Vaginal cancer

Introduction
Causes
Diagnosis
Treatment

Introduction

Vaginal cancer is a rare type of cancer that begins in the vagina. Around 260 new cases are diagnosed in the UK each year.

Cancer that begins in the vagina is called primary vaginal cancer. Cancer that begins in another part of the body - such as the cervix, womb or ovaries - and spreads to the vagina is known as secondary vaginal cancer.

This topic is about primary vaginal cancer. There are separate topics on cervical cancer, ovarian cancer and womb cancer.

Signs and symptoms

The most common symptom of vaginal cancer is abnormal vaginal bleeding. This includes:

bleeding between your normal periods, or after sex
bleeding after the menopause (post-menopausal bleeding)

Other symptoms can include:

smelly or bloody vaginal discharge
pain during sex
pain when urinating
needing to urinate more frequently than usual
blood in your urine
pelvic pain
an itch or lump in your vagina

See your GP if you experience any abnormal vaginal bleeding, changes in your usual pattern of periods (such as irregular periods or heavier periods than usual), or problems urinating.

While it's highly unlikely that these symptoms are caused by vaginal cancer, they should still be investigated by your GP. Read more about diagnosing vaginal cancer.

What causes vaginal cancer

The exact causes of vaginal cancer are unknown, but things that may increase your risk of developing it include:

being infected with a particularly persistent type of the human papilloma virus (HPV), which can be spread during sex
your age - seven out of every 10 cases of vaginal cancer affect women over 60, although some rare types can affect teenage girls and women in their twenties
a previous history of vaginal intraepithelial neoplasia (VAIN) or cervical intraepithelial neoplasia (CIN) - abnormal cells in the vagina or cervix that can sometimes become cancerous

As there is a possible link with HPV, it may be possible to reduce your risk of vaginal cancer by practising safe sex. Read more advice on preventing sexually transmitted infections (STIs).

The HPV vaccination, which is now routinely offered to girls who are 12 to 13 years old, provides protection against two strains of HPV thought to be responsible for most cases of vaginal and cervical cancer.

Read more about the causes of vaginal cancer.

How vaginal cancer is treated

Treatment for vaginal cancer depends on which part of your vagina is affected and how far the cancer has spread (known as the "stage").

The main treatments for vaginal cancer are:

radiotherapy - radiation is used to destroy the cancerous cells
surgery to remove the cancerous cells
chemotherapy - medication is used to kill the cancerous cells; this is often used in combination with radiotherapy

These treatments can cause both short- and long-term side effects that should be discussed with your care team before treatment begins.

Read more about treating vaginal cancer.

Outlook

The chances of vaginal cancer being cured depend on things such as the stage at which it was diagnosed, your age and your general health.

Overall, around six in every 10 women with vaginal cancer will live for at least five years after diagnosis.

Around 110 women die from vaginal cancer every year in the UK.

Want to know more

Causes of vaginal cancer

Cancer occurs when the cells in a certain area of your body divide and multiply too rapidly. This produces a lump of tissue known as a tumour.

The exact reason why this happens in cases of vaginal cancer is unknown, but certain things can increase your chances of developing the condition.

Human papilloma virus (HPV)

Human papilloma virus (HPV) is the name given to a group of viruses that affect the skin and the moist membranes that line the body, such as those in the cervix, anus, mouth and throat. HPV is spread during sex, including anal and oral sex.

There are many different types of HPV and up to eight out of every 10 people are infected with the virus at some time during their lives. In most cases, the virus goes away without causing any harm and doesn't lead to vaginal cancer.

However, HPV is present in more than two-thirds of women with vaginal cancer, which suggests that it may increase your risk of developing the condition.

HPV is known to cause changes in the cells of the cervix, which can lead to cervical cancer. It's thought that the virus could have a similar effect on the cells of the vagina (see below).

Abnormal cells in the cervix or vagina

You're more likely to develop vaginal cancer if you've previously been found to have abnormal cells in your:

cervix - known as cervical intraepithelial neoplasia (CIN)
vagina - known as vaginal intraepithelial neoplasia (VAIN)

CIN and VAIN are terms used to describe cells that are abnormal, but not different enough to be considered cancerous. Both are thought to be closely linked to having a persistent HPV infection.

The abnormal cells don't usually cause any problems themselves and may only be detected during cervical screening, but left untreated there is a small chance they could eventually become cancerous.

If you're found to have CIN or VAIN, a procedure to remove or destroy the abnormal cells may be recommended.

Diethylstilbestrol

A medicine called diethylstilbestrol is known to increase your risk of vaginal cancer. The medication was widely prescribed for pregnant women between 1938 and 1971, because it was thought it could help reduce the risk of miscarriage.

However, in 1971, researchers discovered a link between diethylstilbestrol and cancer in the children of women given the medicine. The use of diethylstilbestrol in pregnant women was then banned.

The risk of vaginal cancer associated with diethylstilbestrol is small and as it's now over 40 years since it was last used during pregnancies, cases of vaginal cancer linked to the medication are very rare.

