How does it develop?
Vaginal cancer, like cervical cancer, is strongly associated with the human papilloma virus (HPV) with 75% of cases being linked to the virus.
The most common type of vaginal cancer is squamous cell carcinoma (90% of cases), this cancer may look like small ulcers or lumps close to the cervix. 10% of vaginal cancer is caused by adenocarcinomas which are usually inside the vaginal canal. Other types of cancer are a melanoma, lymphoma and sarcoma, although they are much less common.
The disease develops when cells change their growth pattern and structure and develop into a lesion or tumour (lump).
Vaginal Cancer Symptoms – Key signs
Although many early-stage vaginal cancers do not have noticeable signs, some possible symptoms include:
- Unexpected vaginal bleeding
- 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
- Pain when urinating
- Persistent pelvic and vaginal pain
Abnormal vaginal bleeding is the most common symptom. Many of these symptoms are more likely to be due to other more common benign (non-cancerous) conditions, such as infections, but it is always important to go and get checked early if you have any of these symptoms, just in case.
Risk Factors
The exact cause of vaginal cancer is unknown, but several risk factors have been identified:
Age
40% of cases are seen in people over the age of 75.
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 skin-to-skin sexual contact. There are many different types of HPV, and 80% of 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, sometimes it lingers and can develop into cancer. 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.
Getting the HPV vaccine if you are eligible and using condoms may help to reduce your risk of developing vaginal cancer in the future. You can find out more about HPV, the cancers related to it, and how to reduce your risk in our Guide to HPV which is available to download.
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 are not cancerous. CIN and VAIN are thought to be closely linked to having a persistent HPV infection.
Other causes include having cervical cancer, having womb cancer treated with radiotherapy, smoking and having a weakened immune system (including lupus, and HIV/AIDS).
How is it diagnosed?
If you visit your doctor because of vaginal bleeding, pain, discharge or other worrying symptoms, your GP will ask you about them and may carry out a physical examination. They will look at your vulva (the external genitalia) before proceeding with an internal examination of your vagina. Your GP will put on a pair of gloves and gently insert 1 or 2 fingers in your vagina to check and see if they can feel anything unusual. A lubricating gel will be used to make this more comfortable for you. A speculum will also be used so your doctor can inspect the cervix at the top of the vagina. They may also take a vaginal swab to check for any signs of infection.
If your GP cannot find an obvious cause of your symptoms, they will probably refer you to a gynaecologist for further investigations.
If you are referred to a gynaecologist, you may have:
- An external and internal examination to look for any unusual vaginal lumps or swellings
- A colposcopy– a speculum will be placed into your vagina and opened gently. A special instrument, called a colposcope, which is like a magnifying glass, will be used to look at your vagina and cervix. The colposcope does not go inside you but can show up anything that looks abnormal
- A biopsy- 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.
These examinations can be uncomfortable for some people, the doctor will try and make sure you are as comfortable as possible. 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 MRI scan, a CT scan (usually of your chest, abdomen and pelvis) and possibly a PET scan (shows 3D images of the inside of your body and highlights any abnormal areas). The doctors looking after you will talk to you about the type of scans you need.
Vaginal Cancer Treatment
Treatment will depend on where the cancer is in your vagina and how far it has spread. Your doctors will talk to you about the best treatment for you.
Radiotherapy
Radiotherapy is the main treatment for vaginal cancer and can be performed in a number of ways:
- External beam radiotherapy – this comes from a machine which beams high-energy rays at your vagina and pelvis from outside your body
- 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. It is unusual to have this treatment on its own.
Surgery
Your doctor may suggest an operation, depending on where your cancer is and how far it has spread. The four main types of surgery to treat vaginal cancer are:
- Partial vaginectomy – removing the upper part 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
2% of people with stage 1-2 vaginal cancer will have radiotherapy following their surgery.
Chemotherapy
Sometimes chemotherapy is prescribed at the same time as radiotherapy, this is called concurrent chemo-radiation.
The Future
Whilst there have been advances in radiation therapy, more progress is needed in improving the treatments for vaginal cancer. This may include immunotherapy (which uses the immune system to kill the cancer cells) or other targeted treatments (drugs which target specific proteins and genes which help cancer cells survive and grow).