Vaginal Cancer
General Information About Vaginal Cancer (Symptoms and Diagnosis)
Stages of Vaginal Cancer
Treatment Options
The vagina (birth canal) leads from the cervix (the opening of
the uterus) to the outside of the body.
The most common type of vaginal cancer is squamous cell
carcinoma, which begins in the thin, flat cells that line the vagina.
Other types of vaginal cancer are adenocarcinoma (cancer that begins in
cells that make mucus and other fluids), melanoma, and sarcoma.
Infection with certain types of human papillomavirus (HPV)
causes most vaginal cancer. Vaccines that protect against infection
with these types of HPV may reduce the risk of vaginal cancer.
Vaginal cancer often does not cause early signs or symptoms.
It may be found during a routine pelvic exam. When found early, vaginal
cancer can often be cured.
General Information About Vaginal Cancer
Key Points
- Vaginal cancer is a disease in which malignant (cancer)
cells form in the vagina.
- Age and being exposed to the drug DES (diethylstilbestrol)
before birth affect a woman's risk of vaginal cancer.
- Signs and symptoms of vaginal cancer include pain or
abnormal vaginal bleeding.
- Tests that examine the vagina and other organs in the
pelvis are used to detect (find) and diagnose vaginal cancer.
- Certain factors affect prognosis (chance of recovery) and
treatment options.
Vaginal
cancer is a disease in which malignant (cancer) cells form in the
vagina.
The vagina is the canal leading
from the cervix
(the opening of uterus)
to the outside of the body. At birth, a baby passes out of the body
through the vagina (also called the birth canal).
Anatomy of the female
reproductive system. The organs in the female reproductive system
include the uterus, ovaries, fallopian tubes, cervix, and vagina. The
uterus has a muscular outer layer called the myometrium and an inner
lining called the endometrium.
Vaginal cancer is not
common. There are two main types of vaginal cancer:
- Squamous cell
carcinoma: Cancer
that forms in squamous cells,
the thin, flat cells
lining the vagina. Squamous cell vaginal cancer spreads slowly and
usually stays near the vagina, but may spread to the lungs, liver, or bone. This is the
most common type of vaginal cancer.
- Adenocarcinoma:
Cancer that begins in glandular
(secretory) cells. Glandular cells in the lining of the vagina make and
release fluids such
as mucus.
Adenocarcinoma is more likely than squamous cell cancer to spread to
the lungs and lymph nodes.
A rare type of adenocarcinoma is linked to being exposed to diethylstilbestrol (DES)
before birth. Adenocarcinomas that are not linked with being exposed to
DES are most common in women after menopause.
Age
and being exposed to the drug DES (diethylstilbestrol) before birth
affect a woman's risk of vaginal cancer.
Anything that increases
your risk of getting a disease is called a risk
factor. Having a risk factor does not mean that you will
get cancer; not having risk factors doesn't mean that you will not get
cancer. Talk with your doctor if you think you may be at risk. Risk
factors for vaginal cancer include the following:
- Being aged 60 or older.
- Being exposed to DES
while in the mother's womb.
In the 1950s, the drug
DES was given to some pregnant
women to prevent miscarriage (premature birth of a fetus that cannot survive).
Women who were exposed to DES before birth have an increased risk of
vaginal cancer. Some of these women develop a rare form of vaginal
cancer called clear cell
adenocarcinoma.
- Having human
papilloma virus (HPV) infection.
- Having a history
of abnormal cells
in the cervix or cervical cancer.
- Having a history of abnormal cells in the uterus or cancer
of the uterus.
- Having had a hysterectomy
for health problems that affect the uterus.
Signs
and symptoms of vaginal cancer include pain or abnormal vaginal
bleeding.
Vaginal cancer often does
not cause early signs
or symptoms. It may
be found during a routine pelvic
exam and Pap test.
Signs and symptoms may be caused by vaginal cancer or by other conditions. Check with your
doctor if you have any of the following:
- Bleeding or discharge
not related to menstrual periods.
- Pain during sexual intercourse.
- Pain in the pelvic
area.
- A lump in the vagina.
- Pain when urinating.
- Constipation.
