The vagina is a three- to four-inch tube that goes from the cervix (bottom section of the uterus or womb) to the vulva (the outside part of female genitals). According to the American Cancer Society, 5,100 women are diagnosed with vaginal cancer each year in the United States.
Vaginal cancer is classified by the type of cell where it begins.
Squamous cell carcinoma: Most vaginal cancers are squamous cell cancers, which start in the vagina lining. These cancers develop slowly, sometimes over many years. Often they begin as vaginal intraepithelial neoplasia (VAIN), which is a precancerous condition. VAIN is found most often in women who have had hysterectomies (removal of the uterus), cervical cancer or cervical precancer.
Adenocarcinoma: This cancer starts in the gland cells of the vagina and is most often found in women over 50. A subtype called clear cell adenocarcinoma is found in younger women whose mothers took the drug DES when they were pregnant.
Melanoma: This type of vaginal cancer starts in the cells that give the skin color.
Sarcoma: A small number vaginal cancers are sarcomas, which start within the wall of the vagina. The most common type is rhabdomyosarcoma, which usually is found in children.
Sometimes cancer that begins in other parts of the body spreads (metastasizes) to the vagina. When this happens, the cancer is named for the part of the body where it started. Cancer of the cervix and vagina is called cervical cancer. Cancer of the vulva and vagina is called vulvar cancer.
Vaginal Cancer Risk Factors
Anything that increases your chance of getting vaginal cancer is a risk factor. These include:
- DES (diethylstilbestrol): This drug was given between 1940 and 1971 to some pregnant women to help them not have a miscarriage (lose the baby).
- Vaginal adenosis: In some women, especially those whose mothers took DES, the cells in the vagina change from squamous cells to endometrium (or glandular) cells.
- HPV (human papilloma virus)
- Cervical cancer or pre-cancer
- Smoking
- Drinking alcohol in excess
- HIV (Human immunodeficiency virus)
Not everyone with risk factors gets vaginal cancer. However, if you have risk factors, you should discuss them with your doctor.
In rare cases, vaginal cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our genetic testing page to learn more.
What are the symptoms of vaginal cancer?
Symptoms of vaginal cancer vary from woman to woman. They may include:
- Abnormal vaginal bleeding, especially after sex
- Abnormal vaginal discharge
- A mass or bump in the vagina
- Pain during sex
- Constipation
- Pain when you urinate
- Pain in the pelvic area that does not go away
If you have these symptoms, it probably does not mean you have cancer. They usually are caused by conditions, such as infections, that are not cancer. However, if you notice any of these signs, you should see a doctor.
In rare cases, vaginal cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our genetic testing page to learn more.
Did You Know?
We use innovative vaginal cancer surgery methods and techniques that allow some women to keep the ability to have children, including trachelectomy.
How is vaginal cancer diagnosed?
The experts at MD Anderson use the most advanced technology and techniques to pinpoint vaginal cancer. They specialize in diagnosing vaginal cancer, and they have a high degree of expertise and skill.
Vaginal cancer diagnostic tests
If you have symptoms that may signal vaginal cancer, your doctor will examine you and ask you questions about your health; your lifestyle, including smoking and drinking habits; and your family history.
One or more of the following tests may be used to find out if you have vaginal cancer and if it has spread. These tests also may be used to find out if treatment is working.
Biopsy
The only way to tell for sure if you have vaginal cancer is a biopsy. A small piece of tissue is removed, and then it is looked at under a microscope. Your doctor may use a colposcope to magnify the area and make it easier to remove the tissue. The doctor then looks at the area using colposcope, which is like binoculars with magnifying lenses, or a magnifying glass. A small piece of the suspicious area will be removed.
Imaging tests, which may include:
- CT or CAT (computed axial tomography) scans
- MRI (magnetic resonance imaging) scans
- PET (positron emission tomography) scans
- Chest X-ray
Endoscopic tests, which may include:
Proctosigmoidoscopy: An endoscope is inserted into the rectum to look at the rectum and colon. Biopsies can be done during the procedure.
Cystoscopy: An endoscope is inserted into the bladder through the urethra. Biopsies can be done during the procedure.
Research shows that many cancers can be prevented.
In rare cases, vaginal cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our genetic testing page to learn more.Blood tests, imaging exams and even surgical procedures are used to check for cancer.
What are the stages of vaginal cancer?
If you are diagnosed with vaginal cancer, your doctor will determine the stage of the disease.Staging is a way of classifying cancer by how much disease is in the body and where it has spread when it is diagnosed. This helps the doctor plan the best way to treat the cancer.
