Vaginal Cancer
Advanced gynecologic cancer treatment in San Diego
Advanced gynecologic cancer treatment in San Diego
A leader in caring for women with vaginal cancer, Scripps gynecologists and cancer specialists are experts in detecting precancerous cells before they become cancer, and treating vaginal cancer in its earliest stages. When vaginal cancer requires more complex treatment, Scripps Cancer Center gynecologic oncologists use the most sophisticated treatments, including minimally invasive surgery that uses small incisions, potentially resulting in shorter hospital stays and a faster recovery, and immunotherapy to harness the power of the body’s own immune system.
Our multidisciplinary, collaborative board of cancer specialists reviews complex cases to ensure the best possible care from diagnosis to recovery.
About vaginal cancer
Vaginal cancer is a rare type of gynecologic cancer that begins in the cells of the vagina. It tends to develop slowly over several years, and may start as precancerous changes that can be treated before they become cancer. Screening exams, such as a Pap test or HPV test, may detect vaginal cancer early.
According to the American Cancer Society, vaginal cancer affects only 1 in 1,100 women in her lifetime.
Types of vaginal cancer
The type of vaginal cancer is determined by the cells in which it begins. As with vulvar cancer, the most common vaginal cancer types are squamous cell carcinomas, adenocarcinomas, melanomas and sarcomas.
Squamous cell carcinoma
About 75% of vaginal cancers are squamous cell carcinomas, which develop in the cells in the vagina lining. Typically developing slowly over several years, these cancers often begin as a precancerous condition called vaginal intraepithelial neoplasia (VAIN).
Adenocarcinoma
About 15% of vaginal cancers are adenocarcinomas, which develop in the gland cells of the vagina. It most often affects women over age 50. A subtype of adenocarcinoma, called clear cell adenocarcinoma, affects younger women whose mothers took the drug DES during pregnancy.
Melanoma
Melanoma skin cancers start in the cells that make skin pigment. Fewer than 10% of vaginal cancers are melanomas.
Sarcomas
Sarcoma cancers start in the bones, muscles or connective tissue. Fewer than 4% of vaginal cancers are sarcomas.
Vaginal cancer causes, risks and family history
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.
Vaginal cancer prevention, screenings and early detection
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.
Vaginal cancer symptoms, diagnosis and stages
In the early stages, vaginal cancer usually doesn’t cause symptoms, nor do the precancerous changes caused by vaginal intraepithelial neoplasia (VAIN).
Learn more about vaginal cancer symptoms, diagnostic testing and stages below. As with most cancers, the earlier vaginal cancer is found, the greater the likelihood of successful treatment.
Vaginal cancer symptoms
Symptoms of vaginal cancer may include:
- Abnormal vaginal bleeding (often after sex)
- Abnormal vaginal discharge
- A mass that can be felt
- Pain during sex
Any of these symptoms may be caused by other conditions that are not cancer. But let your doctor know if you’re experiencing anything unusual, so that you can find and treat any potential problems.
Diagnostic testing
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.
Vaginal cancer stages
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.
Understanding your diagnosis
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.
Treatment and clinical trials
When you’ve been diagnosed with vaginal cancer, you want a team of expert cancer specialists on your side. Scripps' multidisciplinary oncology teams fight vaginal cancer using the latest evidence-based treatments and therapies, including minimally invasive surgery and targeted radiation therapy.
Our approach to treating vaginal cancer
Your Scripps cancer care team includes professionals from every area of gynecologic oncology, including gynecologists, surgeons, radiation oncologists and nurses who specialize in cancer care. Should you need reconstructive surgery after your treatment, count on our plastic surgeons for the expertise that has brought comfort and confidence to many women.
In addition, most patients are partnered with a nurse navigator who is specially trained and experienced in the treatment of female reproductive cancer. Your nurse navigator will help coordinate your care and ensure you get the support you need throughout your treatment and recovery. Learn more about how Scripps puts you at the center of care.
Vaginal cancer treatment options at 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.
Vaginal cancer clinical trials
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 custom cancer treatment plan
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 cancer care team
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.
Vaginal cancer treatment locations
Scripps diagnoses and treats vaginal cancer at numerous locations throughout San Diego County. From Chula Vista and La Jolla to Encinitas and beyond, our extensive network of Southern California cancer care centers includes:
- Four Scripps hospitals on five campuses
- Outpatient clinics
- Specialty cancer treatment centers
For details on specific centers and their services, visit cancer care locations.
Support groups, services and resources
Scripps offers a comprehensive lineup of support groups, support services and resources to help you along every step of your cancer journey.
Vaginal cancer support groups, workshops and events
In addition to the gynecological cancer support group listed below, we also host a handful of free workshops and health and wellness events on a number of topics such as:
- Nutrition
- Expressive writing
- Yoga
- Meditation
Gynecologic cancer support group
The following support group in La Jolla is for gynecologic cancer patients only.
Scripps Campus Point Complex
1st and 3rd Thursdays, 10 – 11:30 am
4275 Campus Point Court
2nd Floor PMO Conference Room
Facilitator: Janine Rodriguez
Contact info: 858-626-7950
For info about other cancer support groups in the San Diego community, call the American Cancer Society at 800-227-2345.
Support services for cancer patients
We are here for you — not only as your oncologists, but as a robust multidisciplinary team of experts who understands that your cancer journey is about much more than your medical treatment. Specifically, Scripps Cancer Center offers a variety of patient support services to ensure your physical, psychological and emotional well-being as well as resources for dealing with the logistical and financial aspects of cancer care. Our services and resources include:
- Oncology nurses and nurse navigators with extensive clinical expertise in cancer care to help guide you and your caregivers to make informed decisions and ensure your optimal care.
- Palliative care to provide an extra layer of supportive care to manage pain and relieve symptoms, offer emotional and spiritual support, and improve your quality of life.
- Oncology social workers specially trained to provide counseling, connect you with community and medical resources, assist with transportation and housing and coordinate care after discharge.
- Our registered dietitian nutritionists offer individualized nutrition support for patients whose efforts to optimize their nutrition may be affected by cancer symptoms or treatment side effects.
- Referrals and professional care from experts in psychology, psychiatry and emotional health, including individual and family counseling to help with the emotional challenges of cancer.
- Physical rehabilitation and occupational therapy services, including wound care, voice therapy and swallowing therapy, lymphedema therapy, balance and vestibular rehabilitation, yoga and more.
- Scripps Center for Integrative Medicine for patients interested in mind-body healing through acupuncture, biofeedback, herbal nutrition, massage therapy, integrative cancer care and more.
- Nondenominational spiritual care offered by our chaplains to help coordinate spiritual care with your own clergy, rabbi or spiritual advisor.
- Visiting patient services if you reside beyond San Diego and want help arranging appointments or learning more about short-term lodging.
For the full spectrum of offerings, please visit our cancer patient support services section.
Additional resources for patients, caregivers and family members
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.