Treatment

The treatment of vaginal cancer depends on the size and location of the tumor, whether the cancer has spread, and the woman's overall health. In addition, treatment may also be based on whether the woman plans to have children. In many cases, a team of doctors (including a gynecologic oncologist, surgeon, and radiation oncologist) will work with the woman to determine the best treatment plan. 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.

This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe effective and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the Clinical Trials section.

Vaginal cancer is most often treated with one or a combination of treatments: surgery, radiation therapy, and/or chemotherapy. Each treatment is described in more detail below, followed by an outline of treatment options based on the stage and type of the disease.

Surgery. Surgery is the primary treatment for vaginal cancer. A surgical oncologist is a doctor who specializes in treating cancer using surgery. The goal of surgery is to remove the tumor. The type of surgery used depends on the stage of the cancer and other factors. Surgery for vaginal cancer includes:

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 plastic 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.

If the cancer has spread to other parts of the body, it may be necessary to also remove the lower colon, rectum, or bladder (removal of the bladder is called a cystectomy). If the woman's bladder is removed, 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 woman's rectum or part of her colon is removed, the remaining intestine will be attached to the abdominal wall, so solid waste can pass through a small opening into a bag worn at the front of the stomach (called a colostomy). 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.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill 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.

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 kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. Some people may receive chemotherapy in their doctor’s office; others may go to the hospital. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a specific time. The goal of chemotherapy can be to destroy cancer remaining after surgery, slow tumor growth, or reduce side effects.

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 (the drugs 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, 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 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.

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

Recurrent vaginal cancer

If the cancer returns after the original treatment, 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. Participation in clinical trials is another treatment option.

Advanced vaginal cancer

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 are similar to those experienced when the disease was first diagnosed.

• 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 advanced vaginal cancer that has spread to the bladder and rectum may receive internal radiation therapy and external-beam radiation therapy or surgery, which may be combined with radiation therapy.

Treatment for advanced vaginal cancer that has spread to other parts of the body may include radiation therapy to relieve symptoms and chemotherapy. Participation in clinical trials is another treatment option.

Find out more about common terms used during cancer treatment.