Other possible factors

Other things that may increase your risk of vaginal cancer include:

your age - seven out of every 10 cases of vaginal cancer occur in women over 60 and the condition is extremely rare in women under 40
having a history of reproductive cancers, such as cervical cancer or vulval cancer - particularly if you were treated with radiotherapy
smoking
having HIV

Want to know more

Cancer Research UK: risks and causes of vaginal cancer

Diagnosing vaginal cancer

To help diagnose vaginal cancer, your GP will ask you about your symptoms and may carry out a physical examination.

They may also refer you for blood tests to rule out other causes of your symptoms, such as infection.

If your GP cannot find an obvious cause of your symptoms, they will probably refer you to a gynaecologist for further testing. A gynaecologist is a specialist in treating conditions of the female reproductive system.

If your GP refers you urgently because they think you have cancer, you have the right to be seen by a specialist within two weeks. Read more about NHS waiting times.

The National Institute for Health and Care Excellence (NICE) recommends that GPs consider referring a woman who has an unexplained mass in or at the entrance to their vagina.

Seeing a gynaecologist

If you are referred to a gynaecologist, you may have:

external and internal vaginal examinations to look for any unusual lumps or swellings
a colposcopy - an examination where a special instrument (colposcope) that acts like a magnifying glass is used to study your vagina in greater detail

If your gynaecologist thinks there may be abnormal tissue inside your vagina, a small sample of the tissue will be removed and checked under a microscope for cancerous cells. This is known as a biopsy.

If the results of the biopsy suggest you have cancer, you may have further tests to see if the cancer has spread.

These tests may include a more detailed internal vaginal examination carried out under general anaesthetic, X-rays, computerised tomography (CT) scans and magnetic resonance imaging (MRI) scans.

Staging

Healthcare professionals use a staging system to describe how far vaginal cancer has advanced.

stage 1 - the cancer has started to grow into the wall of the vagina
stage 2 - the cancer has begun to spread outside the vagina into the surrounding tissues
stage 3 - the cancer has spread into your pelvis and may have spread to nearby lymph nodes
stage 4a - the cancer has spread beyond your vagina and into organs such as your bladder or back passage (rectum)
stage 4b - the cancer has spread into organs further away, such as the lungs

The stage of your cancer is important in determining which treatment is most appropriate and whether a cure is possible. Generally, the lower the stage when cancer is diagnosed, the better the chance of a cure.

If a cure is not possible, treatment can still help relieve any symptoms and slow down the spread of the cancer. Read more about how vaginal cancer is treated.

Want to know more

Treating vaginal cancer

Treatment for vaginal cancer will depend on where the cancer is in your vagina and how far it has spread. Possible treatments include radiotherapy, surgery and chemotherapy.

When you are diagnosed with cancer, you will be cared for by a group of different healthcare professionals, known as a multidisciplinary team (MDT).

Your MDT will include a range of specialists, including surgeons, clinical oncologists (specialists in the non-surgical treatment of cancer), and specialist cancer nurses.

Your MDT will recommend a treatment plan they feel is most suitable for you, but the final decision will be yours.

Before going to hospital to discuss your treatment options, you may find it useful to write a list of questions to ask the specialist. For example, you may want to find out the advantages and disadvantages of particular treatments.

Radiotherapy

Radiotherapy is the main treatment for vaginal cancer. It can be used:

as an initial treatment to cure the cancer
in combination with chemotherapy (chemoradiation)
after surgery to prevent the cancer from returning
to control symptoms when a cure is not possible (palliative radiotherapy)

How it's carried out

There are two main ways that radiotherapy for vaginal cancer can be given:

external radiotherapy - a machine beams high-energy rays at your vagina and pelvis
internal radiotherapy - a small radioactive device, which looks like a tampon, is inserted into your vagina

The type of radiotherapy you receive depends on where the cancer is in your body. For example, internal radiotherapy may be used if the cancer is in the lining of your vagina, and external radiotherapy may be used if the cancer is deeper in the tissues of the vagina. Many women receive a combination of internal and external radiotherapy.

External radiotherapy is usually given for around four to six weeks in short daily sessions, from Monday to Friday. You return home between treatments and have a break at the weekends.

Internal radiotherapy may involve either a long treatment session where you need to stay in hospital for 24 hours, or several short day-case treatments.

Read more about how radiotherapy is performed.

Side effects

Following radiotherapy, it's likely you will have some side effects. These occur because radiotherapy temporarily damages some healthy cells as well as destroying cancerous ones.

Possible side effects of radiotherapy for vaginal cancer include:

sore, red skin - similar to sunburn
vaginal discharge
pain while passing urine
diarrhoea
tiredness
feeling sick
narrowing of the vagina (see below)
early menopause and infertility (see below)

Read more about the side effects of radiotherapy.

Effects on sex

Radiotherapy may cause you to lose interest in sex, particularly if you have side effects such as tiredness or nausea, or you are anxious about your condition or treatment.

