Vaginal Cancer: Types of Treatment

Approved by the Cancer.Net Editorial Board, 09/2022

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with vaginal cancer. Use the menu to see other pages.

This section explains the types of treatments, also known as therapies, that are the standard of care for vaginal cancer. “Standard of care” means the best treatments known. Information in this section is based on medical standards of care for vaginal cancer in the United States. Treatment options can vary from one place to another.

Clinical trials may also be an option for you, which is something you can discuss with your doctor. A clinical trial is a research study that tests a new approach to treatment. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How vaginal cancer is treated

In cancer care, different types of doctors who specialize in cancer, called oncologists, 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 other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, occupational therapists, and others. Learn more about the clinicians who provide cancer care.

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. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of conversations are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is important for vaginal cancer because there are different treatment options. Learn more about making treatment decisions.

The common types of treatments used for vaginal cancer are described below. Vaginal cancer is often treated with 1 treatment or a combination of treatments: surgery, radiation therapy, and/or chemotherapy. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.


Concerns about sexual health and having children

A vaginal cancer diagnosis may bring concerns about if or how cancer treatment may affect sexual health and fertility, or the ability to become pregnant. These topics should be discussed with the health care team before treatment begins. If the patient has not yet experienced menopause and is still potentially able to get pregnant, talking with a reproductive endocrinologist (REI) about how to preserve fertility may be helpful. This discussion should include what options for fertility preservation are covered by your health insurance. There may also be charitable funds available to help with the costs of this type of care. 

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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. A gynecologic oncologist is a doctor who specializes in treating vaginal cancer using surgery.

Surgery may be the only treatment needed for a very small vaginal cancer.

Surgical options for vaginal cancer include:

  • Vaginectomy. This is the removal of part or all of the vagina, which may include the pelvic lymph nodes. In some people, the operation is called a radical or modified radical vaginectomy because tissues next to the vagina also need to be surgically removed. A gynecologic or reconstructive surgeon can repair the vagina or create a new vagina with grafts of tissue from other parts of the body. Sexual intercourse may still be possible after this type of surgery, but a lubrication aid may be needed.

  • Hysterectomy. In many cases when surgery is performed, the uterus and the other internal reproductive organs must be removed to help with the complete removal of vaginal cancer. In addition to the uterus, the ovaries, fallopian tubes, and lymph nodes may be removed. Sometimes, the operation is called a radical or modified hysterectomy and may be performed in conjunction with a radical or modified vaginectomy.

Learn more about the basics of cancer surgery.

Coping with surgery for vaginal cancer

Many people experience a range of feelings after vaginal surgery, such as loss, sadness, or anxiety. Some people may feel that they have lost their identity. 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 begin again. Talk with the health care team about finding additional information or support in coping with this surgery. Learn more about emotional concerns and physical concerns.

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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, in combination with chemotherapy, 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, or schedule, usually consists of a specific number of treatments given over a set period of time.

Internal radiation therapy. When radiation treatment is given using implants, it is called internal radiation therapy, also known as brachytherapy. Types of brachytherapy include intracavitary radiation therapy and interstitial radiation therapy techniques.

Brachytherapy is very useful for treating vaginal cancer and is often used in combination with external-beam radiation therapy. A recent study showed that people with vaginal cancer who received brachytherapy lived longer.

One way of giving intracavitary radiation therapy involves placing hollow tubes in the vagina next to the tumor so that a precise dose of radiation can be inserted into the tubes and directly applied to the tumor. The radioactive substance is left in place in the vagina for several minutes, and patients must stay in bed during this time. This is most often done as an outpatient procedure, meaning there is no overnight stay in the hospital.

Another method is interstitial radiation therapy, in which radioactive material is inserted with special needles directly into the tumor. For this procedure, patients are admitted into the hospital.

Side effects of radiation therapy. Side effects from radiation therapy depend on the dose used, the area targeted, and the type of radiation therapy. Side effects 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, dryness of the vagina, 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. Talk with your health care team about the possible side effects of your specific radiation therapy and how they can be managed.

