any new symptoms. ASCO offers cancer treatment summary forms to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed

Women recovering from vaginal cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes.

The next section offers a list of questions you may want to ask. Use the menu on the side of your screen to select Questions to Ask the Doctor, or you can select another section, to continue reading this guide.  

Vaginal Cancer - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu on the side of your screen.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

  • What type of vaginal cancer do I have?
  • Can you explain my pathology report (laboratory test results) to me?
  • What is the stage of my cancer? What does this mean?
  • What are my treatment options?
  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?
  • What clinical trials are open to me? Where are they located, and how do I find out more about them?
  • What treatment plan do you recommend? Why?
  • Who will be doing the surgery? How experienced is this surgeon with this type of cancer?
  • Who will be part of my health care team, and what does each member do?
  • Who will be coordinating my overall treatment and follow-up care?
  • Will I need reconstructive surgery?
  • What are the possible side effects of treatment, both in the short term and the long term?
  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?
  • How will this treatment affect my sex life, and for how long?
  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?
  • If I’m worried about managing the costs related to my cancer care, who can help me with these concerns?
  • How can I keep myself as healthy as possible during treatment?
  • What are the chances that the cancer will recur?
  • What follow-up tests will I need, and how often will I need them?
  • What support services are available to me? To my family?
  • Whom should I call for questions or problems?

The next section offers some more resources that may be helpful to you. Use the menu on the side of your screen to select Additional Resources, or you can select another section, to continue reading this guide.  

Vaginal Cancer - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Vaginal Cancer. To go back and review other pages, use the menu on the side of your screen.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond. Here are a few sections that may get you started in exploring the rest of Cancer.Net:

- Search for a cancer specialist in your local area using this free database of doctors from the American Society of Clinical Oncology.

Review dictionary articles to help understand medical phrases and terms used in cancer care and treatment.

- Read more about the first steps to take when newly diagnosed with cancer.

- Find out more about clinical trials as a treatment option.

Learn more about coping with the emotions that cancer can bring, including those within a family or a relationship.

Find a national, not-for-profit advocacy organization that may offer additional information, services, and support for people with this type of cancer.

- Explore next steps a person can take after active treatment is complete.

This is the end of Cancer.Net’s Guide to Vaginal Cancer. Use the menu on the side of your screen to select another section to continue reading this guide.