Tests
that examine the vagina and other organs in the pelvis are used to
detect (find) and diagnose vaginal cancer.
The following tests and
procedures may be used:
- Physical
exam and history
: An exam of the body to check general signs of
health, including checking for signs of disease, such as lumps or
anything else that seems unusual. A history of the patient's health
habits and past illnesses and treatments will also be taken.
- Pelvic exam: An exam of the
vagina, cervix, uterus, fallopian
tubes, ovaries,
and rectum. A speculum is inserted into
the vagina and the doctor or nurse
looks at the vagina and cervix for signs of disease. A Pap test of the
cervix is usually done. The doctor or nurse also inserts one or two lubricated, gloved fingers
of one hand into the vagina and places the other hand over the lower abdomen to feel the size,
shape, and position of the uterus and ovaries. The doctor or nurse also
inserts a lubricated, gloved finger into the rectum to feel for lumps
or abnormal areas.
Pelvic exam. A doctor
or nurse inserts one or two lubricated, gloved fingers of one hand into
the vagina and presses on the lower abdomen with the other hand. This
is done to feel the size, shape, and position of the uterus and
ovaries. The vagina, cervix, fallopian tubes, and rectum are also
checked.
- Pap test: A procedure to
collect cells from the surface of the cervix and vagina. A piece of
cotton, a brush, or a small wooden stick is used to gently scrape cells
from the cervix and vagina. The cells are viewed under a microscope to find out if
they are abnormal. This procedure is also called a Pap smear.
Pap test. A speculum is
inserted into the vagina to widen it. Then, a brush is inserted into
the vagina to collect cells from the cervix. The cells are checked
under a microscope for signs of disease.
- Colposcopy
: A procedure in which a colposcope
(a lighted, magnifying instrument) is used to check the vagina and
cervix for abnormal areas. Tissue
samples may be taken using a curette
(spoon-shaped instrument) or a brush and checked under a microscope for
signs of disease.
- Biopsy
: The removal of cells or tissues from the vagina
and cervix so they can be viewed under a microscope by a pathologist to check for
signs of cancer. If a Pap test shows abnormal cells in the vagina, a
biopsy may be done during a colposcopy.
Certain
factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) depends on the
following:
- The stage
of the cancer (whether it is in the vagina only or has spread to other
areas).
- The size of the tumor.
- The grade
of tumor cells (how different they look from normal cells under a
microscope).
- Where the cancer is within the vagina.
- Whether there are signs or symptoms at diagnosis.
- The patient's age and general health.
- Whether the cancer has just been diagnosed or has recurred (come back).
When found in early
stages, vaginal cancer can often be cured.
Treatment options depend
on the following:
- The stage and size of the cancer.
- Whether the cancer is close to other organs that may be damaged
by treatment.
- Whether the tumor is made up of squamous cells or is an
adenocarcinoma.
- Whether the patient has a uterus or has had a hysterectomy.
- Whether the patient has had past radiation treatment to the pelvis.
Stages of Vaginal Cancer
Key Points
- After vaginal cancer has been diagnosed, tests are done to
find out if cancer cells have spread within the vagina or to other
parts of the body.
- There are three ways that cancer spreads in the body.
- Cancer may spread from where it began to other parts of the
body.
- In vaginal intraepithelial neoplasia (VAIN), abnormal cells
are found in tissue lining the inside of the vagina.
- The following stages are used for vaginal cancer:
- Stage I
- Stage II
- Stage III
- Stage IV
After
vaginal cancer has been diagnosed, tests are done to find out if cancer
cells have spread within the vagina or to other parts of the body.
The process used to find
out if cancer has
spread within the vagina
or to other
parts of the body is called staging.
The information gathered from the
staging process determines the stage
of the disease. It is important to know
the stage in order to plan treatment. The following procedures may be
used in the staging process:
- Chest
x-ray : An x-ray
of the organs and
bones inside the chest. An x-ray is a type of energy beam that can go
through the body and onto film, making a picture of areas inside the
body.
