Vaginal Cancer Stages

After vaginal cancer is diagnosed, doctors determine how far the cancer has grown or spread. This process is called staging. Knowing the stage helps your healthcare team understand the extent of the cancer, recommend treatment options, and discuss your prognosis.

Vaginal cancer is divided into four main stages, from stage I through stage IV. In general, lower-stage cancers are limited to the vagina or nearby tissues, while higher-stage cancers have spread farther into the pelvis, nearby organs, lymph nodes, or distant parts of the body.

The vagina, sometimes called the birth canal, is part of the female reproductive system. It connects the vulva to the cervix, which is the lower part of the uterus. Understanding these nearby structures can make vaginal cancer staging easier to understand.

General information about vaginal cancer staging

Stage describes where cancer is located and how far it has spread. It is different from cancer grade, which describes how abnormal the cancer cells look under a microscope.

Most vaginal cancers are squamous cell carcinomas. Less common types include vaginal adenocarcinoma, vaginal melanoma, and sarcoma. A rare type called clear cell adenocarcinoma has been associated with exposure before birth to diethylstilbestrol (DES).

Although the cancer type and pathology provide important general information about the disease, the stage focuses primarily on its extent within and beyond the vagina.

How is vaginal cancer stage determined after diagnosis?

Vaginal cancer is primarily staged using information gathered during the diagnosis rather than surgery alone.

Your healthcare team may use a pelvic exam, imaging studies, and the results of your biopsy to determine how far the cancer has spread. A colposcopy may have been performed earlier in the diagnostic process to closely examine suspicious areas of the vagina and obtain tissue for biopsy.

Imaging may include CT, MRI, PET/CT, or other tests. These studies can help doctors evaluate the tumor, surrounding vaginal tissue, lymph nodes, nearby organs, and other areas of the body.

Unlike a Pap smear, which is primarily used for cervical cancer screening, these diagnostic tests are used to determine the extent of a known vaginal cancer.

Stage I vaginal cancer

In stage I vaginal cancer, the cancer is limited to the vaginal wall.

The cancer has not grown into the tissues surrounding the vagina or reached more distant areas of the body.

Because the tumor remains confined to the vagina, stage I is considered an early stage of vaginal cancer. Treatment depends on factors such as the tumor's size, location, and cancer type.

Stage II vaginal cancer

In stage II vaginal cancer, cancer has grown through the vaginal wall and into the tissue surrounding the vagina.

However, it has not reached the pelvic wall.

Doctors consider the size and location of the tumor when developing a treatment plan. Radiation therapy is commonly used for vaginal cancer, although treatment recommendations are individualized for each patient.

Stage III vaginal cancer

In stage III vaginal cancer, cancer has spread farther within the pelvis.

Stage III disease can involve the pelvic wall and/or regional lymph nodes, depending on the staging system being used. Lymph nodes are small structures that are part of the immune system and can be one of the first places cancer cells spread beyond the original tumor.

Imaging tests can help doctors evaluate the pelvis and regional lymph nodes when determining the extent of disease.

Stage IV vaginal cancer

Stage IV vaginal cancer is the most advanced stage and is divided into stage IVA and stage IVB.

Stage IVA vaginal cancer

In stage IVA, cancer has grown into certain nearby organs, such as the bladder or rectum, or has extended beyond the pelvis.

The bladder and rectum are located close to the vagina, which means a locally advanced vaginal tumor can eventually grow into these structures.

Stage IVB metastatic vaginal cancer

In stage IVB, vaginal cancer has spread to distant parts of the body.

This is called metastatic cancer. Vaginal cancer may spread through the lymphatic system or bloodstream to distant organs, such as the lungs, liver, or bones.

Even when vaginal cancer spreads to another organ, it is still considered vaginal cancer because the cancer cells originated in the vagina.

What does it mean if vaginal cancer spreads to lymph nodes?

Lymph nodes help filter fluid and are part of the body's immune system. Cancer cells can sometimes leave the original vaginal tumor and travel through lymphatic vessels to nearby lymph nodes.

Which lymph nodes are most relevant can depend partly on where the vaginal tumor is located. Imaging may be used to look for enlarged or suspicious lymph nodes.

Lymph node involvement can affect the cancer's stage, prognosis, and vaginal cancer treatment plan.

Do vaginal cancer symptoms tell you the stage?

No. Vaginal cancer symptoms cannot tell you which stage of cancer you have.

Possible symptoms include abnormal vaginal bleeding, unusual vaginal discharge, pelvic pain, pain during sex, urinary or bowel changes, or a lump or mass in the vagina.

Some early cancers cause symptoms, while some more advanced cancers may initially cause few noticeable changes. Symptoms are signs of cancer that may prompt further evaluation, but examination, biopsy, and other testing are needed to establish a diagnosis and determine stage.

