Vaginal Cancer: Causes, Symptoms, and Treatments

Vaginal cancer accounts for a small portion of all gynecologic cancers and is very rare. According to the American Cancer Society, vaginal cancer makes up 1% to 2% of gynecologic cancers. This year, about 8,900 people will be diagnosed with vaginal cancer in the U.S., and 1,630 deaths are expected. The vagina serves many functions. For example, it produces lubrication and lengthens during sex. It also provides a passageway for delivery during childbirth. Although vaginal cancer is not common, it’s important to be aware of your risk for this type of cancer and the symptoms to watch for.

What is vaginal cancer?

People often incorrectly refer to the outer female genitals as the vagina – but that part is actually called the vulva. The vagina is shaped like a tube or canal – you may have heard the term “birth canal.” It’s about 7 to 10 centimeters long (about the length of a color crayon). When you insert a tampon, it sits in the vagina. During sex, the penis goes into the vagina.

Vaginal cancer develops when abnormal cells grow in the vagina. It usually affects older people with a female reproductive system, and the average age at diagnosis is 67.

Although there are many types of vaginal cancer, squamous cell carcinoma accounts for 9 out of 10 cases. It develops in the lining of the vagina and tends to grow slowly.

It might surprise you to learn that it’s more common to find cancer that begins in a nearby organ – like the uterus, cervix, bladder – and spreads to the vagina than to find cancer that starts in the vagina.

Causes and risk factors of vaginal cancer

Because it’s so rare, scientists don’t know the cause of vaginal cancer. But they believe there’s a link between having high-risk strains of the human papillomavirus (HPV) and vaginal cancer.

Certain people who were exposed to diethylstilbestrol (DES) – a miscarriage prevention medication – while in their mother’s womb are also thought to be at increased risk of developing a type of vaginal cancer.

Vaginal intraepithelial neoplasia (VAIN) is a condition where some cells in the lining of the vagina look abnormal, but it’s considered pre-cancerous. But VAIN can become cancer over time.

Still, researchers have found the following risk factors for vaginal cancer:

  • Being older
  • Having been infected with HPV
  • Exposure to DES
  • Having had a hysterectomy
  • Having a personal history of cervical cancer or pre-cancerous changes in the cervix
  • Having had vulvar cancer or VAIN
  • Having a condition or taking medications that weaken your immune system
  • Smoking

Talk to your healthcare provider if you have one or more risk factors.

You may reduce your risk of vaginal cancer by avoiding infection with HPV. This includes having fewer sexual partners, using a condom, avoiding having sex with a person who has HPV, and receiving the HPV vaccine. Abstaining from smoking is another way to lower your risk of vaginal cancer and other cancers.

VAIN is often found during pelvic exams performed by your healthcare provider. A Pap test or HPV test – which is done for cervical cancer screening – can sometimes pick up pre-cancerous changes like VAIN.

So, getting your gynecologic checkups done regularly is an effective way to reduce your risk and catch vaginal cancer early.

Vaginal cancer symptoms to watch for

You may not have any symptoms in the early stage of vaginal cancer. More advanced vaginal cancer, also called invasive vaginal cancer, may produce symptoms such as:

  • Unusual vaginal bleeding or bleeding after sex
  • Abnormal vaginal discharge, which may be watery
  • Painful sex
  • Feeling a mass or lump in your vagina

If the tumor spreads beyond the vagina, you may notice:

  • Pain when you’re urinating
  • Trouble having a bowel movement
  • Pain in your pelvis
  • Pain in your back
  • Leg swelling

Often, these symptoms may be caused by non-cancerous diseases, but it’s hard to know unless you discuss them with your doctor and schedule a visit to get them checked out. Don’t delay because treatment is usually more effective when cancer is diagnosed in its early stage.

How is vaginal cancer diagnosed?

During your checkup, your gynecologist normally performs a pelvic exam. Using a speculum, they’ll look at the vagina and cervix for any abnormalities. They may also do a Pap test or HPV test at that time based on the recommendations.

