Vaginal cancers are rare malignancies that develop in the vagina, a long, muscular canal leading from the cervix to the outside of the body. The vaginal opening is where menstrual blood flows out during menstruation, sexual intercourse occurs, and a baby comes out during labour.
Vaginal cancer is most common in women over 60, however, it can affect anyone with a vagina – including women, teenagers, transgender men, non-binary individuals, and intersex people – at any age.
Types of Vaginal Cancers
There are several types of vaginal cancer, which are categorised by the type of cells they originate from.
Squamous Cell Carcinoma (SCC)
Vaginal squamous cell carcinomas (SCCs) are the most common subtype of vaginal cancer, and are often found in the upper portion of the vagina. Squamous cell carcinomas (SCCs) are cancers that arise from the squamous cells that line organs, such as the vagina. They are usually not aggressive, but can metastasise if left untreated. Vaginal SCCs can have a good prognosis when found early.
Adenocarcinoma
Vaginal adenocarcinomas are a rarer subtype of the disease, which arise from mucus-producing glands in organs, such as the vagina. Some forms of vaginal adenocarcinomas, especially clear cell adenocarcinoma, have been linked to diethylstilbestrol (DES) exposure prior to birth. They can be aggressive, can metastasise and can have a good prognosis when caught early.
Mucosal Melanoma
Melanomas are a type of cancer that develop from melanocytes, which are the cells that produce pigment. While these are generally in the skin, they can also occur in mucosal surfaces. Vaginal melanomas are very rare.
For more information about mucosal melanoma, please refer to the Rare Cancers Australia Melanoma (Mucosal) page.
Rare forms of Vaginal Cancer
These types of vaginal cancers are considered extremely rare:
- Vaginal Sarcoma.
- Vaginal Small Cell Carcinoma.
- Vaginal Lymphoma.
Treatment
If vaginal cancer is detected, it will be staged and graded based on size, metastasis (whether the cancer has spread to other parts of the body) and how the cancer cells look under the microscope. Staging and grading helps your doctors determine the best treatment for you.
FIGO Staging System
Gynaecological cancers, such as vaginal cancers, can be staged using the Federation of Gynaecology and Obstetrics (FIGO) system from stage I to IV:
- Stage I: cancer cells are confined to cervix tissue only. This stage is also known as early-stage cancer.
- Stage II: cancer cells have spread to the upper two-thirds of the vagina and/or other nearby tissue. This is also known as localised cancer.
- Stage III: the cancer has become larger and has spread to lower third of the vagina and/or the side of the pelvic wall. Lymph nodes and kidneys may be affected. This is also known as advanced or metastatic cancer.
- Stage IV: the cancer has spread to the bladder or rectum, or to more distant organs, such as the lungs or the liver. This is also known as advanced or metastatic cancer.
TNM Staging System
The TNM system can also be used to classify a vaginal cancer. The TNM system is comprised of:
- T (tumour) indicates the size and depth of the tumour.
- N (nodes) indicates whether the cancer has spread to nearby lymph nodes.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissue.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localised cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advanced or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Grade I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testing, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment Options
Treatment is dependent on several factors, including fertility, type, stage of disease and overall health.
Treatment options for cervical cancers may include:
- Radiation therapy.
- Surgery, potentially including:
- Partial vaginectomy (partial removal of the vagina).
- Total vaginectomy (complete removal of the vagina).
- Radical vaginectomy (complete removal of the vagina and surrounding tissues).
- Vaginal reconstruction (the creation of a new vagina using skin and muscle from other parts of the body).
- Total hysterectomy (complete removal of the uterus and cervix).
- Salpingo-oophorectomy (removal of one (unilateral) or both (bilateral) ovaries and fallopian tubes).
- Chemotherapy.
- Clinical trials.
- Palliative care.
For more information on the treatment options, please refer to the Rare Cancers Australia Treatment Options page.
Vaginal Cancer Treatment and Fertility
Treatment for vaginal cancer may make it difficult to become pregnant. If fertility is important to you, discuss your options with your doctor and a fertility specialist prior to the commencement of treatment.
