Vaginal cancer is a rare cancer that begins in the lining of the vagina. Most are squamous cell carcinomas in women over 60. Adenocarcinoma, melanoma and sarcoma are much rarer. Cancer found in the vagina has more often spread from the cervix, womb lining or vulva than started there, and this distinction affects treatment.
Owing to the closeness of the bladder and rectum, radiotherapy is the main treatment for most stages, and surgery is reserved for small early tumours and selected situations. Precancerous change, called vaginal intraepithelial neoplasia (VaIN), can be treated before cancer develops.
Symptoms
- Bleeding after the menopause, after sex or between periods
- Bloodstained or unpleasant-smelling vaginal discharge
- Pain during sex
- A lump or mass felt in the vagina
- Pain or difficulty when passing urine, or needing to go often
- Constipation, pain in the pelvis or back passage
- No symptoms, with the abnormality found at a cervical screening or pelvic examination
Causes and risk factors
Persistent infection with high-risk HPV underlies most squamous cell cases, as it does for cervical cancer. Risk is higher in women who have had cervical precancer or cancer, a hysterectomy for such disease, or previous pelvic radiotherapy, and in those who smoke or have weakened immunity, including HIV. Daughters of women given the drug diethylstilbestrol (DES) in pregnancy before the early 1970s have a raised risk of clear cell adenocarcinoma. Long-term irritation from a neglected pessary is a rare factor. HPV vaccination is expected to reduce cases.
How it is diagnosed
- Pelvic examination and colposcopy of the vagina: Careful inspection of all the vaginal walls under magnification, with the speculum rotated so nothing is hidden.
- Biopsy: A sample taken under local anaesthetic confirms the diagnosis. The cervix and vulva are examined and sampled as well to exclude a primary there.
- Examination under anaesthesia: Allows thorough assessment of the extent, sometimes with cystoscopy and proctoscopy to check the bladder and rectum.
- Pelvic MRI: Defines the size of the tumour and its relation to neighbouring organs, and helps plan radiotherapy.
- PET-CT or CT: Checks pelvic and groin lymph nodes and distant sites.
Treatment options
- Treatment of VaIN: Laser ablation, local excision or topical imiquimod or fluorouracil, followed by long-term surveillance because recurrence is common.
- External beam radiotherapy with chemotherapy: Daily pelvic radiotherapy for about 5 weeks, often with weekly cisplatin, by analogy with cervical cancer.
- Brachytherapy: Internal radiotherapy using a vaginal applicator or needles, delivering a high dose to the tumour. Used alone for small superficial tumours or as a boost.
- Surgery: Wide local excision or partial or radical vaginectomy for small stage 1 tumours, especially in the upper vagina. Pelvic exenteration is considered for selected recurrences after radiotherapy.
- Vaginal reconstruction and rehabilitation: Reconstruction with skin grafts or flaps when needed, and dilators, moisturisers and oestrogen cream after radiotherapy to limit narrowing.
- Systemic therapy: Chemotherapy or immunotherapy for advanced or recurrent disease, largely following cervical cancer protocols.
When it is urgent
Seek emergency care close to home for heavy vaginal bleeding or bleeding that causes lightheadedness, for inability to pass urine, for leakage of urine or stool through the vagina, or for fever with severe pelvic pain. During chemoradiotherapy, fever, persistent diarrhoea or vomiting need same-day review by the treating team.
Travelling to Türkiye for treatment
Because vaginal cancer is rare, an opinion from a gynaecological oncology team with brachytherapy expertise is valuable, and case review can begin remotely with your pathology and MRI. Laser or excision treatment of VaIN, or surgery for a small early tumour, fits a stay of 1 to 2 weeks. Chemoradiotherapy with brachytherapy occupies 6 to 8 weeks without breaks; choose it abroad only if you can remain for the full course. Follow-up examinations for at least 5 years should be arranged with a gynaecologist at home.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
Frequently Asked Questions
How is it different from cervical cancer?
It has the same main cause, HPV, and is treated in a similar way, but it starts in the vaginal wall. By definition, a tumour that touches the cervix is classed as cervical cancer.
I had a hysterectomy. Do I still need smear tests?
If the hysterectomy was for cervical precancer or cancer, vault smears or HPV tests are usually recommended for some years. After hysterectomy for benign reasons they are generally not.
Will treatment affect my sex life?
Radiotherapy and surgery can cause dryness, narrowing and shortening of the vagina. Dilators, topical oestrogen and specialist support help, and should be offered routinely.
Can VaIN turn into cancer?
High-grade VaIN can progress if untreated, which is why it is treated and monitored. Low-grade change often resolves without treatment.