Vaginal Cancer Treatment

Vaginal cancer treatment depends on the cancer’s stage, size, location, and type, as well as your overall health and previous treatments. Because vaginal cancer is rare, treatment is highly individualized. Radiation therapy is one of the most common treatments, while surgery may be appropriate for some early-stage cancers. Chemotherapy may also be combined with radiation for more advanced disease.

How diagnosis and tests guide vaginal cancer treatment

Before recommending treatment, doctors need to confirm the diagnosis and determine how far the cancer has spread. Diagnosis and tests may include a pelvic exam, colposcopy, biopsy, and imaging tests such as CT, MRI, or PET/CT.

A biopsy allows a pathologist to examine abnormal cells and determine the type of vaginal cancer. Most vaginal cancers are squamous cell carcinomas, but less common types include adenocarcinoma, melanoma, and sarcoma.

A Pap test, also called a Pap smear, may sometimes identify abnormal vaginal cells, but a biopsy is needed to confirm cancer.

How stage and prognosis affect treatment

Cancer stage is one of the most important factors in choosing treatment and estimating prognosis. Early vaginal cancer is limited to the vagina, while more advanced cancer may involve nearby tissues, lymph nodes, the bladder or rectum, or distant organs.

In general, stage I disease may be treated with radiation or, in selected cases, surgery. Stages II and III are commonly treated with radiation, sometimes combined with chemotherapy. Treatment for stage IV disease depends on where the cancer has spread and may focus on controlling the disease, relieving symptoms, and maintaining quality of life.

Radiation therapy for vaginal cancer

Radiation therapy, also called radiotherapy, is a major treatment for vaginal cancer. It uses high-energy radiation to damage cancer cells and stop them from growing.

External beam radiation therapy (EBRT) delivers radiation from a machine outside the body to the tumor and surrounding tissues. Nearby lymph nodes may also be treated when there is a risk that cancer has spread.

Brachytherapy, or internal radiation therapy, places a radioactive source inside or near the vagina. This allows radiation to be delivered directly to the cancer while limiting exposure to surrounding healthy tissue. Brachytherapy may be used alone for selected tumors or combined with external beam radiation.

Chemotherapy and chemoradiation

Chemotherapy uses medications that travel through the bloodstream to destroy cancer cells or prevent them from growing.

For some locally advanced vaginal cancers, chemotherapy is given at the same time as radiation. This approach is called chemoradiation. Cisplatin may be used because it can make cancer cells more sensitive to radiation.

Chemotherapy may also be considered for recurrent or metastatic disease. Because vaginal cancer is rare, some treatment approaches are based partly on research and experience with related gynecologic cancers, particularly cervical cancer.

Surgery and vaginal reconstruction

Surgery may be an option for selected patients with small, localized vaginal cancers that can be removed safely. The procedure depends on the size and location of the tumor.

A local excision removes the cancer along with a margin of surrounding healthy tissue. A vaginectomy removes part or all of the vagina. If the tumor is located near the cervix or upper vagina, surgery may also include a hysterectomy.

After some surgeries, vaginal reconstruction may be possible. Reconstructive procedures can create or restore the vagina using tissue from another part of the body. Your surgeon can explain whether reconstruction is appropriate and how treatment may affect sexual function.

A pelvic exenteration is a much more extensive operation involving removal of multiple pelvic organs or tissues. It is generally reserved for carefully selected cases, such as some locally recurrent cancers.

Treatment by vaginal cancer type

Most vaginal cancers are squamous cell carcinomas, which begin in the cells lining the vagina. Radiation is commonly used, sometimes with chemotherapy for locally advanced disease. Surgery may be appropriate for selected early tumors.

Vaginal adenocarcinoma begins in glandular cells. A rare form called clear cell adenocarcinoma has been associated with exposure before birth to diethylstilbestrol (DES). Treatment can include surgery, radiation, or both.

Vaginal melanoma is rare and behaves differently from more common vaginal cancers. Treatment may include surgery, immunotherapy, targeted therapy, or other systemic treatments depending on the individual cancer.