If the pelvic exam or tests show anything concerning, your gynecologist may recommend a colposcopy to examine any abnormal area using a magnifying lens. A biopsy, where tissue samples are removed, may also be done at the same time and sent to a laboratory to check for cancer cells.

Stages of vaginal cancer

If cancer is found, you may need additional imaging tests to help your doctors check if the tumor has spread. Some of these tests are a computed tomography (CT) scan, magnetic resonance imaging (MRI), and positron emission tomography (PET) scan. This step is called staging.

You may hear the word “metastasis” if the tumor has spread. Your healthcare provider may describe vaginal cancer in 4 stages:

Stage I: Cancer cells are in the vagina only and have not spread to nearby lymph nodes.

Stage II: The tumor has grown through the vaginal wall but has not reached nearby lymph nodes.

Stage III: Cancer has grown into the pelvic wall or spread to nearby lymph nodes.

Stage IV: The tumor has spread beyond the vagina and is found in the bladder, rectum, or in distant organs like the lungs or bone.

Each stage can be further characterized by a substage based on the results of the staging tests.

How is vaginal cancer treated?

After staging, your providers will consider several factors to determine the best treatment plan.

For pre-cancerous vaginal lesions, like VAIN, laser surgery or topical therapy may be used. These treatments are typically not used for invasive vaginal cancer.

Radiation therapy is often used to treat vaginal cancer. It may be given internally – called brachytherapy – or externally. Many times, a combination of both types of radiation therapy is recommended. Sometimes, chemotherapy may be used along with radiation therapy for a more effective treatment.

In addition to being used together with radiation therapy, chemotherapy may be recommended to shrink vaginal tumors before surgery or if the tumor has spread.

Surgery may be discussed as an option for certain stages of vaginal cancer. Vaginectomy is a type of surgery where the vagina is removed. A trachelectomy (removal of the cervix) may be performed in cases where the cancer starts in the upper part of the vagina, near the cervix. Your doctor may also recommend a hysterectomy in some cases. In other instances, a major surgery – called pelvic exenteration – may be performed depending on how far the tumor has spread.

You may also consider participating in a clinical trial if it’s an option. Clinical trials help scientists understand if a new cancer treatment is working and safe.

Remember to discuss your preferences and wishes when talking with your doctors about your treatment options. For example, if a vaginectomy is recommended, ask about the possibility of a vaginal reconstruction which may make vaginal sex possible after a vaginectomy.

Conclusion

Like many gynecologic cancers, vaginal cancer affects people with a female reproductive system in a unique way. Understanding your risk factors and knowing the warning signs may help you catch vaginal cancer sooner. Taking steps to lower your risk of HPV infection, quitting smoking, and getting your gynecological check ups regularly may help decrease your risk of vaginal cancer.

Key takeaways

Vaginal cancer is rare. As with most cancers, the survival rate is highest when vaginal cancer is caught before it spreads.

You may not have any warning signs in the early stage of vaginal cancer. But the chance of catching the disease increases with regular gynecologic exams.

Talk to your healthcare provider if you notice anything unusual such as painless vaginal bleeding in between your periods, after sex, or after you’ve gone through menopause.

Resources:

American Cancer Society. Key Statistics for Vaginal Cancer.

American Cancer Society. Signs and Symptoms of Vaginal Cancer.

American Cancer Society. Treating Vaginal Cancer.

American Society of Clinical Oncology. Vaginal Cancer: Diagnosis.

American Society of Clinical Oncology. Vaginal Cancer: Stages.

American Society of Clinical Oncology. Vaginal Cancer: Statistics.

Centers for Disease Control and Prevention. What Are the Risk Factors?

Gold, J. M., et al. (2021). Physiology, Vaginal. National Center for Biotechnology Information.

National Cancer Institute. Vaginal Cancer Treatment (PDQ) – Health Professional Version.

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