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Learn about diagnosis and treatment of vaginal cancer

Vaginal cancer often does not cause noticeable symptoms in the early stages and is sometimes detected during routine pelvic exams. 

Vaginal cancer can be ruled out or confirmed through an analysis of your medical history, symptoms, pelvic exam, pap test, and biopsy if necessary. Learn more about how vaginal cancer is diagnosed.

How is vaginal cancer diagnosed?

Tests used to rule out vaginal cancer include the following:

• Physical exam:
  • Physical exam to look for general signs and symptoms of disease, such as tumors or anything else that appears abnormal.
• Pelvic exam:
  • Includes examination of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. 
  • A doctor or nurse inserts a pair of lubricated, gloved fingers of one hand into the vagina and places the other in the lower abdomen to feel the size, shape, and location of the uterus and ovaries. 
  • A speculum can also be put into the vagina, and the doctor or nurse examines the vagina and cervix for symptoms of disease. 
• Pap smear or pap test:
  • Diagnostic test that involves collecting cells from the cervix and vaginal surface. 
  • Some cells are scraped from the cervix and vagina with the help of a piece of cotton, brush, or small wooden stick.
  • If the cells are abnormal, they are examined under a microscope.
• Biopsy:
  • If a pap smear reveals abnormal cells in the vagina, a biopsy may be performed during a colposcopy.
  • Involves removing cells or tissues from the vagina and cervix so that a pathologist can examine them under a microscope for signs of cancer
• Colposcopy:
  • Procedure that uses a colposcope (a lighted, magnifying tool) to examine the vagina and cervix for abnormalities.
  • Tissue samples can be collected with a curette (a spoon-shaped tool) and examined under a microscope for signs of cancer.
• Endoscopic tests: 
  • This screening may be required on an individual basis. Endoscopic tests are classified into two:
    • Proctosigmoidoscopy
    • Cystoscopy

Other tests that may be required to confirm whether the cancer has spread to other areas in the body include:

• Chest X-ray
• Computed tomography (CT) scan
• CT-guided needle biopsy
• Magnetic resonance imaging scan
• Positron emission tomography scan

However, to rule out or confirm vaginal cancer, pelvic screening and pap smear tests are considered best diagnostic criteria.

What are different types of vaginal cancer?

Vaginal cancer can begin in the vagina (primary) and/or spread to other parts of the body (secondary).

Primary vaginal cancer

There are two main types of primary vaginal cancer:

1. Squamous cell (70% of cases): Most common type of vaginal cancer. Often present in the upper region of the vagina and typically affects women aged 50-70
2. Adenocarcinoma (15% of cases): Typically affects women younger than 20 years although it can develop in older women as well. Develops from glandular cells in the vaginal lining, which secrete fluids that increase the likelihood of adenocarcinomas spreading to the lungs and lymph nodes

Secondary vaginal cancer

Secondary vaginal cancer is more common than primary vaginal cancer and typically begins in the cervix, lining of the womb (endometrium), or adjacent organs such as the bladder or intestine.

Two rare types of vaginal cancer include

1. Sarcoma: Type of cancer that begins in the cells of the bone, muscle or connective tissue. Unlike squamous cell carcinomas, which form on the epithelial surface, vaginal sarcomas form deep within the vaginal walls.
2. Melanoma: Melanomas are more typically found on sun-exposed body parts and are rarely found on the vagina. The majority of vaginal melanomas develop on the exterior or lower region of the vagina.

What are signs and symptoms of vaginal cancer?

Early stage vaginal cancer does not usually have symptoms. As the tumor grows, however, the following symptoms may occur:

• Vaginal discharge
• Vaginal itching or discomfort
• Vaginal bleeding
• Bleeding after intercourse
• Hematuria (bloody or pink-colored urine)
• Difficult or painful urination or bladder pain
• Frequent urination or bowel movements
• Lump in the vagina
• Dyspareunia (pain during sexual intercourse)
• Pelvic or abdominal pain or fullness
• Rectal pain or fullness
• Constipation
• Blood-streaked stools

Vaginal cancer can be fatal in some instances. Serious symptoms of vaginal cancer that require emergency medical attention include:

• Inability to have bowel movements or pass gas
• Decreased urination
• Rectal bleeding or blood in the stool
• Severe abdominal or pelvic pain
• Uncontrolled or heavy bleeding (hemorrhage)

What are risk factors for vaginal cancer?

Although the specific cause of vaginal cancer is unknown, possible risk factors include:

• Age (risk increases with age, especially after age 50)
• Personal history of cervical cancer
• History of radiation therapy
• History of hysterectomy
• Chronic human papillomavirus (HPV) infection
• Exposure to a drug called diethylstilbestrol before birth
• Smoking
• Vaginal intraepithelial neoplasia (precancerous cells that can develop into cancer)

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What are the stages of vaginal cancer?