HPV, risk factors, and vaginal neoplasia

Persistent human papillomavirus (HPV) infection is an important vaginal cancer risk factor, particularly for squamous cell carcinoma. High-risk HPV can cause abnormal cells in the vagina that may develop into vaginal intraepithelial neoplasia (VaIN).

VaIN is a precancerous condition, not invasive vaginal cancer. Treatment for VaIN differs from treatment for cancer and may include observation, topical treatment, laser therapy, or surgery depending on its severity.

Once invasive cancer develops, HPV status and previous HPV infection may provide useful clinical information, but treatment is primarily determined by the cancer’s type, stage, location, and other individual factors.

Immunotherapy, targeted therapy, and clinical trials

Newer systemic treatments may be appropriate for some people with advanced or recurrent vaginal cancer. Immunotherapy helps the immune system recognize and attack cancer cells, while targeted therapies act on specific characteristics of cancer cells.

Doctors may recommend biomarker testing for some advanced cancers to identify molecular features that could affect treatment options.

Because vaginal cancer is rare, clinical trials are particularly important. Trials may study immunotherapy, targeted treatments, new drug combinations, or different approaches to radiation. Ask your oncologist whether a clinical trial is appropriate at any point in your care.

Treatment for recurrent or metastatic vaginal cancer

Recurrent vaginal cancer has returned after treatment, while metastatic vaginal cancer has spread to distant areas of the body.

Treatment depends on where the cancer is located and which therapies you previously received. Previous radiation, for example, can affect whether additional radiation can be safely given. Surgery may be considered for certain localized recurrences, while chemotherapy, immunotherapy, other systemic treatments, or clinical trials may be appropriate for other patients.

For advanced cancer, treatment goals may include slowing cancer growth, reducing symptoms, extending survival, and preserving quality of life.

Managing vaginal cancer treatment side effects

Side effects depend on the treatment you receive. Pelvic radiation can cause fatigue, diarrhea, bladder symptoms, skin irritation, vaginal dryness, narrowing, or scar tissue. Chemotherapy may cause nausea, fatigue, decreased blood counts, and increased infection risk. Surgery can affect bowel, urinary, reproductive, and sexual function depending on its extent.

Treatment can also affect sexual health. Vaginal moisturizers, lubricants, pelvic floor therapy, vaginal dilators, and other treatments may help manage some changes after radiation or surgery.

Ask your healthcare team about expected short- and long-term side effects before treatment begins.

Vaginal cancer symptoms during and after treatment

Tell your healthcare team about new or worsening vaginal cancer symptoms, including vaginal bleeding, unusual discharge, pelvic pain, urinary or bowel changes, or a new lump.

Symptoms during or after treatment do not necessarily mean that cancer is progressing or has returned. Treatment itself can cause changes in the vagina and pelvis. Your healthcare team can determine whether additional examination or testing is necessary.

Help and support during vaginal cancer treatment

Cancer treatment can affect physical and mental health, relationships, sexuality, finances, and everyday life. Help and support are an important part of cancer care.

Palliative care can help manage pain, fatigue, bowel or bladder problems, sexual health concerns, and other symptoms while you continue cancer treatment. Social workers, mental health professionals, financial navigators, and support communities can also help with practical and emotional challenges.

Our Vaginal Cancer Support page provides additional information about finding peer support and connecting with other patients. A cancer chat forum or other patient community may also help some people feel less isolated during treatment.

Questions to ask your doctor about treatment

Before starting treatment, consider asking your healthcare team:

• What treatment do you recommend and why?

• What is the goal of treatment?

• How does my stage affect my prognosis?

• Will I need radiation, chemotherapy, surgery, or more than one treatment?

• What short- and long-term side effects should I expect?

• Could treatment affect my sexual health or fertility?

• Is vaginal reconstruction an option if I need surgery?

• Should my tumor undergo biomarker testing?

• Are there clinical trials I should consider?

• Should I get a second opinion?

Because vaginal cancer is uncommon, you may also want to ask whether your treatment plan has been reviewed by a gynecologic oncologist or a cancer center experienced in treating rare gynecologic cancers.