Learn more about the basics of radiation therapy. For more information on radiation therapy for gynecologic cancers, see the American Society for Therapeutic Radiology and Oncology's pamphlet, Radiation Therapy for Gynecologic Cancers (PDF; please note that this link takes you to a separate, independent website).

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The treatment plan may include medications to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.

This treatment is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication. Medications are often given through an intravenous (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally). If you are given oral medications to take at home, be sure to ask your health care team about how to safely store and handle them.

The type of systemic therapy used for vaginal cancer is chemotherapy. Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

A chemotherapy regimen, or 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 symptoms related to the cancer. A patient may receive 1 drug at a time or a combination of different drugs given at the same time.

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.

Typically, when radiation therapy (see above) to the pelvis is used, a low dose of chemotherapy is given to make the radiation therapy more effective. This combination of treatment is referred to as "chemoradiation."

The side effects of chemotherapy depend on the individual and the dose used, but they 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 early menopause. Learn more about sexual health and reproductive health concerns.

Learn more about the basics of chemotherapy.

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. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases.

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Physical, emotional, social, and financial effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative and supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative and supportive care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative and supportive care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative and supportive care options. Talking with a pelvic physical therapist may be helpful to relieve vaginal side effects, including pain and sexual function. Many patients also benefit from talking with a social worker and participating in support groups for help with coping with this diagnosis. Ask your doctor about these resources, too.

Cancer care is often expensive, and navigating health insurance can be difficult. Ask your doctor or another member of your health care team about talking with a financial navigator or counselor who may be able to help with your financial concerns.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative and supportive care in a separate section of this website.

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Treatment by stage of vaginal cancer

Different treatments may be recommended for each stage of vaginal cancer. The general options by stage are described below. For more detailed descriptions of each treatment approach, see “How vaginal cancer is treated,” above. Your doctor will work with you to develop a specific treatment plan for you based on your specific diagnosis and needs. Clinical trials may also be a treatment option for each stage.

Stage I or II

  • Surgical removal of the tumor, including part or all of the vagina and possible removal of pelvic lymph nodes, and in select patients, followed by radiation therapy with or without low-dose chemotherapy

  • Internal radiation therapy with or without external-beam radiation therapy

Stage III or IVA

  • Combined internal radiation therapy and external-beam radiation therapy, often with concurrent low-dose chemotherapy

  • Systemic chemotherapy in specific patients 

Stage IVB

  • Radiation therapy

  • Systemic chemotherapy

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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 also 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

People 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 and supportive care will be important to help relieve symptoms and side effects.

If the bladder is removed (in a surgery called a cystectomy), a small piece of intestine will be attached to the abdominal wall, allowing the person 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 person with vaginal cancer may 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. The waste is collected in a pouch worn by the patient. Learn more about colostomies.

For many people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of your health care team. It may be helpful to talk with other patients, such as through a support group or other peer support program.

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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 is 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 returns 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).

If a recurrence happens, a new cycle of testing will begin to learn as much as possible about it. After this testing is done, you and your doctor will talk about the 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.

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. When there is a recurrent pelvic cancer after radiation therapy to the pelvis and if no metastatic disease is found outside the pelvis, a very extensive operation called a "pelvic exenteration" might be considered to provide a chance to cure the cancer. The operation removes the vagina and often the bladder and rectum. Radiation therapy and/or chemotherapy may be used for treatment.

Your doctor may suggest clinical trials that are studying new ways to treat recurrent vaginal cancer. Whichever treatment plan you choose, palliative and supportive care will be important for relieving symptoms and side effects.

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

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If treatment does not work

Recovery from vaginal 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 for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

Planning for your future care and putting your wishes in writing is important, especially at this stage of disease. Then, your health care team and loved ones will know what you want, even if you are unable to make these decisions. Learn more about putting your health care wishes in writing.

People who have advanced cancer and who are expected to live less than 6 months may want to consider 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 talk with your doctor or a member of your palliative care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option 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.

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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 read in this guide.