- CT
scan (CAT scan): A procedure that makes a
series of detailed pictures of areas inside the body, taken from
different angles. The pictures are made by a computer linked to an
x-ray machine. A dye
may be injected
into a vein or
swallowed to help the organs or tissues
show up more clearly. This procedure is also called computed
tomography, computerized tomography, or computerized axial tomography.
- MRI
(magnetic resonance imaging): A procedure that uses a
magnet, radio waves, and a computer to make a series of detailed
pictures of areas inside the body. This procedure is also called
nuclear magnetic resonance imaging (NMRI).
- PET
scan (positron emission tomography scan): A
procedure to find malignant
tumor cells in the body. A small
amount of radioactive
glucose (sugar)
is injected into a vein. The PET scanner
rotates around the body and makes a picture of where glucose is being
used in the body. Malignant tumor cells show up brighter in the picture
because they are more active and take up more glucose than normal cells
do.
- Cystoscopy
: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope is inserted
through the urethra into the bladder. A cystoscope is a thin, tube-like
instrument with a light and a lens
for viewing. It may also have a tool to remove tissue samples, which
are checked under a microscope
for signs of cancer.
Cystoscopy. A
cystoscope (a thin, tube-like instrument with a light and a lens for
viewing) is inserted through the urethra into the bladder. Fluid is
used to fill the bladder. The doctor looks at an image of the inner
wall of the bladder on a computer monitor.
- Ureteroscopy
: A procedure to look inside the ureters to check for
abnormal areas. A ureteroscope is inserted through the bladder and into
the ureters. A ureteroscope is a thin, tube-like instrument with a
light and a lens for viewing. It may also have a tool to remove tissue
to be checked under a microscope for signs of disease. A ureteroscopy
and cystoscopy may be done during the same procedure.
Ureteroscopy. A
ureteroscope (a thin, tube-like instrument with a light and a lens for
viewing) is inserted through the urethra into the ureter. The doctor
looks at an image of the inside of the ureter on a computer monitor.
- Proctoscopy
: A procedure to look inside the rectum to check for abnormal
areas. A proctoscope
is inserted through the rectum. A proctoscope is a thin, tube-like
instrument with a light and a lens for viewing. It may also have a tool
to remove tissue to be checked under a microscope for signs of disease.
- Biopsy
: A biopsy may be done to find out if cancer has
spread to the cervix.
A sample of tissue is removed from the cervix and viewed under a
microscope. A biopsy that removes only a small amount of tissue is
usually done in the doctor's office. A cone
biopsy (removal of a larger, cone-shaped piece of tissue
from the cervix and cervical
canal) is usually done in the hospital. A biopsy of the vulva may also be done to
see if cancer has spread there.
There
are three ways that cancer spreads in the body.
Cancer can spread
through tissue, the
lymph system, and
the blood:
- Tissue. The cancer spreads from where it began by growing
into nearby areas.
- Lymph system. The cancer spreads from where it began by
getting into the lymph system. The cancer travels through the lymph vessels to other parts
of the body.
- Blood. The cancer spreads from where it began by getting
into the blood. The cancer travels through the blood vessels to other parts
of the body.
Cancer
may spread from where it began to other parts of the body.
When cancer spreads
to another part of the body, it is called metastasis.
Cancer cells break
away from where they began (the primary
tumor) and travel through the lymph system or blood.
- Lymph system. The cancer gets into the lymph system,
travels through the lymph vessels, and forms a tumor (metastatic tumor) in another
part of the body.
- Blood. The cancer gets into the blood, travels through the
blood vessels, and forms a tumor (metastatic tumor) in another part of
the body.
The metastatic tumor is
the same type of cancer as the primary tumor. For example, if vaginal cancer spreads to
the lung, the
cancer cells in the lung are actually vaginal cancer cells. The disease
is metastatic vaginal cancer, not lung cancer.
In
vaginal intraepithelial neoplasia (VAIN), abnormal cells are found in
tissue lining the inside of the vagina.
These abnormal cells are
not cancer. Vaginal
intraepithelial neoplasia (VAIN) is grouped based on how
deep the abnormal cells are in the tissue lining the vagina:
- VAIN 1: Abnormal cells are found in the outermost one third
of the tissue lining the vagina.
- VAIN 2: Abnormal cells are found in the outermost
two-thirds of the tissue lining the vagina.
