Vaginal Cancer

The exact causes of vaginal cancer are not known, but researchers have identified several factors that seem to be linked to the disease. For example, high-risk types of human papillomavirus (HPV), such as types 16 and 18, produce two proteins that can disrupt cells’ production of substances called tumor suppressor gene products, which keep cells from dividing too quickly and becoming cancerous. 

Another link to vaginal cancer development is exposure to diethylstilbestrol (DES) before birth. Daughters of mothers who took DES during pregnancy have a greater risk for developing clear cell carcinoma. DES also increases the likelihood of vaginal adenosis (gland-type cells in the vaginal lining rather than the usual squamous cells). 

There are other risk factors for vaginal cancer. Many women with these risk factors never develop vaginal cancer, and some women who do have cancer do not have any of the known risk factors.

Vaginal cancer risk factors include:

Age

Almost half of all vaginal cancers occur in women older than 70. Only 15% of vaginal cancers are found in women younger than 40.

Exposure to DES before birth

The drug DES was used between 1940 and 1971 to help prevent miscarriages. Women whose mothers were treated with DES during pregnancy have a higher than normal risk of clear cell adenocarcinoma of the vagina. The risk seems to be highest among women whose mothers took the drug during the first 16 weeks of pregnancy. According to the American Cancer Society, about 1 in 1,000 women whose mothers took DES while pregnant develop vaginal cancer.

Vaginal adenosis

In nearly all women who were exposed to DES while their mothers were pregnant, the squamous cells that normally line the vagina are lined with glandular cells instead. These gland cell areas are called adenosis, and having them raises the risk of clear cell carcinoma. While the risk of developing clear cell carcinoma is small, women with adenosis should talk with their doctors about regular screenings.

HPV infection

HPV infection may cause precancerous changes in the cells of the vagina. If not treated, these cells may become cancerous. Up to 9 of every 10 vaginal cancers and precancers are linked to HPV infection. For more on HPV, scroll down to the next section.

Cervical cancer

Women who have had cervical cancer or precancer tend to have a higher risk of vaginal cancer. This is likely due to the shared risk factors for the diseases, including HPV infection and smoking.

Tobacco use

Women who smoke have more than double the risk of vaginal cancer than non-smokers.

HIV infection

Infection with human immunodeficiency virus (HIV) damages the immune system, making HPV infection more likely and raising the risk for vaginal cancer.

Having any of these risk factors does not mean you will develop vaginal cancer. If you’re concerned about your risk, talk with your doctor. If you have family members who have had vaginal cancer, consider talking with one of our genetic counselors.

More on HPV

HPV is a group of more than 150 related viruses which can infect cells lining the genitals, anus, mouth and throat. It’s spread from one person to another during skin-to-skin contact, including sex. Two of the most high-risk types for gynecologic cancer are HPV 16 and 18. Up to 80% of men and women who have had sex have HPV. In 9 out of 10 cases, the body’s immune system clears the virus on its own, and most women with HPV will not develop cervical cancer. But if the infection becomes chronic, the risk of cervical cancer increases. A vaccine series is available for HPV and is recommended for pre-teens between the ages of 11 and 12. In some cases, the vaccine may be recommended up to age 26.

According to the American Cancer Society, most vaginal squamous cell cancers begin as precancerous changes called vaginal intraepithelial neoplasia (VAIN). A woman may have VAIN for years before it becomes cancer. Screening exams for cervical cancer may also detect vaginal precancers, which can then be treated before cancer develops.

Between your exams, practice awareness — know the signs and symptoms of vaginal cancer and call your doctor if you notice anything unusual.

Preventive factors

Vaginal cancer cannot be completely prevented, but you can take the following steps to help with prevention:

• Avoid tobacco
• Have annual pelvic exams
• Have HPV tests as recommended by your physician
• Ask your doctor about an HPV vaccine
• Use condoms during sex to protect against sexually transmitted diseases
• Have precancerous conditions treated

Pap test

The Pap test (also known as a Pap smear) is used to find abnormal cells in the cervix. But because of the nature of the test, abnormal vaginal cells may be found as well. It’s a quick test that involves gently scraping cells from the opening of the cervix. Cells are then examined under a microscope. Not only can the test find cancer at an early stage, it can detect changes in cells before they even become cancerous. The Pap test is usually performed as part of an annual well-woman exam, and is fast and painless.

