Vaginal Cancer

There is no dedicated screening tool for vaginal cancer. In some cases, pre-cancerous changes in the vagina can be found with a Pap test — however, these tests are not validated screening tools for vaginal cancer. Vaginal cancers can also be identified during pelvic exams.

Vaginal cancer may be asymptomatic or may be associated with symptoms depending on the size of the tumor and its location. When present, symptoms of vaginal cancer can include one or more of the following:

• Abnormal vaginal bleeding (often occurring after sex)
• Abnormal vaginal discharge
• A lump or mass in the vagina
• Pain during sex

Advanced vaginal cancer means the cancer has spread beyond the vagina into nearby parts of the body or lymph nodes. Advanced vaginal cancer symptoms can include painful urination, constipation, pain in pelvis or lower belly, back pain, or swelling in the legs. For more detailed information about vaginal cancer, visit the American Cancer Society.

Though many who develop vaginal cancer have no clear risk factors, certain factors may increase the chances of developing vaginal cancer, including:

• Increased age, as vaginal cancer is rare in women under age 40, and nearly half of cases are found in women over 70 years old.
• HPV (human papillomavirus) infection. High-risk HPV types that make a person more likely to develop cervical cancer can also be associated with vaginal cancer.
• Smoking.
• HIV (human immunodeficiency virus).
• DES (diethylstilbestrol) exposure. DES is a hormonal drug that was prescribed to many women between 1938 and 1971, as a way to prevent miscarriages. Studies have shown that people whose mothers took this drug, particularly during the first 16 weeks of pregnancy, have a significantly increased rate of a rare type of vaginal or cervical cancer called clear-cell adenocarcinoma.

There are several different types of vaginal cancer, including:

• Squamous cell carcinoma, a typically slow-developing cancer that starts in the squamous cells of the vagina’s epithelial lining, most commonly in the upper part of the vagina near the cervix. This accounts for approximately nine out of 10 vaginal cancer diagnoses.
• Adenocarcinoma, a cancer that starts in glandular cells and may be associated with a patient’s exposure to diethylstilbestrol (DEST) in utero.
• Melanoma of the vagina, which is considered to be a type of mucosal melanoma, is an aggressive and extremely rare type of vaginal cancer, usually affecting the lower or outer part of the vagina. This accounts for fewer than three out of 100 vaginal cancer cases.
• Sarcomas are cancers that develop in the muscles or connective tissue deep in the wall of the vagina. These are very rare.

A biopsy is ultimately needed in order to confirm a vaginal cancer diagnosis. If a doctor suspects a patient may have vaginal cancer, they may perform tests including;

• Physical exam with medical history, where a doctor will perform a pelvic exam and possibly a Pap test, and will discuss complete medical history, risk factors, and symptoms.
• Colposcopy involves a doctor using a speculum to hold open the vaginal walls to examine the cervix and/or vagina with a colposcope. A colposcope is a magnifying tool to view potentially abnormal areas. Applying vinegar to the walls of the vagina or the cervix during a colposcopy exam can also help identify abnormal cells.
• Biopsy, removal of tissue for further examination, may be performed if a colposcopy shows an abnormal area suggesting presence of cancer. The biopsy may be a bit painful, and can produce some cramping after the procedure. This will definitively tell if pre-cancerous or cancer cells are present.
• Imaging tests such as a chest x-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI), and positron emission tomography (PET) scan, may be performed after diagnosis of vaginal cancer to determine if and how far the cancer has spread.
• Endoscopic tests are not typically used for vaginal cancer, but in some cases a doctor may perform a proctosigmoidoscopy, which is an examination of the rectum and colon with a lighted tube; or a cystoscopy, which checks for spread to the bladder by inserting a thin tube with a lens into the bladder, through the urethra.

Vaginal cancer stages range from stage 1 (1) to stage 4 (IV). A lower vaginal cancer stage indicates more localized disease, whereas a higher stage indicates the cancer has spread. The stage of vaginal cancer will help inform next steps as far as treatment and prognosis.
A condition called vaginal intraepithelial neoplasia (VAIN) refers to the presence of pre-cancerous cells in the vagina. This is sometimes referred to as stage 0 vaginal cancer. Depending on the type of pre-cancerous cells, doctors may choose to treat VAIN right away, or take a wait-and-see approach. See details about vaginal cancer stages from the American Cancer Society.

Depending on the stage of vaginal cancer, or in some cases pre-cancer, doctors will recommend a course of treatment. Treatments for vaginal cancer may include:

• Radiation therapy, which may be used in combination with surgery or chemotherapy in some cases. Radiation with chemotherapy may be used to treat higher stages of vaginal cancer. Radiation therapy uses high-energy rays or particles to destroy cancer cells. Learn more about radiation therapy for vaginal cancer from the American Cancer Society.
• Surgery may be recommended for early stage vaginal cancers that can be removed with local excision. This may involve resection of a portion of the vaginal wall, or resection of the entire vagina along with the cervix and uterus, depending on the size and location of the tumor. In some cases, surgery may be used after radiation if there is persistent disease in the pelvis.
• Chemotherapy may be used in combination with radiation therapy for vaginal cancer, or as treatment for vaginal cancer that has spread to other areas of the body.
• Topical therapies, laser treatment, intracavitary radiation (brachytherapy) or surgery may be used to treat VAIN, pre-cancerous cells in the vagina. Learn more about treatment for vaginal cancer from the American Cancer Society.

If cancer returns after treatment, it is called a recurrence. Not every patient will experience a recurrence, but if they do, the cancer may return near the area where it first developed, or elsewhere in the body. Plans for treatment and care should be discussed with a patient’s medical team. Some patients may wish to participate in a cancer clinical trial.

Survivors of vaginal cancer have an increased risk of developing other HPV-related cancers, including vulvar or cervical cancer. Vaginal cancer survivors may also be more likely to develop lung cancer or bladder cancer, though this may be due to the fact that smoking is a shared risk factor for vaginal, lung, and bladder cancer.

Vaginal cancer survival rates vary based on whether the cancer is first detected and treated while it is still localized and how far it has spread. The relative five-year survival rate is 69% for vaginal cancer found at a localized stage. The relative five-year survival rate is 57% for vaginal cancer with regional spread, through the vaginal wall or nearby lymph nodes. The five-year relative survival rate is 26% for vaginal cancer that has spread to distant organs, such as to the liver, lungs, or bones.

The average age of diagnosis of vaginal cancer is 69. According to the CDC, in the U.S., 1,372 women were diagnosed with vaginal cancer in 2021 (the latest year for which data is available) and 434 women died from vaginal cancer in 2022.