- VAIN 3: Abnormal cells are found in more than two-thirds of
the tissue lining the vagina. When abnormal cells are found throughout
the tissue lining, it is called carcinoma
in situ.
VAIN may become cancer
and spread into the vaginal wall. VAIN is sometimes called stage 0.
The
following stages are used for vaginal cancer:
Stage
I
In stage I, cancer is found in the vaginal wall only.
Stage
II
In stage II, cancer has spread through
the wall of the vagina
to the tissue
around the vagina. Cancer has not spread to the wall of the pelvis.
Stage
III
In stage III, cancer has spread to the
wall of the pelvis.
Stage
IV
Stage IV is divided into
stage IVA and stage IVB:
- Stage IVA:
Cancer may have
spread to one or more of the following areas:
- The lining of the bladder.
- The lining of the rectum.
- Beyond the area of the pelvis
that has the bladder, uterus,
ovaries, and
cervix.
- Stage IVB:
Cancer has spread to parts of the body that are not near the vagina, such as the lung or bone.
Recurrent Vaginal Cancer
Recurrent vaginal cancer is cancer that has recurred (come back) after
it has been treated. The cancer may come back in the vagina or in other parts of
the body.
Treatment Option Overview
Key Points
- There are different types of treatment for patients with
vaginal cancer.
- Three types of standard treatment are used:
- Surgery
- Radiation therapy
- Chemotherapy
- New types of treatment are being tested in clinical trials.
- Patients may want to think about taking part in a clinical
trial.
- Patients can enter clinical trials before, during, or after
starting their cancer treatment.
- Follow-up tests may be needed.
There
are different types of treatment for patients with vaginal cancer.
Different types of
treatments are available for patients with vaginal
cancer. Some treatments are standard
(the currently used treatment), and some are being tested in clinical trials. A treatment
clinical trial is a research
study meant to help improve current treatments or obtain
information on new treatments for patients with cancer. When clinical trials
show that a new treatment is better than the standard treatment, the
new treatment may become the standard treatment. Patients may want to
think about taking part in a clinical trial. Some clinical trials are
open only to patients who have not started treatment.
Three
types of standard treatment are used:
Surgery
Surgery is the most common
treatment of vaginal cancer. The following surgical procedures may be
used:
- Laser surgery:
A surgical procedure that uses a laser
beam (a narrow beam of intense light) as a knife to make
bloodless cuts in tissue
or to remove a surface lesion
such as a tumor.
- Wide local excision:
A surgical procedure that takes out the cancer and some of the healthy
tissue around it.
- Vaginectomy:
Surgery to remove all or part of the vagina.
- Total hysterectomy:
Surgery to remove the uterus,
including the cervix.
If the uterus and cervix are taken out through the vagina, the
operation is called a vaginal hysterectomy.
If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is
called a total abdominal
hysterectomy. If the uterus and cervix are taken out through a small
incision in the abdomen using a laparoscope,
the operation is called a total laparoscopic
hysterectomy.
Hysterectomy. The
uterus is surgically removed with or without other organs or tissues.
In a total hysterectomy, the uterus and cervix are removed. In a total
hysterectomy with salpingo-oophorectomy, (a) the uterus plus one
(unilateral) ovary and fallopian tube are removed; or (b) the uterus
plus both (bilateral) ovaries and fallopian tubes are removed. In a
radical hysterectomy, the uterus, cervix, both ovaries, both fallopian
tubes, and nearby tissue are removed. These procedures are done using a
low transverse incision or a vertical incision.
- Lymph node
dissection: A surgical procedure in which lymph nodes are removed and
a sample of tissue is checked under a microscope
for signs of
cancer. This procedure is also called lymphadenectomy. If the cancer is
in the upper vagina, the pelvic
lymph nodes may be removed. If the cancer is in the lower vagina, lymph
nodes in the groin
may be removed.
- Pelvic exenteration:
Surgery to remove the lower colon,
rectum, bladder, cervix, vagina, and
ovaries. Nearby
lymph nodes are also removed. Artificial openings (stoma) are made for urine and stool to flow from the body
into a collection bag.
