Vaginal Cancers

Fast Facts

• Vaginal cancer is rare. It accounts for 1% to 2% of cancers in the female genital tract, and a very small portion of cancers overall.
• Approximately 18,000 new cases of vaginal cancer were reported worldwide in 2020 and 8,000 women died from the disease.
• Infection with human papillomavirus (HPV) causes two-thirds of the cases of vaginal cancer. Vaccines that protect against infection with HPV may reduce the risk of vaginal cancer.
• Vaginal cancer most commonly affects postmenopausal women aged 50 and older.

About Vaginal Cancer

Vaginal cancer is a rare cancer that occurs in the vagina, the muscular tube that connects the uterus to the outer genitals. It most commonly occurs in the cells that line the surface of the vagina, which is sometimes called the birth canal. While several types of cancer can spread to the vagina from other places in the body, cancer that begins in the vagina (primary vaginal cancer) is rare.

Vaginal cancer is divided into different types based on the type of cell where the cancer began.

• Vaginal squamous cell carcinoma, which begins in the thin, flat cells (squamous cells) that line the surface of the vagina, and is the most common type
• Vaginal adenocarcinoma, which begins in the glandular cells on the surface of the vagina
• Vaginal melanoma, which develops in the pigment-producing cells (melanocytes) of the vagina
• Vaginal sarcoma, which develops in the connective tissue cells or muscles cells in the walls of the vagina

Risk Factors

Certain factors appear to increase your risk of the disease, including:

• Being exposed to human papillomavirus (HPV). HPV is a sexually transmitted infection that increases the risk of several cancers, including vaginal, vulvar cancer and cervical cancer. Many young, sexually active people are exposed to HPV, but for most the infection goes away on its own. For some, the infection causes cell changes and increases the risk of cancer in the future.
• Smoking. Smoking increases the risk of vaginal cancer.
• Having a weakened immune system. People who take medications to suppress the immune system, such as those who've undergone organ transplant, and those with conditions that weaken the immune system, such as human immunodeficiency virus (HIV), have an increased risk of vaginal cancer.
• Having a history of precancerous conditions of the cervix, vulva, or vagina.
• Having a skin condition involving the vulva with chronic itching or burning.

Signs and Symptoms

Early vaginal cancer may not cause any signs and symptoms. It may be found during a routine pelvic exam and Pap test. As it progresses, vaginal cancer may cause signs and symptoms such as:

• Unusual vaginal bleeding, for example, after intercourse or after menopause
• Watery vaginal discharge
• A lump or mass in your vagina
• Painful urination
• Frequent urination
• Constipation
• Pelvic pain

Prevention and Screening

Reduce your risk of sexually transmitted infections, including HPV. Use a condom every time you have sex. Condoms may reduce your risk of contracting HPV but can't fully protect against it. Get the HPV vaccine. Children and young adults may consider the HPV vaccine, which protects against the strains of the virus that are thought to cause the most cases of vaginal cancer.

Ask your doctor about pelvic exams. A pelvic exam allows your doctor to visually examine your vulva and manually examine your internal reproductive organs to check for abnormalities. Talk to your doctor about your risk factors for vaginal cancer and other pelvic cancers to determine the most appropriate screening exam schedule for you.

Treatment

Types of surgery that may be used to treat vaginal cancer include:

• Removal of small tumors or lesions. Cancer limited to the surface of the vagina may be cut away, along with a small margin of surrounding healthy tissue to ensure that all of the cancer cells have been removed.
• Removal of the vagina (partial or full).
• Removal of the majority of the pelvic organs (pelvic exenteration). This extensive surgery may be an option if cancer has spread throughout the pelvic area or if vaginal cancer has recurred. During pelvic exenteration, the bladder, ovaries, uterus, vagina, rectum and the lower portion of the colon may be removed.

Radiation Therapy

Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. Radiation can be delivered externally or internally (brachytherapy) or both.

Chemotherapy

If surgery and radiation does not control the cancer, chemotherapy may be offered. It is unclear whether chemotherapy is useful for treating vaginal cancer and generally isn’t used on its own to treat vaginal cancer. Chemotherapy may be used during radiation therapy to enhance the effectiveness of radiation.