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Vaginal Cancer - Introduction

Approved by the Cancer.Net Editorial Board, 08/2017

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 for this complete 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, which are folds of skin around the vaginal 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. Underneath the epithelium, the vaginal wall is made up of connective tissue, involuntary muscle tissue, lymph vessels, and nerves.

About precancerous lesions in the vagina

Vaginal intraepithelial neoplasia (VaIN), or vaginal dysplasia, is a condition in which abnormal cells in the vagina can become cancer in some people. These abnormal cells are often found with cervical dysplasia, also known as cervical intraepithelial neoplasia (CIN), a precancerous lesion of the cervix. In most patients, these lesions are associated with human papillomavirus (HPV) infections (see Risk Factors and Prevention).

The treatment for these potentially precancerous lesions includes surgical removal, laser surgery, and medications, including estrogen hormone therapy. Laser surgery is the use of a focused beam of light that burns the cancer off the vaginal wall.

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 the precancerous condition called vaginal intraepithelial neoplasia or VaIN, described above.

  • 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. Although it is rare, melanoma can begin in the vagina. Melanomas are usually found on skin in parts of the body commonly exposed to the sun, but it can rarely develop where there is no sun exposure. Melanomas appears as dark-colored lesions with irregular borders. Learn more about melanoma.

The next section in this guide is Statistics. It helps explain the number of people who are diagnosed with this disease and general survival rates. You may use the menu to choose a different section to read in this guide.

Vaginal Cancer - Statistics

Approved by the Cancer.Net Editorial Board, 08/2017

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

Vaginal cancer is uncommon. Approximately 1 of every 1,100 women will be diagnosed with the disease during her lifetime. This year, an estimated 5,350 women in the United States will be diagnosed with vaginal cancer. Recent research has shown that about 75% of vaginal cancers diagnosed from 2008 through 2012 were due to human papillomavirus or HPV (see Risk Factors and Prevention). A woman’s risk for vaginal cancer increases with age. Similar to cervical cancer, vaginal cancer is more common among groups of women who are less likely to have access to screening for cervical cancer.

It is estimated that 1,430 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. The 5-year survival rate for women with any stage of vaginal cancer is 47%.

Because vaginal cancer is rare, its survival rates are given in ranges. If cancer is found at the earliest stage before it has spread (stage I; see Stages), the 5-year survival rate ranges from 75% to 95%%. If the cancer has not spread outside the vagina (stage II), the 5-year survival rate is 50% to 80%. If it is found after the cancer has spread outside of the vaginal wall (stage III or IV), the 5-year survival rate ranges from 15% to 60%.

It is important to remember that statistics on the survival rates for women with vaginal cancer are an estimate. The estimate comes from annual data based on the number of women with this cancer in the United States. Also, experts measure the survival statistics every 5 years. So the estimate may not show the results of better diagnosis or treatments that have been available for less than 5 years. Talk with your doctor if you have any questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts & Figures 2017: Special Section – Rare Cancers in Adults, and the ACS website (January 2019).

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

 

 

Vaginal Cancer - Medical Illustrations

Approved by the Cancer.Net Editorial Board, 08/2017

ON THIS PAGE: You will find drawings of the main body parts affected by this disease. Use the menu to see other pages.

Women's Cancers Anatomy

This illustration shows a frontal and sagittal (side) view of a woman’s reproductive system. The frontal section shows the fallopian tubes, 2 small ducts that link the 2 ovaries (1 on each side) to the hollow, pear-shaped uterus. The lower, narrow part of the uterus is called the cervix, which leads to the vagina. The uterus is located in the pelvis, between the bladder and rectum, and the vagina is located behind the urethra, which connects to the bladder. Copyright 2003 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

The next section in this guide is Risk Factors and Prevention. It explains what factors may increase the chance of developing this disease. You may use the menu to choose a different section to read in this guide

Vaginal Cancer - Risk Factors and Prevention

Approved by the Cancer.Net Editorial Board, 08/2017

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. Around 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.

  • 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.

  • 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 whose mothers who took DES are now between 50 and 70, the number of cases has decreased substantially, and now this is a rare tumor. The long-term risks of DES exposure are not known.

Prevention and early detection

The HPV vaccine Gardasil is approved by the U.S. Food and Drug Administration (FDA) to prevent cervical cancer and vaginal precancer and cancer. Gardasil helps prevent infection from the most common types, called strains, of HPV.