Skin grafting may follow
surgery, to repair or reconstruct the vagina. Skin grafting is a
surgical procedure in which skin is moved from one part of the body to
another. A piece of healthy skin is taken from a part of the body that
is usually hidden, such as the buttock or thigh, and used to repair or
rebuild the area treated with surgery.
Even if the doctor
removes all the cancer that can be seen at the time of the surgery,
some patients may be given radiation
therapy after surgery to kill any cancer cells that are left.
Treatment given after the surgery, to lower the risk that the cancer
will come back, is called adjuvant
therapy.
Radiation
therapy
Radiation therapy is a
cancer treatment that uses high-energy x-rays
or other types of radiation
to kill cancer cells or keep them from growing. There are two types of
radiation therapy:
- External radiation
therapy uses a machine outside the body to send radiation
toward the cancer.
- Internal radiation
therapy uses a radioactive
substance sealed in needles, seeds,
wires, or catheters
that are placed directly into or near the cancer.
The way the radiation
therapy is given depends on the type and stage
of the cancer being treated. External and internal radiation therapy
are used to treat vaginal cancer, and may also be used as palliative therapy to
relieve symptoms
and improve quality of life.
Chemotherapy
Chemotherapy is a cancer
treatment that uses drugs
to stop the growth of cancer cells, either by killing the cells or by
stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs
enter the bloodstream and can affect cancer cells throughout the body (systemic chemotherapy). When
chemotherapy is placed directly into the cerebrospinal
fluid, an organ,
or a body cavity
such as the abdomen, the drugs mainly affect cancer cells in those
areas (regional chemotherapy).
The way the chemotherapy is given depends on the type and stage of the
cancer being treated.
Topical chemotherapy for squamous cell vaginal cancer
may be applied to the vagina in a cream or lotion.
New
types of treatment are being tested in clinical trials.
This summary section
describes treatments that are being studied in clinical trials. It may
not mention every new treatment being studied. Information about
clinical trials is available from the NCI website.
Radiosensitizers
Radiosensitizers are drugs
that make tumor cells more sensitive to radiation therapy. Combining
radiation therapy with radiosensitizers may kill more tumor cells.
Patients
may want to think about taking part in a clinical trial.
For some patients,
taking part in a clinical trial
may be the best treatment choice. Clinical trials are part of the
cancer research process. Clinical trials are done to find out if new
cancer treatments are safe and effective or better than the standard treatment.
Many of today's
standard treatments for cancer are based on earlier clinical trials.
Patients who take part in a clinical trial may receive the standard
treatment or be among the first to receive a new treatment.
Patients who take
part in clinical trials also help improve the way cancer will be
treated in the future. Even when clinical trials do not lead to
effective new treatments, they often answer important questions and
help move research forward.
Patients
can enter clinical trials before, during, or after starting their
cancer treatment.
Some clinical trials
only include patients who have not yet received treatment. Other trials
test treatments for patients whose cancer has not gotten better. There
are also clinical trials that test new ways to stop cancer from recurring (coming back) or
reduce the side effects
of cancer treatment.
Clinical trials are
taking place in many parts of the country. See the Treatment Options
section that follows for links to current treatment clinical trials.
These have been retrieved from NCI's
listing of clinical trials.
Follow-up
tests may be needed.
Some of the tests that
were done to diagnose
the cancer or to find out the stage of the cancer may be repeated. Some
tests will be repeated in order to see how well the treatment is
working. Decisions about whether to continue, change, or stop treatment
may be based on the results of these tests.
Treatment Options by Stage
Vaginal Intraepithelial Neoplasia (VAIN)
Treatment of vaginal intraepithelial neoplasia
(VAIN) 1 is usually watchful
waiting.
Treatment of VAIN 2 and
3 may include the following:
- Watchful waiting.
- Laser surgery.
- Wide local excision,
with or without a skin graft.
- Partial or total vaginectomy,
with or without a skin graft.
- Topical chemotherapy.
- Internal radiation
therapy.
- A clinical trial
of a new topical chemotherapy drug.
Stage I Vaginal Cancer
Treatment of stage I squamous cell vaginal cancer may include
the following:
- Internal radiation
therapy.
