Vaginal Cancer

Vaginal cancer is a very rare disease which originates in the vagina, and is diagnosed in just over 250 women in the UK each year. It is most commonly diagnosed in women over 60 years of age and is rare in women under 40.

How does it develop?

Cancer of the vagina is a skin (also known as squamous) cancer and is very uncommon. However, there is a sub-type of vaginal cancer called mucosal melanoma, which can predict how the cancer might behave. You may find that you are cared for by a team of gynaecologists and melanoma specialists to give you the best all-round support.

It begins when a cells change their growth pattern and structure, to develop into a lesion or tumour (lump).

Surgery is the usual treatment for vaginal cancer; however, it can also be treated using chemotherapy and radiotherapy depending on its particular pattern change. The last section of this page has more details of treatments.

Vaginal Cancer Symptoms – Key signs

It is rare for vaginal cancer symptoms to manifest in the very early stages of cancer or the pre-cancerous changes called vaginal intraepithelial neoplasia (VAIN).

Although many early-stage cancers do not have indicative signs, some possible symptoms include:

  • Unexpected bleeding, eg. between periods, after menopause or after sex
  • Vaginal discharge that smells or may be blood stained
  • Vaginal pain during sexual intercourse
  • A vaginal lump or growth that you or your doctor can feel
  • A vaginal itch that won’t go away and pain when urinating
  • Persistent pelvic and vaginal pain

However, as many as 20 per cent of women diagnosed with vaginal cancer have no symptoms at all and many of the above symptoms are far more likely to be due to other conditions, such as infections.

Risk Factors

The exact causes of vaginal cancers but several risk factors have been identified to include:

Age
More than 7 out of 10 vaginal cancers are in women over 60.

Human papilloma virus
HPV is a group of viruses, rather than a single virus, of which there are more than 100 different types. It is spread during penetrative sexual intercourse and other types of sexual activity (such as skin-to-skin contact of the genital areas).

There are many different types of HPV, and most 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 further problems.

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

Abnormal cells in the cervix or vagina
You’re more likely to develop cancer of the vagina 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 chance they could eventually become cancerous.

How is it diagnosed?

You might visit your doctor because of vaginal pain or other worrying symptoms. To help diagnose or rule out a vaginal cancer diagnosis, your GP will ask you about your symptoms and may carry out a physical examination.

If your GP cannot find an obvious cause of your symptoms, they will probably refer you to a gynaecologist for further testing.

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

  • external and internal examinations to look for any unusual vaginal 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 (a biopsy) and checked under a microscope for cell changes.

If the results of the biopsy show you have cancer, you will 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, an X-ray, and possibly CT and MRI scans.

Vaginal Cancer Treatment

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

Radiotherapy
Radiotherapy is the main treatment for vaginal cancer and can be performed a number of ways:

  • external beam radiotherapy – a machine beams high-energy rays at your vagina and pelvis
  • internal radiotherapy – a small radioactive device, is put into your vagina for a short period of time – normally a few hours. This is also known as brachytherapy.

Surgery
There are four main types of surgery used to treat vaginal cancer, depending on the extent of the disease:

  • 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 exoneration – removing all of your vagina and surrounding tissue, including the bladder and/or rectum (back passage)