Vaginal Cancer

The UofL Brown Cancer Center is dedicated to providing you with the best care for vaginal cancer.  Overview

Experts from our Multidisciplinary Gynecologic Oncology Clinic are dedicated to providing you with the best care for vaginal cancer. From diagnosis through treatment and follow-up, your care is personalized and designed to meet your individual needs. 

A team of gynecologic oncologists, radiation oncologists, reconstructive surgeons, colorectal surgeons, pathologists and radiologists will collaborate to provide a personalized treatment for you. UofL Brown Cancer Center is dedicated to providing you with cutting-edge treatment.

Vaginal cancer is a rare disease. About one in every 1,100 will develop vaginal cancer in her lifetime.

The vagina is sometimes called the birth canal. It leads from the cervix, or opening of the uterus, to the outside of the body.

Types of vaginal cancer

There are two main types of vaginal cancer:

  • Squamous Cell Carcinoma: This is the most common type of vaginal cancer. It spreads slowly and usually stays near the vagina, but may spread to the lungs, liver or bone.
  • Adenocarcinoma: This begins in the glandular or secretory cells lining the vagina that make and release fluids such as mucus.

Risk Factors

Risk factors for vaginal cancer include:

  • Being age 60 or older
  • DES (diethylstilbestrol) exposure:  this was a drug used in the 1950s to treat women who were at risk of having a miscarriage
  • HPV (human papillomavirus)
  • Cervical cancer or cervical dysplasia (precancer)
  • Smoking
  • Excess alcohol drinking
  • History of abnormal cells in the uterus or cancer of the uterus
  • Having had a hysterectomy for health problems that affect the uterus

Not everyone with risk factors will get vaginal cancer, but your risk is increased. Talk with your doctor about your risk and ways to prevent vaginal cancer.

Symptoms of vaginal cancer vary from woman to woman.  They may include:

  • Abnormal vaginal bleeding
  • Abnormal bleeding after sex
  • A mass or bump in the vaginal area
  • Pain during sex
  • Constipation
  • Pain with urination
  • Pelvic pain

If you have these symptoms, it does not mean you have cancer, as many other conditions can cause these symptoms. However, if you notice these symptoms, discuss them with your doctor. 

Vaginal cancer may be prevented with prompt treatment of precancer lesions, regular Pap tests, and vaccination.

Vaginal cancer may be diagnosed on biopsy. Further testing with blood tests and imaging may be needed. 

If you have symptoms that are concerning for vaginal cancer, your doctor will do an exam and take a thorough health history. One or more of the following tests may be ordered:

  • Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. A speculum is inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test of the cervix is usually done. The doctor or nurse also inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas. A doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and presses on the lower abdomen with the other hand. This is done to feel the size, shape, and position of the uterus and ovaries. The vagina, cervix, fallopian tubes, and rectum are also checked.
  • Pap test: A procedure to collect cells from the surface of the cervix and vagina. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the cervix and vagina. The cells are viewed under a microscope to find out if they are abnormal. This procedure is also called a Pap smear. A speculum is inserted into the vagina to widen it. Then, a brush is inserted into the vagina to collect cells from the cervix. The cells are checked under a microscope for signs of disease.
  • Colposcopy: A procedure in which a colposcope (a lighted, magnifying instrument) is used to check the vagina and cervix for abnormal areas. Tissue samples may be taken using a curette (spoon-shaped instrument) or a brush and checked under a microscope for signs of disease.
  • Biopsy: The removal of cells or tissues from the vagina and cervix so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a Pap test shows abnormal cells in the vagina, a biopsy may be done during a colposcopy.

Source: National Cancer Institute

Vaginal cancer staging

The stage of vaginal cancer is determined by clinical exam. Staging is used to determine the spread of cancer. This helps your team determine your treatment. 

Treatment of vaginal cancer depends on the type of cancer, the stage of cancer, your health, and your desire for children. Treatment will be customized to your needs. Treatment may involve surgery, chemotherapy, and/or radiation therapy. 

Surgery

Surgery may be used for early stage vaginal cancer, sarcomas, or melanomas. Reconstruction may be required. Surgeries include:

  • Laser Surgery:  this may be used to treat precancerous lesions. Abnormal cells are destroyed with a laser beam.
  • Excision: some cancer may be surgically excised in a small area.
  • Vaginectomy: all or part of the vagina is removed.  Reconstruction may be required.
  • Radical Trachelectomy: the cervix, upper vagina, and surrounding tissue may be removed if vaginal cancer is early stage and the patient desires children. 
  • Lymph nodes may be removed during surgery.
  • Radical Hysterectomy: the uterus, cervix, upper vagina, and surrounding tissue may be removed if vaginal cancer is early stage. 
  • Vaginal Reconstruction: after surgeries for vaginal cancer, some women will require surgery to make a new vagina from other tissue to allow for sex in the future.
  • Pelvic Exenteration: this is an extensive procedure that involves removal of the vagina, uterus, cervix, bladder, and rectum with reconstruction.  This may be performed in patients who cannot receive other therapies or their cancer comes back.

Chemotherapy and Radiation Therapy

Chemotherapy may be used with radiation therapy or with vaginal cancer has spread to other organs.

Radiation therapy is one of the mainstays of treatment for vaginal cancer. Radiation therapy for vaginal cancer involves external radiation (delivered by a machine outside of the body) and internal radiation (brachytherapy).

Our doctors at UofL Brown Cancer Center are proudly part of UofL Physicians and the UofL School of Medicine.

We believe knowledge comes from questioning the status quo, discovering more about disease and using that knowledge to improve the health of our community. Our physicians are the teachers and researchers at the UofL School of Medicine, involved in the research and development of new treatments and cures for cancer. This means you receive the most advanced and appropriate treatment, even for complex or rare conditions.

To learn more about the physicians who make the academic difference in vaginal cancer treatment, visit the UofL Physicians website here.