HPV DNA test

The HPV DNA test determines whether a woman is infected with the HPV virus, which is a major risk factor for vaginal cancer. This test can be combined with the Pap test.

For women 30 and older, screening with both an HPV test and a Pap test at the same time is more likely to find abnormal cell changes than either test performed alone, according to the National Cancer Institute.

Talk with your doctor about your personal screening recommendations.

If a screening test or pelvic exam finds anything unusual, your doctor may recommend further testing. Scripps physicians use advanced imaging and lab tests to diagnose vaginal cancer. These may include:

Colposcopy

During a colposcopy, the physician uses an instrument called a colposcope to examine the magnified surface of the cervix. The colposcope remains outside of the body.

Vaginal biopsy

A biopsy is the only way to confirm vaginal cancer. During a biopsy, the doctor removes a small tissue sample from the vagina to be examined under a microscope.

Computed tomography (CT) scan

A CT scan is an imaging test that captures images of the body from different angles. The images are combined to create detailed cross-sectional views of organs, bones and blood vessels.

Magnetic resonance imaging (MRI)

MRI relies on a powerful magnet, radio waves and advanced digital technology to provide detailed images of organs, bone and soft tissue.

Positron emission tomography (PET) scan

A PET scan involves a type of radioactive sugar that existing cancer cells will quickly absorb so they can be identified under a special camera. It’s combined with a CT scan to give physicians the ability to view a picture of potentially cancerous areas through the PET while also seeing more detailed images from a CT scan.

Cystoscopy or proctoscopy

Cystoscopy or proctoscopy is the insertion of slender tubes with lights and/or lenses that allow doctors to see if vaginal cancer has spread to nearby organs.

Scripps oncologists use vaginal cancer stages to determine whether cancer has spread from the vagina to other areas of the body. Staging is important for developing a vaginal cancer prognosis and treatment plan. 

Stage 0

Cancer cells are found only in the top layer of the cells lining the vagina. Stage 0 also is called carcinoma in situ or vaginal intraepithelial neoplasia 3 (VAIN 3).

Stage I

Stage I vaginal cancer has grown through the top layer of cells, but not out of the vagina or to nearby lymph nodes.

Stage II

Stage II vaginal cancer has spread to the connective tissues next to the vagina, but not to the walls of the pelvis or to any organs or lymph nodes.

Stage III

In stage III vaginal cancer, the cancer:

• Has spread to the wall of the pelvis and may or may not have spread to nearby lymph nodes, but not to distant body sites, or
• May have grown into the connective tissue nearby and has spread to lymph nodes nearby, but not to distant sites. 

Stage IV

Stage IV vaginal cancer has two substages:

• Stage IVA is when cancer has spread from the vagina to nearby organs. It may or may not have spread to lymph nodes, but has not spread to distant sites.
• Stage IVB is when cancer has spread to distant organs, such as the lungs.

A cancer diagnosis can turn your world upside down. It’s completely normal to feel anxious, scared, depressed or overwhelmed. Learning all you can about your diagnosis and your options can help you make informed, confident decisions about the next steps to take.

Questions and considerations

Here are some questions you may want to ask your doctor or health insurance provider regarding your diagnosis:

• Should I get a second opinion?
• How do I find a specialist?
• What is my cancer treatment plan?
• Will I have to miss work/school?
• What are the side effects of vaginal cancer treatment?
• How successful is my treatment likely to be?
• What costs will be covered by insurance?
• Which costs will I be responsible for?

Your Scripps team is here to help you find the answers you need to take an active role in your care. In addition, there are a number of community cancer resources that provide education, information and helpful resources — often at no cost.

Learn more about the many cancer patient resources available to you and your loved ones via Scripps.

Your Scripps cancer care team will customize your treatment plan based on several factors, including:

• The stage of your cancer
• Whether your cancer has spread
• Whether you plan to become pregnant
• Your age and overall health

Treatment for precancerous vaginal intraepithelial neoplasia (VAIN), early-stage vaginal cancer, sarcomas and melanomas typically involves surgery. More advanced cases may include chemotherapy or radiation therapy.

Topical therapy

In some cases, physicians may be able to treat early precancerous vaginal cell changes with medicine applied to the area.