- External radiation
therapy, especially for large tumors
or the lymph nodes
near tumors in the lower part of the vagina.
- Wide local excision
or vaginectomy with
vaginal
reconstruction. Radiation therapy
may be given after the surgery.
- Vaginectomy and lymph
node dissection, with or without vaginal reconstruction.
Radiation therapy may be given after the surgery.
Treatment of stage I vaginal adenocarcinoma may include
the following:
- Vaginectomy,
hysterectomy,
and lymph node dissection.
This may be followed by vaginal reconstruction and/or radiation therapy.
- Internal radiation
therapy. External
radiation therapy may also be given to the lymph nodes near tumors in the lower part of
the vagina.
- A combination of therapies
that may include wide local
excision with or without lymph node dissection and
internal radiation therapy.
Check the
list of NCI-supported cancer clinical trials that are now accepting
patients with stage I vaginal cancer. For more specific results, refine
the search by using other search features, such as the location of the
trial, the type of treatment, or the name of the drug. Talk with your
doctor about clinical trials that may be right for you. General
information about clinical trials is available from the NCI website.
Stage II Vaginal Cancer
Treatment of stage II vaginal cancer is
the same for squamous cell cancer
and adenocarcinoma.
Treatment may include the following:
- Both internal
and external radiation therapy
to the vagina.
External radiation therapy may also be given to the lymph nodes near tumors in the lower part of
the vagina.
- Vaginectomy
or pelvic exenteration.
Internal and/or external radiation therapy may also be given.
Check the
list of NCI-supported cancer clinical trials that are now accepting
patients with stage II vaginal cancer. For more specific results,
refine the search by using other search features, such as the location
of the trial, the type of treatment, or the name of the drug. Talk with
your doctor about clinical trials that may be right for you. General
information about clinical trials is available from the NCI website.
Stage III Vaginal Cancer
Treatment of stage III vaginal cancer is
the same for squamous cell cancer
and adenocarcinoma.
Treatment may include the following:
- External radiation
therapy. Internal
radiation therapy may also be given.
- Surgery
(rare) followed by external radiation therapy. Internal radiation
therapy may also be given.
Check the
list of NCI-supported cancer clinical trials that are now accepting
patients with stage III vaginal cancer. For more specific results,
refine the search by using other search features, such as the location
of the trial, the type of treatment, or the name of the drug. Talk with
your doctor about clinical trials that may be right for you. General
information about clinical trials is available from the NCI website.
Stage IVA Vaginal Cancer
Treatment of stage IVA vaginal cancer is
the same for squamous cell cancer
and adenocarcinoma.
Treatment may include the following:
- External radiation
therapy and/or internal
radiation therapy.
- Surgery
(rare) followed by external radiation therapy and/or internal radiation
therapy.
Check the
list of NCI-supported cancer clinical trials that are now accepting
patients with stage IVA vaginal cancer. For more specific results,
refine the search by using other search features, such as the location
of the trial, the type of treatment, or the name of the drug. Talk with
your doctor about clinical trials that may be right for you. General
information about clinical trials is available from the NCI website.
Stage IVB Vaginal Cancer
Treatment of stage IVB vaginal cancer is
the same for squamous cell cancer
and adenocarcinoma.
Treatment may include the following:
- Radiation therapy
as palliative therapy,
to relieve symptoms
and improve the quality of life.
Chemotherapy may
also be given.
- A clinical trial
of anticancer drugs and/or radiosensitizers.
Although no anticancer drugs have been shown to help patients with
stage IVB vaginal cancer live longer, they are often treated with
regimens used for
cervical cancer. (See the
PDQ summary on Cervical
Cancer Treatment.)
Treatment Options for Recurrent Vaginal Cancer
Treatment of recurrent vaginal cancer may include
the following:
- Pelvic exenteration.
- Radiation therapy.
- A clinical trial
of anticancer drugs and/or radiosensitizers.
Although no anticancer
drugs have been shown to help patients with recurrent vaginal cancer
live longer, they are often treated with regimens
used for cervical cancer.
(See the PDQ
summary on Cervical Cancer Treatment.)
-NIH