Vaginal cancer stages
(source: National Cancer Institute)
The stage of most vaginal cancers is most often described using the FIGO (International Federation of Gynecology and Obstetrics) System of Staging combined with the American Joint Committee on Cancer (AJCC) TNM system. This system classifies the diseases in Stages 0 through IV depending on the extent of the tumor (T), whether the cancer has spread to lymph nodes (N) and whether it has spread to distant sites (M for metastasis).
Tumor extent (T)
- Tis: Cancer cells are only in the most superficial layer of cells of the vagina without growth into the underlying tissues. This stage is also called carcinoma in situ (CIS) or vaginal intraepithelial neoplasia 3 (VAIN 3). It is not included in the FIGO system.
- T1: The cancer is only in the vagina.
- T2: The cancer has grown through the vaginal wall, but not as far as the pelvic wall.
- T3: The cancer is growing into the pelvic wall.
- T4: The cancer is growing into the bladder or rectum or is growing out of the pelvis.
Lymph node spread of cancer (N)
- N0: The cancer has not spread to lymph nodes.
- N1: The cancer has spread to lymph nodes in the pelvis or groin (inguinal region).
Distant spread of cancer (M)
- M0: The cancer has not spread to distant sites.
- M1: The cancer has spread to distant sites.
Stage Grouping
Once the T, N, and M categories have been assigned, this information is combined to assign an overall stage in a process called stage grouping. The stages identify tumors that have a similar outlook and are treated in a similar way.
Stage 0 (Tis, N0, M0): In this stage, cancer cells are only in the top layer of cells lining the vagina (the epithelium) and have not grown into the deeper layers of the vagina. Cancers of this stage cannot spread to other parts of the body. Stage 0 vaginal cancer is also called carcinoma in situ (CIS) or vaginal intraepithelial neoplasia 3 (VAIN 3). This stage is not included in the FIGO system.
Stage I (T1, N0, M0): The cancer has grown through the top layer of cells but it has not grown out of the vagina and into nearby structures (T1). It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
Stage II (T2, N0, M0): The cancer has spread to the connective tissues next to the vagina but has not spread to the wall of the pelvis or to other organs nearby (T2). (The pelvis is the internal cavity that contains the internal female reproductive organs, rectum, bladder, and parts of the large intestine.) It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
Stage III: Either of the following:
- T3, any N, M0: The cancer has spread to the wall of the pelvis (T3). It may (or may not) have spread to nearby lymph nodes (any N), but it has not spread to distant sites (M0), OR
- T1 or T2, N1, M0: The cancer is in the vagina (T1) and it may have grown into the connective tissue nearby (T2). It has spread to lymph nodes nearby (N1), but has not spread to distant sites (M0).
Stage IVA (T4, Any N, M0): The cancer has grown out of the vagina to organs nearby (such as the bladder or rectum) (T4). It may or may not have spread to lymph nodes (any N). It has not spread to distant sites (M0).
Stage IVB (Any T, Any N, M1): Cancer has spread to distant organs such as the lungs (M1).
What are the treatment options for vaginal cancer?
At MD Anderson, a team of renowned physicians customizes your care to be sure you receive the most advanced treatments for vaginal cancer. And, because we go beyond treating the disease, we always keep your quality of life in mind. For this reason, we focus on therapies that have the least impact on your body, yet target the cancer with leading-edge methods.
MD Anderson treats more women each year with vaginal cancer than most oncologists in the nation. This gives us a level of expertise that is rare and translates to better outcomes in many cases of vaginal cancer.
Like all surgeries, vaginal cancer surgery is most successful when performed by a specialist with as much experience as possible in the particular procedure. MD Anderson surgeons are among the most skilled and recognized in the world. They perform a number of surgeries for vaginal cancer each year, using the newest, most-advanced techniques. Special areas of focus include:
- Surgical methods that allow some women to keep the ability to have children
- Reconstructive surgery after treatment
And we’re constantly researching newer, safe, more-advanced vaginal cancer treatments. This translates to a number of clinical trials for vaginal cancer.
Our vaginal cancer treatments
If you are diagnosed with vaginal cancer, your doctor will discuss the best options to treat it. This depends on several factors, including:
- Type and stage of the cancer
- Your age and general health
- If you want to have children
Your treatment for vaginal cancer will be customized to your particular needs. Sometimes two or more treatments are combined. Chemotherapy and/or radiation may be used before surgery to help shrink the tumor and make it easier to remove. Sometimes radiation is used to treat lymph nodes that may have cancer.
One or more of the following therapies may be recommended to treat vaginal cancer or help relieve symptoms.