Treatment options for vaginal cancer vary depending on age, underlying health conditions, and the stage of cancer:

• Stage I: Cancer may have spread only to the vaginal wall.
• Stage II: Cancer may have spread to the tissues around the vagina.
• Stage III: Pelvis is partially affected.
• Stage IV:
  • Stage IVA: Bladder and rectum linings and around the entire pelvis are affected.
  • Stage IVB: Cancer may have spread to distant organs such as the lungs.

How is vaginal cancer treated?

The most common treatment for vaginal cancer is surgery, which is often followed by radiation therapy. Chemotherapy is occasionally used as surface treatment in very early stages or as systemic treatment in more advanced types of cancer.

Treatment for vaginal cancer may involve a combination of the following:

Surgery

The mainstay of vaginal cancer treatment is surgery. Depending on the stage of the disease, several surgical treatments are advised for vaginal cancer:

• Wide excision or local excision: Surgical procedure that removes the tumor along with a small portion of the healthy tissue called margin.
• Vaginectomy: Recommended to either remove a part of the vagina (partial vaginectomy) or the entire vagina (radical vaginectomy) depending on the extent of the disease.
• Hysterectomy: Procedure in which the vagina, uterus, and cervix are removed (either total abdominal hysterectomy or laparoscopic hysterectomy).
• Lymphadenectomy: Removes lymph nodes around the vagina, which are inspected further for evidence of cancer (if cancer is detected in the upper vagina, lymph nodes in the pelvic region are removed; if cancer is detected in the lower vagina, lymph nodes in the groin are removed).
• Pelvic exenteration: Removes all vital organs in the pelvic area, including the colon, rectum, and bladder, as well as the cervix, ovaries, and vagina. The lymph nodes around these organs are also removed.
• Laser surgery: Tumor is killed by directing a laser beam (a narrow beam of intense-energy, single wavelength light) toward it. This method is noninvasive and has fewer treatment-related problems.

Radiation therapy

• Radiation treatment is the use of high-energy radiation to kill cancer cells or prevent them from proliferating and spreading.
• The radioactive substance may be administered through needles, seeds or catheters.

Chemotherapy

• During chemotherapy, powerful anticancer medications are used to eliminate tumor cells and slow cancer progression.
• Chemotherapy can be given intravenously, orally, or intramuscularly.
• Chemotherapy can be given before surgery (neoadjuvant treatment) to reduce the tumor or after surgery (adjuvant therapy) to eradicate any remaining cancer cells.
• Chemotherapy may be used in conjunction with radiation therapy to improve the overall efficacy of the treatment.

Supportive treatments

Other therapies may be used to assist improve overall health and balance any adverse effects of therapy:

• Antinausea medications
• Blood cell growth factors to increase the number of healthy blood cells
• Blood transfusions to temporarily replace blood components, such as red blood cells, that have been reduced or lost
• Dietary counseling to help you maintain strength and nutritional status
• Pain medications as needed
• Reconstructive surgery to restore structures that have been removed

Complementary treatments

Some alternative therapies may assist some women in dealing with vaginal cancer and related treatments. These treatments, often known as alternative therapies, are used in addition to established medical treatments (never as stand-alone). Complementary therapies are not intended to replace regular medical care. If you use nutritional supplements or homeopathic (nonprescription) treatments, contact your doctor because they may interfere with your recommended medical medication. Complementary treatments may include:

• Acupuncture
• Massage therapy
• Nutritional dietary supplements, herbal remedies, tea beverages and similar products
• Yoga

Clinical trials

• Clinical trials are done to determine if novel cancer therapies are safer and more effective than current treatments. 
• Participating in a research study may be the best therapy option for some individuals. Others see it as an opportunity to assist enhance cancer treatment in the future.

Hospice care

• When vaginal cancer has reached an advanced stage and is no longer responding to therapy, the emphasis of treatment may shift from treating the illness to focusing on measures to keep you comfortable and enhance your quality of life.
• Hospice care includes treating pain and other symptoms while also offering psychological and emotional support, as well as services to help family members.

What are possible complications of vaginal cancer?

Untreated vaginal cancer can lead to serious or even fatal complications. Vaginal cancer complications may include:

• Adverse effects of treatment (surgery, chemotherapy, and radiation)
• Bladder obstruction
• Bowel obstruction
• Decreased sexual activity
• Hemorrhage
• Spread of cancer

Can vaginal cancer be prevented?

Primary prevention

• Vaccination for human papillomavirus infection
• Vaginal hygiene
• Avoid sex with multiple partners
• Avoid having intercourse at a young age
• Avoid unprotected sex 
• Avoid drinking and smoking
• Maintain a healthy lifestyle—eat healthy, exercise, and go for routine health checkups

Secondary prevention

• Routine pelvic examinations
• Pap test every other year

What is the prognosis of vaginal cancer?

Vaginal cancer is very rare, affecting roughly 8,200 women in the United States each year. 

Many factors influence vaginal cancer prognosis, including your age, location and size of the tumor, type of cancer, extent of metastasis, and your general health. The sooner the vaginal cancer is detected and treated, the better the prognosis.