Regular gynecologic examinations can help detect cancer or precancerous conditions at an early stage in women with risk factors for vaginal cancer. During a gynecologic 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.

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

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. You may use the menu to choose a different section to read in this guide.  

Vaginal Cancer - Symptoms and Signs

Approved by the Cancer.Net Editorial Board, 08/2017

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.

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 a different medical condition that is not cancer.

Precancerous conditions, such as VaIN (see Introduction), and early-stage vaginal cancer do not often cause symptoms. 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).

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

  • Abnormal bowel function

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 figure 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. You may use the menu to choose a different section to read in this guide.  

Vaginal Cancer - Diagnosis

Approved by the Cancer.Net Editorial Board, 08/2017

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. Not all tests listed below 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 examines the vagina, the rest of the reproductive tract, 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. HPV testing is usually part of the Pap test in women who are older than 30.

  • Colposcopy. The doctor may do a colposcopy to check the vagina and cervix for any abnormalities, especially when Pap or HPV tests return abnormal results. A colposcope is a special instrument, similar to a microscope, that magnifies the surface 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. 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.

  • Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs.

  • 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 taken orally.

  • 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 taken orally.

  • 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 extent of 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. You may use the menu to choose a different section to read in this guide.

Vaginal Cancer - Stages

Approved by the Cancer.Net Editorial Board, 08/2017

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. For vaginal cancer, the staging system developed by FIGO, the International Federation of Obstetrics and Gynecology (Federation Internationale de Gynecologie et d'Obstetrique), is most commonly used.

FIGO stages in vaginal cancer

Doctors assign the stage of the cancer by evaluating the tumor and whether the cancer has spread to lymph nodes and other parts of the body.

Stage I: The tumor is only in the vagina. It has not spread through the vaginal wall or to other parts of the body.

Stage II: The tumor has spread through the vaginal wall but not to the walls of the pelvis.

Stage III: Either of these conditions applies:

  • Cancer has spread to the lymph nodes in the pelvis.

  • Cancer has spread to the pelvic wall.

Stage IVA: Cancer has spread to the bladder, rectum, or beyond the pelvis. The lymph nodes may or may not be involved.

Stage IVB: Cancer has spread to a distant part of the body.

Recurrent vaginal cancer

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.

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

Vaginal Cancer - Treatment Options

Approved by the Cancer.Net Editorial Board, 08/2017

ON THIS PAGE: You will learn about the different treatments doctors use for 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 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. 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, such as physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Descriptions of these 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 with your doctor about the goals of each treatment and what you can expect while receiving the treatment. Vaginal cancer is most often treated with 1 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 health and ability to have children, called fertility. These topics should be discussed with the health care team before treatment begins.

Surgery

Some very small vaginal cancers can be treated primarily with 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. A gynecologic oncologist is a doctor who specializes in treating vaginal cancer using surgery.

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.

Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. 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 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, or 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. Patients must stay in bed during this time. This type of procedure is very useful for treating vaginal cancers and is often used with external-beam radiation therapy. A recent study showed that women with vaginal cancer who received brachytherapy lived longer. Another method is interstitial radiation therapy, in which radioactive material is injected directly into the tumor.

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.

Learn more about the basics of 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 ending the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical or gynecologic oncologist, a doctor who specializes in treating cancer with medication.

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 combinations of different drugs given 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 early menopause. Learn more about sexual and reproductive health concerns.

Learn more about the basics of 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 treatments intended 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 at the same time that they receive treatment to ease side effects. In fact, patients who receive both at the same time 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. 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

Stages I and II

  • Surgical removal of the tumor, including part or all of the vagina and possible removal of pelvic lymph nodes, followed by possible radiation therapy

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

Stages III and IVA

  • Combined internal radiation therapy and external-beam radiation therapy, with low-dose chemotherapy at the same time

Stage IVB

  • Radiation therapy

  • Regular-dose systemic 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 (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 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 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 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. 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.

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. 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 doesn’t work

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 for many people, advanced cancer is difficult to discuss. 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 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. You may use the menu to choose a different section to read in this guide.  

Vaginal Cancer - About Clinical Trials

Approved by the Cancer.Net Editorial Board, 08/2017

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 are some risks with a clinical trial, including possible side effects and that the new treatment may not work. People are encouraged to talk with their health care team about the pros and cons of joining a specific study.