Topical Therapy
A drug is applied directly onto the cancer. Topical therapy is not used to treat invasive vaginal cancer.
Surgery
Surgery may be used for:
- Early stage vaginal cancer
- Sarcomas
- Melanomas
Your team of doctors will decide which method is best for you. Common surgeries for vaginal cancer include:
- Laser surgery: This procedure may be used to treat precancerous changes, but it is not used for invasive vaginal cancer. Abnormal cells are burned off with a laser beam.
- Excision: The cancer and some tissue on each side of it are surgically removed.
- Vaginectomy: All or part of the vagina is removed.
- Trachelectomy: The cervix and surrounding tissue are surgically removed but not the vagina. This procedure sometimes can be used for young women who wish to keep the ability to have children.
- Lymph nodes may be removed during surgery. A cerclage or stitch is used to help support the base of the uterus. If more cancer is found during the surgery, a hysterectomy probably will be done.
- This is a highly specialized procedure that requires a great deal of skill on the part of the surgeon to be successful. If you are considering this surgery to treat vaginal cancer, be sure the doctor performing it has a high level of experience in this procedure.
- Hysterectomy: This operation removes the uterus and the cervix, but not the tissue next to the uterus. The vagina and nearby lymph nodes are not removed. The surgery may be done through the vagina or through an incision (cut) in the abdomen.
- Radical hysterectomy: The cervix, uterus, part of the vagina, the tissues surrounding the cervix (parametria) and nearby lymph nodes are removed, either through the vagina or a cut on the abdomen. The ovaries and fallopian tubes also may be removed at the same time. This is called a bilateral salpingo-oophorectomy (BSO).
- Vaginal reconstruction: After surgery to remove the vaginal cancer, some women are able to have surgery to make a new vagina from tissue or skin from elsewhere on the body. This allows you to have intercourse.
- Lymphadenectomy: If cancer has spread to lymph nodes in the groin or pelvis areas, or the surgeon wants to examine them to see if cancer has spread, it may be necessary to remove the glands surgically. This also is called a lymph node dissection. Lymphedema, which is caused by decreased fluid drainage, may be a side effect of this surgery.
- Pelvic exenteration: Although this surgery is used rarely for vaginal cancer, it may be needed if the cancer has come back or it cannot be treated with radiation. As well as the organs and tissues removed in a radical hysterectomy, the bladder, cervix, rectum and part of the colon are removed.
- If the bladder is removed, a piece of intestine may be used to make a new bladder. Then urine may be drained through a catheter (tube) into a urostomy, which is a small opening on the abdomen, or into a small plastic bag worn on the outside of the body.
- If the rectum and part of the colon are removed, you may have a colostomy, which is an opening on the abdomen that allows solid waste (stool) to pass into a small bag worn on the outside of the body. Sometimes the colon may be reconnected so that a colostomy is not needed.
To learn more about the surgery, watch Total Pelvic Exenteration: What You Need to Know.
Chemotherapy
MD Anderson offers the most up-to-date and advanced vaginal cancer chemotherapy options.
Radiation Therapy
New radiation therapy techniques and remarkable skill allow MD Anderson doctors to target vaginal cancer tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.
MD Anderson provides the most advanced radiation treatments, including:
- Brachytherapy: Tiny radioactive seeds or rods are placed in the body close to the tumor
- External beam radiation: From a machine outside the body
Our vaginal cancer clinical trials
Because of its status as one of the world’s premier cancer centers, MD Anderson participates in clinical trials of new therapies for vaginal cancer. Sometimes they are your best option for treatment. Other times, they help researchers learn how to treat cancer and improve the future of cancer treatment. Learn more about clinical trials.
Why come to MD Anderson for vaginal cancer care?
When you come to MD Anderson's Gynecologic Oncology Center for vaginal cancer care, a team of experts focuses on you. These nationally known physicians customize your therapy to include the most advanced vaginal cancer treatments with the least impact on your body.
Your care team works together closely, communicating and collaborating often to be sure you receive the most comprehensive and efficient care. The group may include surgical, medical, radiation and gynecological oncologists; surgeons and reconstructive surgeons; diagnostic radiologists and pathologists. A specially trained support staff joins them in delivering your care for vaginal cancer.
MD Anderson treats more women each year with this complex type of cancer than most oncologists in the nation. This gives us a level of experience and expertise that is rare and translates to more successful outcomes for many women with vaginal cancer.
Surgical skill
Surgery often is one of the methods used to treat vaginal cancer. Our skilled surgeons – who include some of the top reconstructive surgeons in the country – are known for innovative techniques and excellent outcomes.
