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Vaginal Cancer - Introduction

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will find 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. Use the menu to see other pages. 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 to 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 healthy cells in the vagina change and grow out of control, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor is a tumor that can grow but will not spread. There are 4 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 1 woman out of 1,000 women exposed to DES will develop vaginal cancer.

  • Melanoma. Melanoma can 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.

The next section in this guide is Statistics. It helps explain the way many people are diagnosed with this disease and general survival rates. Use the menu to choose a different section to continue reading in this guide.  

Vaginal Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will find information about the numbers of women diagnosed with vaginal cancer each year. You will learn general information about surviving the disease. Remember, survival rates depend on several factors. Use the menu to see other pages.

Vaginal cancer is uncommon. This year, an estimated 4,620 women in the United States will be diagnosed with vaginal cancer.

It is estimated that 950 deaths from this disease will occur this year.

Survival rates for vaginal cancer vary based on different factors, including the stage (or extent) of the disease at the time of diagnosis. The 5-year survival rate tells you what percent of women live at least 5 years after the cancer is found. Percent means how many out of 100.

If cancer is found at the earliest stage before it has spread (stage I; see Stages), the 5-year survival rate is 84%. If the cancer has not spread outside the vagina (stage II), the 5-year survival rate is 75%. If it is found after the cancer has spread outside of the vaginal wall (Stage III or IV), the 5-year survival rate is 57%.

It is important to remember that statistics describing the number of women who survive this type of cancer are an estimate. The estimate comes from data based on thousands of women with this cancer in the United States each year. So, your own risk may be different. Doctors cannot give a specific time for how long any woman will live with metastatic vaginal cancer. Experts measure the survival statistics every 5 years. This means that the estimate may not show the results of better diagnosis or treatments that have been available for less than 5 years. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts & Figures 2016, and the ACS website.

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by this disease. Use the menu to choose a different section to continue reading in this guide.

Vaginal Cancer - Risk Factors and Prevention

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. Use the menu to see other pages.

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. 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 shows that infection with this virus is a risk factor for vaginal cancer. Sexual activity with someone who has HPV is the most common way someone gets HPV. There are different types of HPV, called strains. Research links some HPV strains more strongly with certain types of cancers. There are vaccines available to protect you from some HPV strains.  

  • 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. 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 you currently smoke

Gardasil, a vaccine used to prevent cervical cancer for girls and women between ages 9 and 26, is approved to prevent vaginal cancer. Gardasil helps prevent infection from the 4 most common strains or types of HPV. The vaccine does not protect people who already have HPV.

Different factors cause different types of cancer. Researchers continue to look into what factors cause this type of cancer. Although there is no proven way to completely prevent this disease, you may be able to lower your risk. Talk with your doctor for more information about your personal risk of cancer.

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems this disease can cause. Use the menu to choose a different section to continue reading in this guide.  

Vaginal Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. Use the menu to see other pages.

Precancerous conditions, such as VAIN (see Introduction), and early-stage vaginal cancer do not often cause symptoms in the early stages. Cancer in later stages can cause symptoms. 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 have any of these changes. Or, the cause of a symptom may be another medical condition that is not cancer.

The most common symptom of vaginal cancer is abnormal vaginal bleeding. Vaginal bleeding during or after menopause may be the sign of a problem and should be discussed with your doctor. 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 any changes you experience, 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 be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Use the menu to choose a different section to continue reading in this guide. 

Vaginal Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They do tests to learn if cancer has spread to a different part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

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:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and medical condition

  • The results of earlier medical tests

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. During a 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, similar to a microscope, that magnifies the cells of the cervix and vagina. 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. A pathologist analyzes the sample(s). 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. An endoscopy 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 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can 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 in 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) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a 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 help the doctor describe the cancer; this is called staging.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to continue reading in this guide.  

Vaginal Cancer - Stages

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. Use the menu to see other pages.

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 the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor 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.

TNM staging system

One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

  • Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?

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 (T)

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 1 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 (N)

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.

Metastasis (M)

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

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.

Grade (G)

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 may help the doctor predict how quickly the cancer will spread.

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 the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Used with permission of the AJCC, Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition, published by Springer-Verlag New York, www.cancerstaging.org. Please note that AJCC’s Eighth Edition (2017) has been released; related changes to the information provided above are underway. Please check back soon for updated staging definitions or talk with your doctor about whether these changes affect your diagnosis.

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Use the menu to choose a different section to continue reading in this guide.  

Vaginal Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will learn about the different methods doctors use to treat women with this type of cancer. Use the menu to see other pages.

This section tells you the treatments that are the standard of care for this type of cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, patients are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn if the new method is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About 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. Cancer care teams include a variety of other health care professionals, including physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

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 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. 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 some surrounding healthy 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) 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, fallopian tubes, and lymph nodes may be removed.

Learn more about the basics of 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 the 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 1 to 2 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). 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. Other 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 1 drug at a time or combinations of different drugs at the same time.

Systemic chemotherapy gets into 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 after 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 is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process. 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, emotional support, and other therapies. You may receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, or 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 palliative 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 can be 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 spreads to a different part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating metastatic vaginal cancer. Doctors can have different opinions about the best standard treatment plan. Clinical trials might be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

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. Palliative care will 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 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 be called having “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. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments 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 suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

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 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 the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and advanced cancer 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 6 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 in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to continue reading in this guide.  