Do HPV and vaginal precancer affect cancer stage?

Persistent human papillomavirus (HPV) infection is an important risk factor for vaginal cancer, particularly squamous cell carcinoma.

HPV can cause abnormal cells and precancerous lesions in the vaginal lining. These changes are known as vaginal intraepithelial neoplasia (VaIN).

VaIN is not assigned a vaginal cancer stage because it is not invasive cancer. Staging begins once cancer cells have invaded beyond the surface lining into vaginal tissue.

Other factors, including smoking and a history of cervical precancer or cervical cancer, can increase vaginal cancer risk but do not determine the stage once cancer develops.

Does the type of vaginal cancer affect staging and care?

Most vaginal cancers are squamous cell carcinomas, but adenocarcinoma, melanoma, and sarcoma can also begin in the vagina.

The cancer type provides important information about how the disease may behave and which treatments may be appropriate. However, stage primarily describes where the cancer is and how far it has spread.

Vaginal cancer should also be distinguished from cancer that begins in another part of the reproductive system and spreads to the vagina. For example, cancer beginning in the cervix is classified as cervical cancer rather than vaginal cancer.

Your pathology results and stage are considered together when your oncology team develops your treatment plan.

How does stage affect vaginal cancer treatment?

Cancer stage is one of the most important factors used to select vaginal cancer treatment.

Treatment may include radiation therapy, surgery, chemotherapy, or a combination of approaches. The size and location of the tumor, cancer type, previous treatments, overall health, and patient preferences can also influence treatment decisions.

Radiation is an important treatment for many vaginal cancers. External beam radiation therapy delivers radiation from a machine outside the body, while brachytherapy delivers radiation internally near the tumor.

Selected early cancers may be treated surgically. Depending on the tumor's location and extent, surgery can include removal of part or all of the vagina, called a vaginectomy.

A much more extensive operation called pelvic exenteration may be considered in uncommon and carefully selected cases of advanced or recurrent cancer.

What cancer care is available for advanced vaginal cancer?

People with advanced vaginal cancer may receive care from a multidisciplinary team that includes specialists in gynecologic oncology, medical oncology, and radiation oncology.

Treatment may focus on controlling the cancer, relieving symptoms, prolonging survival, or a combination of these goals. Clinical trials may also provide access to treatments being studied for rare gynecologic cancers.

Palliative care can be provided alongside cancer-directed treatment at any stage of serious illness. It focuses on relieving pain and other symptoms and supporting quality of life for the person with cancer and their family. Receiving palliative care does not mean that cancer treatment has stopped.

Because vaginal cancer is rare, some patients may face barriers to finding specialists with extensive experience treating the disease. Your healthcare team can discuss whether consultation at a comprehensive cancer center or another center specializing in gynecologic cancers would be helpful.

Does vaginal cancer stage affect survival?

In general, vaginal cancer diagnosed before it has spread extensively has a better prognosis than cancer that has reached nearby organs or distant areas of the body.

However, stage cannot predict exactly what will happen to an individual patient. Prognosis can also be affected by the tumor's size and location, cancer type, age, overall health, response to treatment, and whether the cancer is newly diagnosed or has returned.

Survival statistics describe groups of patients and should not be interpreted as an individual prediction.

What is recurrent vaginal cancer?

Recurrent vaginal cancer is cancer that returns after treatment.

A recurrence can occur in or near the vagina, in regional lymph nodes, or in another part of the body. Recurrent cancer is not assigned a new original stage. Instead, doctors describe where the cancer has returned and use that information to determine the next treatment options.

Treatment for recurrent disease depends on where the cancer has returned, which treatments you previously received, your overall health, and other individual factors.

Finding specialized care after vaginal cancer staging

Because vaginal cancer is uncommon, having a team experienced in rare gynecologic cancers can be valuable. Specialists in gynecology and obstetrics may identify an abnormality initially, while a gynecologic oncologist specializes in diagnosing and treating cancers involving the female reproductive system.

The National Cancer Institute and comprehensive cancer centers can also provide information about cancer care and clinical trials.

Your care team can explain what your stage means and help you understand the goals, potential benefits, and side effects of each treatment option.

Questions to ask your doctor about your vaginal cancer stage

Understanding your stage can make it easier to participate in treatment decisions. Consider asking:

• What stage is my vaginal cancer?

• Where has the cancer spread?

• Are any lymph nodes involved?

• Do I need additional imaging or tests?

• What does my stage mean for my treatment options?

• What is the goal of treatment?

• How does my stage affect my prognosis?

• Should I consider getting a second opinion?

• Are there clinical trials appropriate for my stage of vaginal cancer?

Your healthcare team can explain what your stage means specifically for you and how it influences your treatment plan.