We consider your quality of life one of our top priorities. That's why we offer the most advanced surgical methods for vaginal cancer, including procedures that allow some women to keep the ability to have children.
Pioneering vaginal cancer research
We're constantly researching newer, safe, more-advanced vaginal cancer treatments. This translates to a number of clinical trials of new treatments for vaginal cancer.
And at MD Anderson you're surrounded by the strength of one of the nation's largest and most experienced comprehensive cancer centers, which has all the support and wellness services needed to treat the whole person – not just the disease.
I just want to do my best to brighten patients' days and let them know I'm here for them.
The Gynecologic Oncology Center at MD Anderson
HPV-Related Cancers Moon Shot
More than 70% of vaginal cancer cases are caused by human papillomavirus (HPV) infection, for which a safe and effective vaccine currently exists. MD Anderson’s HPV-Related Cancers Moon Shot® aims to improve outcomes for vaginal cancer patients through prevention initiatives and new treatments.
Learn moreMary Taylor thought she was experiencing pelvic pain due to endometriosis in early 2015. She never suspected it was a symptom of vaginal cancer.
After weeks with no change, she decided to see her gynecologist, who noticed abnormalities in Mary’s vaginal wall and performed a biopsy. When Mary didn’t hear back for several weeks, she figured the test must have come back clear. Then, she received a call from her doctor: Mary had vaginal cancer. Her doctor had taken extra time and checked the biopsy results several times to be sure.
Mary was shocked. She immediately called her husband, Robert.
“My husband is like an angel in a crisis,” says Mary, a symphony violinist and violin teacher in Charleston, South Carolina. Wanting more information, they drove together to the gynecologist’s office.
Receiving a vaginal cancer diagnosis
When Robert and Mary arrived, her gynecologist said that she felt Mary was going to have a difficult time with cancer. Mary felt confused and upset.
Soon afterwards, she saw a local oncologist, who ordered an MRI. It only showed vaginal cancer. But the oncologist suspected that the cancer may have spread there from another origin. Additional tests came back clear, but the doctor recommended Mary undergo a capsule endoscopy, in which the patient swallows a pill-like capsule containing a wireless camera to take pictures of the digestive tract.
Getting a second opinion at MD Anderson
Mary instead decided to get a second opinion. A friend recommended MD Anderson.
“MD Anderson is one of the most amazing places that we’ve ever been,” says Mary. “It’s just like something from a heavenly realm.”
Mary had her first appointment in June 2015. Before they arrived, Mary and Robert prepared a letter for their new gynecologic oncologist stating they did not want to know what stage the cancer was, statistics on survival, or projected length of life with the diagnosis. Understanding that no one knew exactly what the outcome of Mary’s individual cancer treatment would be, they wanted to remain positive.
At MD Anderson, Mary had another biopsy, MRI, PET scan and chest X-ray. Using these scans, the pathology, radiology and clinical teams checked for signs of cancer in her lymph nodes, bones and throughout her body, but they found the cancer hadn’t spread and was confined to the vaginal wall. MD Anderson’s gynecologic oncology pathologists validated this conclusion, recognizing features of the cancer cells that they identified as primary vaginal cancer.
A three-part vaginal cancer treatment plan
At the end of June 2015, Mary began her treatment. She started with five weeks of intensity-modulated radiation therapy (IMRT) — a precise form of radiation delivered through an external beam — under the care of radiation oncologist Ann Klopp, M.D., followed by four rounds of chemotherapy with the drug cisplatin given through an IV infusion. Between these infusions, Mary experienced some nausea and had to force herself to eat — a common side effect of chemotherapy.
After radiation therapy and chemotherapy, Mary received interstitial brachytherapy implant treatment, which delivers radiation therapy with tiny pieces of radioactive material that are placed inside the patient’s body as close to the tumor as possible. This allows doctors to deliver very high doses of radiation directly to the patient’s tumor while limiting radiation exposure to healthy tissue.
The power of positivity
Long before her vaginal cancer diagnosis, Mary had begun meditating. She relied on mediation again to help her through the ups and downs of treatment.
“To me, meditation is just a different kind of prayer,” she says.
Mary also visited MD Anderson’s Integrative Medicine Center and looked at books on the relationship between the mind, body and spirit. “It was really interesting, and it was really helpful,” she says.
On July 31, 2015, Mary completed her treatment. She returned in November for a PET scan, which showed she had no evidence of disease.
Now, she returns to MD Anderson yearly for her checkups. When friends and family ask how she’s doing, she doesn’t say anything about the ups and downs of the past few years. She simply tells them, “I’m perfect.”
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