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 a way to contribute to the 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.

Insurance coverage of clinical trials costs differs by location and by study. In some programs, some of the patient’s expenses from participating in the clinical trial are reimbursed. In others, they are not. It is important to talk with the research team and your insurance company first to learn if and how your treatment in a clinical trial will be covered. Learn more about health insurance coverage of clinical trials.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” 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:

  • Describe all of the patient’s options so that the person understands how the new treatment differs from the standard treatment.

  • List all of the risks of the new treatment, which may or may not be different from the risks of standard treatment.

  • 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.

Clinical trials also have certain rules called “eligibility criteria” that help structure the research and keep patients safe. You and the research team will carefully review these criteria together.

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.

PRE-ACT, Preparatory Education About Clinical Trials

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. You may use the menu to choose a different section to read in this guide.

Vaginal Cancer - Latest Research

Approved by the Cancer.Net Editorial Board, 08/2017

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:

  • Visit the website of the Conquer Cancer Foundation to find out how to help support cancer research. Please note that this link takes you to a separate ASCO website. 

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. You may use the menu to choose a different section to read in this guide.  

Vaginal Cancer - Coping with Treatment

Approved by the Cancer.Net Editorial Board, 08/2017

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 they are 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 in 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. These effects may include changes to your sexual health and fertility.

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 sadness, 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 response.

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 the stigma of vaginal cancer

Vaginal cancer, like other cancers that affect the sex organs, can be difficult to discuss. People with many different types of cancer, such as cervical, testicular, penile, and vulvar cancers, can experience feelings of embarrassment when discussing these “sensitive” areas of their bodies. However, this should never stop you from requesting and receiving the emotional support you deserve and your treatment team will never be embarrassed by discussing these issues with you. Your team can help you feel comfortable talking about this with others as well.

Because vaginal cancer is associated with HPV, patients may feel that they will not receive as much support or help from people around them because they believe that others may think that their behavior caused the disease. Although many vaginal cancers are caused by HPV, it is important to remember that most genital HPV infections will not cause cancer. Vaginal cancer can affect anyone.

Living with this stigma can make patients feel guilty, hopeless, embarrassed, ashamed, and isolated. Patients and their families should tell the health care team if they are affected by any of these emotions. There are resources to help those living with vaginal cancer. Some patients feel comfortable discussing their disease and experiences with their doctor, nurse, family, and friends. Other women find help through a support group or other support options.

Learn more about counseling and finding a support group.

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. Patients and their families are encouraged to talk about financial concerns with a member of their health care team. 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 checkups after you finish cancer treatment. You may use the menu to choose a different section to read in this guide.  

Vaginal Cancer - Follow-Up Care

Approved by the Cancer.Net Editorial Board, 08/2017

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 done 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.

The anticipation before having a follow-up test or waiting for test results can add stress to you or a family member. This is sometimes called “scan-xiety.” Learn more about how to cope with this type of stress.

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. 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 discuss 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 when 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 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 and with 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. You may use the menu to choose a different section to read in this guide.

Vaginal Cancer - Survivorship

Approved by the Cancer.Net Editorial Board, 08/2017

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 about coping with everyday life.

Survivors may feel some stress when their frequent visits to the health care team end after completing 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 when 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 center of the place 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.

It is important to have recommended medical checkups 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 that 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 those in different age groups.

The next section offers Questions to Ask the Health Care Team to help start conversations with your cancer care team. You may use the menu to choose a different section to read in this guide.  

Vaginal Cancer - Questions to Ask the Doctor

Approved by the Cancer.Net Editorial Board, 08/2017

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 your health care team 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 a digital 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?

  • 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 part of my health care team, and what does each member do?

Questions to ask about choosing a treatment and managing side effects

  • If surgery is recommended, who will be doing the surgery? How experienced is this surgeon with this type of cancer?

  • 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?

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

Questions to ask about planning follow-up care

  • 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. You may use the menu to choose a different section to read in this guide.  

Vaginal Cancer - Additional Resources

Approved by the Cancer.Net Editorial Board, 08/2017

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 see 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.

Beyond this guide, here are some links to help you explore other parts of Cancer.Net

This is the end of Cancer.Net’s Guide to Vaginal Cancer. You may use the menu to choose a different section to read in this guide.