Radiotherapy can also cause scar tissue to form in your vagina, which can make it narrower and means having sex is difficult or uncomfortable.

If you feel up to it, your care team may suggest having sex regularly during treatment to help stop this happening. Devices called dilators, which are inserted into the vagina, can also be used after treatment stops to help stop your vagina getting narrower.

You may also experience some vaginal dryness or pain when having sex. If this happens, you can try using lubricants or asking your care team about possible treatments.

Menopause and fertility

If you have external radiotherapy to your pelvis, you may experience an early menopause (if you have not had the menopause already).

This means you will no longer be able to have children (infertility). This is can be very upsetting, particularly for younger women who wanted to have children. Before your treatment, your care team will explain whether this is a risk and discuss the options and support available.

Surgery

There are four main types of surgery used to treat vaginal cancer:

partial vaginectomy - removing the upper section of your vagina
radical vaginectomy - removing all of your vagina and pelvic lymph nodes
radical vaginectomy and radical hysterectomy - removing all of your vagina, womb, ovaries, fallopian tubes and pelvic lymph nodes
pelvic exenteration - removing all of your vagina and surrounding tissue, including the bladder and/or rectum (back passage)

Partial vaginectomy

A partial vaginectomy can be used to treat stage 1 vaginal cancer, when radiotherapy has failed to remove the cancer or where a woman prefers to have surgery rather than radiotherapy because she still wants to have children.

Your surgeon will remove the cancerous section of the vagina, as well as some surrounding healthy tissue, just in case a small number of cancerous cells have spread.

Your surgeon will repair the defect in the vaginal wall, which means you will be able to have sex after you have recovered from the operation.

Radical vaginectomy

A radical vaginectomy may be used to treat cases of advanced stage 1 and stage 2 vaginal cancer. The surgeon will remove most, or all, of your vagina.

A plastic surgeon may be able to make a new vagina using skin, muscle and tissue taken from another part of your body - usually one of your thighs or buttocks.

You will still be able to have sex after a vaginal reconstruction, although you will need to use lubricant, because the lining of the new vagina cannot make the mucus it would naturally make.

Radical hysterectomy

A radical hysterectomy is often performed at the same time as a radical vaginectomy.

During a radical hysterectomy, all of the reproductive system is removed, including the womb, fallopian tubes, ovaries and nearby lymph nodes.

Read more about hysterectomies, including how to prepare for the operation and your recovery.

Pelvic exenteration

Pelvic exenteration is used in a few cases to treat recurrent or advanced cases of vaginal cancer.

If you no longer have a bladder, you will need another way to pass urine. One solution is for your surgeon to make a hole (stoma) in your tummy. A bag is then attached to the stoma so that urine can be passed into it. The bag is known as a urostomy bag.

Similarly, as you may no longer have a rectum, you will need a way to pass stools (faeces) out of your digestive system. Another stoma can be made and attached to a collection bag, known as a colostomy bag.

Chemotherapy

Chemotherapy is usually used in combination with radiotherapy or to control symptoms when a cure is not possible (palliative chemotherapy). It's usually given by injection (intravenous chemotherapy).

Like radiotherapy, the powerful cancer-killing medicines used in chemotherapy can also damage healthy tissue and cause a range of side effects. Side effects of chemotherapy for vaginal cancer can include:

tiredness
feeling sick
increased risk of infections
diarrhoea
hair loss

Read more about the side effects of chemotherapy.

Coping with treatment

Treatment for vaginal cancer can have a significant emotional impact, particularly for young women who experience an early menopause as a result of treatment.

The removal of some or all of the vagina can be traumatic for pre- and post-menopausal women alike, and some women feel less "womanly" than they did before. It's not uncommon to feel a sense of loss and bereavement after treatment. In some women, this may lead to depression.

You may find it helpful to talk to other women who have had similar treatment. Your GP or hospital staff may be able to recommend a suitable local support group. Charities can also help:

Macmillan Cancer Support has information on groups you can join and a support line that you can call for free on 0808 808 00 00 (Monday to Friday, 9am-8pm)
Cancer Research UK provides a free phone number that you can call on 0808 800 40 40 (Monday to Friday, 9am-5pm)
you can also find cancer support services in your area

The Hysterectomy Association provides hysterectomy support services, including a one-to-one telephone support line, counselling and "preparing for hysterectomy" workshops.

If feelings of depression persist, speak to your GP about the treatment and support available.

Clinical trials

As vaginal cancer is rare, you may be asked to take part in a clinical trial. Clinical trials are an important way for healthcare professionals to learn more about the best way to treat specific conditions.

Most clinical trials involve comparing a new treatment with an existing treatment to determine whether the new treatment is more or less effective. If you do receive a new treatment, there is no guarantee it will be more effective than an existing one.

You can find out whether there are currently any clinical trials for vaginal cancer, or ask your care team if there are clinical trials in your area. Your care team can explain the advantages and disadvantages of taking part.