What Is Vaginal Cancer? Causes, Symptoms, And Treatments

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Talking about cancer can be scary. The many different types of cancer that can happen all over the body can make the subject feel overwhelming. Fortunately, today we are diving into a rare type– vaginal cancer, to help you understand its symptoms, risk factors, and treatment options. While many different cancers can spread to the vagina, the vaginal canal is rarely the starting place for cancer. Doctors diagnose fewer than 9,000 people with vaginal cancer in the United States every year. So, what exactly is vaginal cancer? How can you look out for symptoms? If diagnosed, how can it be treated? Read on to learn more about vaginal cancer.

What Is Vaginal Cancer?

Any type of cancer involves the uncontrolled growth of cells within the body. In the case of vaginal cancer, there are two common types, as well as a precancerous stage. Each type originates in the vagina and can spread to other body parts. The most common types of vaginal cancer are:

  • VAIN (vaginal intraepithelial neoplasia) or vaginal ‘precancer’ – while this isn’t technically cancer, this condition involves abnormal changes in the skin cells of the vagina that could become cancer in the future. These cell changes sometimes go away on their own.
  • Squamous Cell Carcinoma – 9 out of 10 cases of vaginal cancer are squamous cell carcinomas. These cancerous lesions typically appear near the cervix and are primarily due to the human papillomavirus (HPV). These lesions usually form slowly after the VAIN stage of vaginal precancer. Squamous cell carcinomas typically stay in the vagina but sometimes can spread to the bone, the lungs, or the liver. 
  • Adenocarcinoma – this cancer begins in glandular cells, which are cells that produce mucus. It is much rarer than squamous cell carcinomas and accounts for about 1.5 out of 10 cases. This aggressive type of vaginal cancer is more likely to spread to the lungs and lymph nodes.

Rare Types of Vaginal Cancer

There are a few extremely rare types of vaginal cancer as well:

  • Melanoma – although this condition is typically referred to as skin cancer, it can develop in the outer portion of the vagina that has sun exposure. Melanoma makes up fewer than 3 out of every 100 cases of vaginal cancer.
  • Sarcoma – this cancer, which also occurs in fewer than 3 of 100 cases, forms deep in the tissue walls of the vagina. There are several types of sarcomas, but the most common vaginal sarcoma (Rhabdomyosarcoma) mainly affects children. The sarcoma that mainly affects females over the age of 50 is leiomyosarcoma. 

There are also cancers that can spread to the vagina, a phenomenon more common than cancers that originate there. Cancers get their names for the organ in which they start, and the following types more often experience spread to the vagina:

  • Cervical cancer 
  • Vulvar cancer 
  • Bladder cancer
  • Rectal cancer

Stages of Vaginal Cancer

Staging cancer can help understand how widespread the cancer cells have become in the body and, therefore, the options for treatment and prognosis. The stages of vaginal cancer are:

  1. Stage I – The tumor is only in the vagina. It has not spread to other parts of the reproductive system or the lymph nodes
  2. Stage II – The tumor has spread through the walls of the vagina but has not spread beyond the pelvis and has not impacted lymph nodes
  3. Stage III – The cancer has spread to the pelvic lymph nodes in the pelvis or through the pelvic wall.
  4. Stage IV – This stage is broken up into two substages
    1. The cancer has spread to the bladder or the rectum and beyond the pelvis.
    2. The cancer has spread or metastasized to distant body parts like the lungs, liver, or bones. 

Symptoms and Risk Factors of Vaginal Cancer

The main symptoms of vaginal cancer can mimic symptoms of benign bodily processes such as menstruation, menopause, and implantation bleeding. This is why it is crucial to visit your doctor for screening regularly. Symptoms include:

  • Abnormal vaginal bleeding, the primary symptom of vaginal cancer. But, this can easily be mistaken for menstruation.
  • Abnormal vaginal discharge (change in odor, color, or texture)
  • A lump or mass in the vagina
  • Pain during sex

If the cancer is more advanced, these symptoms may present:

  • Painful urination
  • Leg swelling
  • Constipation
  • Pelvic or lower abdominal pain
  • Back pain