Vaginal Cancer - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will learn more about clinical trials, which are among the ways that new medical approaches are tested to see how well they work. Use the menu to see other pages.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for patients with vaginal cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. Every drug that is now approved by the U.S. Food and Drug Administration (FDA) was tested in clinical trials.

Many clinical trials focus on new treatments. Researchers want to learn if a new treatment is safe, effective, and possibly better than the treatment doctors use now. 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 can be some of the first to get a treatment before it is available to the public. However, there is no guarantee that the new treatment will be safe, effective, or better than what doctors use now.  

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects. There are also clinical trials studying ways to prevent cancer.

Deciding to join a clinical trial 

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 these studies are an excellent way to contribute to 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, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” However, placebos are usually combined with standard treatment in most cancer clinical trials. 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.

Patient safety and informed consent

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 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.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. These may include that the new treatment is not working or there are serious side effects. Clinical trials are 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. 

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for vaginal cancer, learn more in the Latest Research section.

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.

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research. It explains active areas of scientific research for this type of cancer. Use the menu to choose a different section to continue reading in this guide.

Vaginal Cancer - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

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

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.

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

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding vaginal cancer, explore these related items that take you outside of this guide:

The next section in this guide is Coping with Treatment. It offers some guidance in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. Use the menu to choose a different section to continue reading in this guide.

Vaginal Cancer - Coping with Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. This page includes several links outside of this guide to other sections of this website. Use the menu to see other pages.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people don’t experience the same side effects even when given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of cancer treatment “palliative care.” It is an important part of your treatment plan, regardless of age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for vaginal cancer are described within the Treatment Options section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health.

Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

Coping with emotional and social effects

You can have emotional and social effects as well as physical effects after a cancer diagnosis. This may include dealing with difficult emotions, such as anxiety or anger, or managing your stress level. Sometimes, patients have problems expressing how they feel to their loved ones, or people don’t know what to say in return.

Patients and their families are encouraged to share their feelings with a member of their health care team. You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with financial effects

Cancer treatment can be expensive. It is often a big source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost keeps them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Learn more about managing financial considerations, in a separate part of this website.

Caring for a loved one with cancer

Family members and friends often play an important role in taking care of a person with vaginal cancer. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

Caregivers may have a range of responsibilities on a daily or as-needed basis. Below are some of the responsibilities caregivers accept:

  • Providing support and encouragement

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

Learn more about caregiving.

Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they are likely to happen?

  • What can we do to prevent or relieve them?

Be sure to tell your health care team about any side effects that happen during treatment and afterward. Tell them even if you don’t think the side effects are serious. This discussion should include physical, emotional, and social effects of cancer.

Ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan.

The next section in this guide is Follow-up Care. It explains the importance of check-ups after you finish cancer treatment. Use the menu to choose a different section to continue reading in this guide.  

Vaginal Cancer - Follow-Up Care

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will read about your medical care after cancer treatment is completed, and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with cancer does not end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. 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 recommend other tests, including x-rays, CT scans, ultrasound studies, or MRI scans. Tell your doctor about any new symptoms.

Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests as part of regular follow-up care, but testing recommendations depend on several factors including the type and stage of cancer originally diagnosed and the types of treatment given. 

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to ask about any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment you received and develop a survivorship care plan after treatment is completed.

This is a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the general care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her, as well as all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to continue reading in this guide.  

Vaginal Cancer - Survivorship

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will read about how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to see other pages.

What is survivorship?

The word “survivorship” means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

Survivorship is one of the most complicated parts of having cancer. This is because it is different for everyone.

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain of how to cope with everyday life.

Survivors may feel some stress when frequent visits to the health care team end following completion of treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true as new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexuality and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenges you face

  • Thinking through solutions

  • Asking for and allowing the support of others

  • Feeling comfortable with the course of action you choose

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource program of the center where you received treatment.

Changing role of caregivers

Family members and friends may go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving in this article.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make positive lifestyle changes.

People recovering from vaginal cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

In addition, it is important to have recommended medical check-ups and tests (see Follow-up Care) to take care of your health. Cancer rehabilitation may be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible.

Talk with your doctor to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note these links will take you to other sections of Cancer.Net:

  • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The booklet is available as a PDF, so it is easy to print out.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.

  • Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including for survivors in different age groups.

The next section offers Questions to Ask the Doctor to help start conversations with your cancer care team. Use the menu on the side of your screen to choose a different section to continue reading in this guide.  

Vaginal Cancer - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

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. Use the menu to see other pages.

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 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.

Questions to ask after getting a diagnosis

  • 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?

Questions to ask about choosing a treatment and managing side effects

  • 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 available for 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 leading my overall treatment?

  • 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 of cancer care, who can help me?

  • How can I keep myself as healthy as possible during treatment?

Questions to ask about planning follow-up care

  • What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • What follow-up tests will I need, and how often will I need them?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records? 

  • Who will be leading my follow-up care?

  • What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources. It offers more resources on this website beyond this guide that may be helpful to you. Use the menu to choose a different section to continue reading in this guide.  

Vaginal Cancer - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2016

ON THIS PAGE: You will find 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. Use the menu to go back and review other pages.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, 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 links to help you explore beyond this guide to other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Vaginal Cancer. Use the menu to select a different section to continue reading in this guide.