Risk factors
While the cause of vaginal cancer remains unknown, the following factors may increase the risk of developing the disease:
- Having vaginal intraepithelial neoplasia (VAIN).
- Having an infection with human papillomavirus (HPV).
- Smoking.
- Having a personal history of a gynaecological cancer (such as ovarian, uterine, vulvar, fallopian etc.).
- Previous radiation therapy to the pelvic area.
- Exposure to diethylstilboestrol (DES).
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Diethylstilbestrol (DES) exposure
Diethylstilbestrol (DES) is a synthetic form of the female hormone estrogen. It was prescribed to pregnant women between 1940 and 1971 to prevent miscarriage, premature labour, and related complications of pregnancy. The use of DES declined after studies in the 1950s showed that it was not effective in preventing these problems.
In 1971, researchers linked prenatal (before birth) DES exposure to a type of cancer of the cervix and vagina called clear cell adenocarcinoma in a small group of women. Soon after, the Food and Drug Administration (FDA) notified physicians throughout the country that DES should not be prescribed to pregnant women. The drug continued to be prescribed to pregnant women in Europe until 1978.
Women who have taken DES, and women whose mothers took DES whilst pregnant, may be at higher risk of vaginal cancer, as well as other conditions.
Early symptoms
Many people with early-stage vaginal cancer may appear asymptomatic. As the cancer progresses, some of the following symptoms may appear:
- Unusual bloody vaginal discharge (not related to menstrual period) – occasionally having a strong and usual odour.
- Pain and/or bleeding during or after sexual intercourse.
- Pain in the pelvic area and/or rectum.
- A lump in the vagina.
- Changes in bladder/bowel habits, potentially including:
- Blood in urine.
- Frequent urination.
- Painful bowel movements.
- Unusual urination during the night.
Not everyone with the symptoms above will have cancer but see your general practitioner (GP) if you are concerned.
Diagnosis/diagnosing
If your doctor suspects you have vaginal cancer, they may order the following tests to confirm the diagnosis and refer you to a specialist for treatment.
Pelvic examination
The doctor will inspect the abdomen for any swelling or masses, followed by your genitalia. The doctor will then insert two fingers into your vagina while simultaneously pressing on your abdomen with their other hand to feel your uterus and ovaries. Following this, the doctor may use a device called a speculum into your vagina, which will separate the vaginal walls and allow viewing of your vaginal canal and cervix for any visible abnormalities. You many request a family member, friend, or nurse to be present during this exam.
Imaging & Blood tests
The doctor will take images of your body using magnetic resonance imaging (MRI), a computed tomography scan (CT scan), pelvic ultrasound (including abdominal and trans-vaginal ultrasounds) and/or positron emission tomography (PET scan), depending on where it is suspected the cancer is. The doctor may also look at other parts of the body and looks for signs of metastasis. Additionally, a blood test may be taken to assess your overall health and help guide treatment decisions.
Colposcopy
A colposcopy is a type of pelvic examination that looks closely at the cervix and vagina. Your doctor will use a speculum to separate the walls of the vagina, and apply a vinegar-like liquid and iodine to the cervix and vagina to help highlight any abnormal areas. The colposcope (a microscope with a light) is placed near your vulva, but does not enter your body. If any abnormalities are observed, a biopsy may be taken.
Biopsy
Once the location of the cancer has been identified, the doctor will perform a biopsy to remove a section of tissue using a needle. This is often done by a fine needle aspiration (FNA), a core needle biopsy (CNB), or during a procedure (such as a colposcopy or large loop excision of transformational zone (LLETZ)). These samples will then be analysed for cancer cells.
Prognosis (Certain factors affect the prognosis and treatment options)
While it is not possible to predict the exact course of the disease, your doctor may be able to give you a general idea based on the rate and depth of tumour growth, susceptibility to treatment, age, overall fitness, and medical history. Generally, early-stage vaginal cancers have a better prognosis and survival rates. However, if the cancer is advanced and has spread, the prognosis may not be as good and there may be a higher risk of cancer recurrence. It is very important to discuss your individual circumstances with your doctor to better understand your prognosis.
References
Some references are to overseas websites. There may be references to drugs and clinical trials that are not available here in Australia.