Vaginal cancer surgery

Depending on the stage of the cancer and how far it may have spread, Scripps physicians may use several surgical procedures to treat vaginal cancer. These surgeries include the following:

• Laser surgery is when the physician uses a laser beam to destroy abnormal cells.
• Excision is when the cancer and about a ½ inch of skin on each side of it are removed.
• Vaginectomy is when the surgeon removes the vagina. Following the procedure, a plastic surgeon may perform reconstructive surgery to form a new vagina from other tissue.
• Trachelectomy is when surgeons remove the cervix, upper part of the vagina and nearby lymph nodes. The uterus is not removed, which allows a woman to still become pregnant.
• Hysterectomy is the removal of the uterus and possibly the cervix. Whenever possible, Scripps surgeons perform hysterectomy using single-site robotic surgery, which requires just one small incision. If this isn’t appropriate, our surgeons can perform the hysterectomy through an abdominal incision, through the vagina or through minimally invasive procedures, such as laparoscopic surgery or robotic-assisted surgery.
• Lymph node dissection is when surgeons remove lymph nodes from the pelvic region to see if the cancer has spread. This can be performed through a minimally invasive laparoscopic surgery.
• Pelvic exenteration is the most extensive surgical approach and is used in advanced cases of vaginal cancer. It involves removal of the vagina and lymph nodes, and may include removal of the cervix, uterus, bladder, rectum and possibly part of the colon, based on how far the cancer has spread.

With pelvic exenteration, the following organs may be involved:

• If the bladder is removed, the surgeon may use a piece of intestine to form a new bladder, and urine may be drained through a catheter (tube) into a small plastic bag worn outside of the body.
• If the rectum and part of the colon are removed, you may have an opening on the abdomen that allows solid waste (stool) to pass into a small bag worn on the outside of the body, called a colostomy. In some cases, the surgeon may be able to reconnect the colon, so no colostomy is needed.
• If the vagina is removed, the surgeon may be able to make a new one from other tissue.

Radiation therapy

Radiation therapy may be used to treat vaginal cancers that have spread beyond the cervix, or to shrink large tumors before surgery. Scripps radiation oncologists use advanced radiation therapy techniques that precisely target tumors while minimizing radiation exposure to nearby healthy tissues and organs.

• High-dose brachytherapy is an internal radiation therapy in which radioactive material is inserted through the vagina and placed near the tumor for a few minutes at a time. Radioactive implants may be given alone or with a shortened course of external beam radiation therapy.
• Intensity-modulated radiation therapy (IMRT) is an advanced form of radiation therapy. IMRT allows the radiation oncologist to specify the dose of radiation for the tumor while restricting the dose to surrounding healthy tissues.

Chemotherapy

Chemotherapy may be given as a primary treatment for metastatic vaginal cancer (cancer that has spread). It also may be used in combination with radiation therapy.

Some vaginal cancer treatment plans may involve clinical trials. Talk with your physician about whether a clinical trial is right for you.

For a list of clinical trial that are currently enrolling patients, see our current list of clinical trials.

Your Scripps cancer team will develop a customized treatment plan outlining the treatments and therapies we recommend for your care. Before you begin treatment, you and your physician will review your plan together and discuss any questions or concerns you may have.

Your vaginal cancer treatment plan generally includes:

• Family and medical history
• A summary of your cancer diagnosis and staging information
• Diagnostic testing completed (e.g., imaging, biopsy, lab tests)
• Plans for surgery, radiation, chemotherapy and/or other treatments
• Potential side effects of treatments
• Contact information for your cancer care team members

Along with helping you understand your course of treatment and encouraging discussion between you and your physician, your plan helps your team coordinate your care. You also can share your treatment plan with other providers who may be involved in your medical care.

Your vaginal cancer care team includes health and medical professionals from a wide range of specialties. Scripps will customize your team to ensure you have the expertise and support you need.

Your team may include:

• Gynecologists
• Gynecologic surgeons
• Surgeons and surgical oncologists
• Radiation oncologists
• Medical oncologists
• Registered nurses
• Nurse navigators
• Dietitians
• Oncology social workers

Visit your cancer care team for more on Scripps' multidisciplinary approach to treatment.

Patient education is an integral part of understanding and coping with your cancer diagnosis and treatment. To stay informed, we encourage our patients, along with their caregivers and family members, to:

• Bookmark the Scripps glossary of cancer terms for easy referencing.
• Download the appointment form and list of medications form on our resources page.
• Consult your oncology team for educational materials and a list of trusted online sources beyond the Scripps site. 

Navigating cancer might seem overwhelming — especially with so much information online. To ensure you receive the most accurate details, always look to your multidisciplinary team of cancer care experts first.