Developing Vaginal Cancer

  • HPV – A current or past human papillomavirus (HPV) infection greatly increases the risk for vaginal cancer. HPV is most commonly transmitted through sexual contact. Strains of HPV that cause cancer are referred to as high-risk strains. Other strains of HPV, such as the strain that causes genital warts, have no links to cancer. 
  • Age – Age is another big risk factor. Females between 50 and 70 are most at risk for developing squamous cell carcinoma. The average age of diagnosis is 67.
  • Tobacco use – smoking is thought to increase the risk of developing vaginal cancer.
  • Previous radiation treatment – if you’ve previously received radiation therapy in the vaginal region, your risk of developing vaginal cancer increases.
  • Cervical cancer – if you’ve previously been diagnosed with cervical cancer, your chances of developing vaginal cancer increase.
  • HIV – having Human Immunodeficiency Virus (HIV) increases the risk of vaginal cancer diagnosis.
  • Alcohol – frequent drinking may increase a person’s risk of developing vaginal cancer. 

Vaginal Cancer Diagnosis

If you are experiencing any concerning symptoms listed above or are at risk for developing vaginal cancer, you will need to consult your OB-GYN or primary doctor. If they determine you are high-risk, they will refer you to a gyno-oncologist who will run a series of tests to:

  • Determine if the cancer is present
  • Gauge the stage of progression of the cancer
  • Measure the tumor or lesion. 

Some common diagnostic tools include:

  • Pelvic exam – can be performed by either an OB-GYN or a gyno-oncologist. This involves a visual examination and imaging of the vaginal canal to look for abnormalities or masses.
  • Pap smear – this cervix swab will check for abnormal or cancerous cells in the cervix and vagina. Your doctor may order a colposcopy or biopsy if there are cancerous cells.
  • Colposcopy – Your doctor will closely examine any abnormal tissue of the vaginal canal or cervix.
  • Biopsy – if a pap smear returns abnormal, your doctor may perform a biopsy to study the abnormal cells to check for cancer. 
  • Ultrasound – this machine uses soundwaves to look for tumors or abnormalities in organs.
  • MRI/CT/PET scan – these imaging tests show a more complete picture of the size of the tumor and the damage the cancer has done at the time it is identified.

Treatments and Interventions

How do doctors treat vaginal cancer? There are a few different treatment options for vaginal cancer, depending on the type of cancer, its stage, as well as an individual’s medical history, overall health, and life goals. Some treatments for vaginal cancer can impact a person’s sexual health and fertility.

  • Surgery: The first line of defense in the early stages of vaginal cancer is surgery, such as local excision. This is where doctors cure out the tumor without removing organs/tissues. Other surgeries include vaginectomy, where they remove the entire vagina, and a total hysterectomy. A hysterectomy is when a doctor removes all female reproductive organs. 
  • Radiation: Another treatment option is the use of radiation, where they use high-energy x-rays to destroy cancer cells. It is extremely hard on the body and is used when surgery is either not an option or is unsuccessful. Radiation, unfortunately, carries inherent side effects and risks, such as nausea, intestinal discomfort, vaginal dryness, and increased risk for another type of pelvic cancer.
  • Chemotherapy: Doctors sometimes use chemotherapy medications in combination with radiation to destroy cancer cells or keep them from growing. They can give it locally or systemically through the bloodstream, usually via an IV. These medications often come with unpleasant and severe side effects such as hair loss, nausea, and loss of appetite., Chemotherapy and radiation may become necessary if the cancer has progressed beyond what surgery can accomplish. Regular screening to catch vaginal cancer early on can decrease the likelihood of needing radiation or chemotherapy. 

What Is the Outlook for Vaginal Cancer?

Cancer survival data is based on a 5-year survival rate of individuals already diagnosed. About 5 of every 10 vaginal cancer patients survive beyond five years. However, if the cancer is caught sooner when it is localized, or confined in the vagina, more than 6 out of 10 patients survive beyond five years. We cannot overstate the importance of regular checkups with your OB-GYN or primary care provider to ensure you are healthy and well.

Next Steps

If you are experiencing any concerning symptoms, talk to your doctor about your concerns. If you have already been diagnosed, support groups are available online and in person. Learn more about online support groups here. You can also learn more about counseling services here.

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