ON THIS PAGE: You will learn about the different types of treatments doctors use for women with vaginal cancer. Use the menu to see other pages.
This section explains the types of treatments that are the standard of care for vaginal cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, you 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 whether the new treatment 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. Clinical trials are an option to consider for treatment and care for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.
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, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.
Descriptions of the common types of treatments used for vaginal cancer are listed below. Vaginal cancer is most often treated with 1 or a combination of treatments: surgery, radiation therapy, and/or chemotherapy. Your care plan may include treatment for symptoms and side effects, an important part of 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 talks 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 particularly important for vaginal cancer because there are different treatment options. Learn more about making treatment decisions.
Concerns about sexual health and having children
Women with vaginal cancer may have concerns about if or how their treatment may affect their sexual health and fertility. These topics should be discussed with the health care team before treatment begins. Premenopausal women who are still potentially able to get pregnant and want to preserve their fertility may be referred to a reproductive endocrinologist (REI). It may be helpful to discuss 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 care.
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 women, 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 woman’s 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. In some women, 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 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 a woman. 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. Women should 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.
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, 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 cancers and is often used in combination with external-beam radiation therapy. A recent study showed that women 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. These are most often done as outpatient procedures.
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 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).
Systemic therapy is the use of medication to destroy cancer cells. This type of medication is given through the bloodstream to reach cancer cells throughout the body. Systemic therapies are generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication. Common ways to give systemic therapies include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).
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 side effects. 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 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. Learn more about your prescriptions by using searchable drug databases.
Physical, emotional, and social 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 care or 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 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 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 treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.
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.
Treatment by stage of vaginal cancer
Different treatments may be recommended for each stage of vaginal cancer. Your doctor will recommend a specific treatment plan for you based on the cancer’s stage and other factors. Detailed descriptions of each type of treatment are provided earlier in this page. Clinical trials may also be a treatment option for each stage.
Stages I and II
Surgical removal of the tumor, including part or all of the vagina and possible removal of pelvic lymph nodes, and in selected patients, followed by radiation therapy with or without low-dose chemotherapy
Internal radiation therapy with or without external-beam radiation therapy
Stages III and IVA
Combined internal radiation therapy and external-beam radiation therapy, often with concurrent low-dose chemotherapy
Systemic chemotherapy in selected patients
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
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 (in a surgery 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. The waste is collected in a pouch worn by the patient. Learn more about colostomies.
For most 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 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 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).
When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. 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. In women who have 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 this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.
People with recurrent cancer often experience emotions such as disbelief or fear. You are encouraged to talk with the health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.
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 many 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.
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 the health 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.
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.