By Rebeca Schiller 

Updated on August 21, 2023

 Medically reviewed by Doru Paul, MD

Vaginal cancer is a disease in which cells in the vagina begin to grow out of control. It’s considered a rare form of cancer, with only about one of every 1,100 women developing vaginal cancer in her lifetime.¹ It is more common in women age 60 or older.

If you’ve been infected with the human papillomavirus (HPV) or your mother was prescribed diethylstilbestrol (DES) to prevent a miscarriage in the 1950s, you are at increased risk of developing vaginal cancer.² Your risk of vaginal cancer is also higher if you have had abnormal cells in the vagina, cervix, or uterus.

Sebastian Condrea / Getty Images

Types of Vaginal Cancer

There are five types of vaginal cancer, and each type forms from a different type of cell in the vagina:

• Squamous cell carcinoma: This is the most common type of vaginal cancer, accounting for approximately 85% of all vaginal cancers.³ It develops in the squamous cells that line the inside of the vagina, and is most common in the upper part of the vagina near the cervix. If left untreated, it can grow deeper into and through the vaginal wall and spread to nearby tissues. This type of cancer often develops slowly, but may spread to the bones, lungs, and liver.⁴

• Adenocarcinoma: Adenocarcinoma develops in the vaginal glandular cells. About 5% to 10% of vaginal cancers are diagnosed as adenocarcinoma, and it is more prone to spread to the lungs and lymph nodes.⁵ The most common type of vaginal adenocarcinoma is found in women older than 50. Another type, clear cell adenocarcinoma, is more common in young women who were exposed to DES when they were in their mother’s womb.⁶

• Melanoma: Normally found on skin, melanoma can also develop in the vagina and other internal organs.³ Fewer than three of every 100 cases of vaginal cancer are melanomas.⁶ Melanoma tends to affect the lower or outer portion of the vagina.

• Sarcomas: Sarcomas are cancers that start in the cells of bones, muscles, or connective tissue. Like melanoma, it very rarely develops in the vagina, with fewer than three out of every 100 cases of vaginal cancer being sarcomas.⁶ These cancers form deep in the wall of the vagina, not on its surface. Rhabdomyosarcoma is the most common type of sarcoma that affects the vagina. It’s most commonly found in children and is rare in adults. A sarcoma called leiomyosarcoma more often affects adults, specifically in women older than 50.

• Cancers that spread to the vagina: Cancers that start in the vagina are much less common than cancers that start in other organs (such as the cervix, uterus, rectum, or bladder) and then spread to the vagina.⁶ If a cancer involves both the cervix and vagina, it is considered a cervical cancer. Likewise, if the cancer involves both the vulva and the vagina, it’s considered a vulvar cancer.

 What Is the Vagina?

Vaginal Cancer Symptoms

In the early stages of vaginal cancer, symptoms may not appear. Symptoms only become noticeable when the cancer has progressed and spread deeper into the layers of the vagina’s tissue. Because of this, it's important for women to have regular gynecological exams, which can sometimes detect vaginal cancer even before symptoms appear.

Eight out of 10 women with invasive vaginal cancer have one or more of the following symptoms:⁷

• Pain during sex

• Vaginal bleeding post-intercourse

• Abnormal vaginal discharge

• A lump or mass in the vagina that can be felt

• Painful urination

• Constipation

• Pelvic pain

Most of the time, however, these symptoms are caused by something less serious than vaginal cancer. Regardless, if you have any of these symptoms, see your healthcare provider as soon as possible to determine what is causing these symptoms.  

 Surgery to Treat Vaginal Septum

Causes

The exact cause of most vaginal cancers is not known, but it is linked to a number of conditions and risk factors, including:⁸

• A prior infection with HPV is associated with a higher risk of developing vaginal cancer. Research has shown that normal cells make substances called tumor suppressor gene products to keep cells from growing too rapidly and becoming cancers.⁹ High-risk HPV types like 16 and 18 produce two proteins (E6 and E7) that can change the way known tumor suppressor gene products work.

• People with vaginal intraepithelial neoplasia (VAIN), which is a vaginal precancer, where changes have been found in only the cells in the innermost surface layer of the vagina.⁶ These cell changes are not cancer, but could become cancer over time. VAIN is more common in women who have had their uterus removed (hysterectomy).

• Infection with HIV increases the risk of vaginal cancer.

• People who had cervical cancer or precancer are more likely to have vaginal cancer. This is most likely because cervical and vaginal cancers have a lot of the same risk factors, such as HPV infection and smoking.

• Women whose mothers took DES to prevent a miscarriage between 1940 and 1971. This group of women are known as DES daughters. DES increases the likelihood of vaginal adenosis (gland-type cells in the vaginal lining rather than the usual squamous cells).⁹ Those with a rare type of adenosis called atypical tuboendometrial adenosis have a higher risk of developing vaginal cancer.

• Smoking doubles the risk of developing vaginal cancer.

• Age of 60 years or older. Few cases are found in people younger than 40. Almost half of cases occur in people who are 70 years old or older.¹⁰

Note that these risk factors do not necessarily mean that someone will definitely develop vaginal cancer. If you have any of these risk factors and are concerned about having vaginal cancer, talk to your healthcare provider.

 Signs and Symptoms of HIV in Women

Diagnosis

Routine well-woman exams and cervical cancer screening can sometimes find cases of VAIN and early invasive vaginal cancer. If you are experiencing symptoms, your healthcare provider will use a number of tests to determine whether you have vaginal cancer, including:⁴ 

• A pelvic exam of the vagina and other organs to find suspicious lumps or masses.

• A Pap smear of the cervix to find any cell changes that may be cancerous or lead to cancer.

• A colposcopy is done to view any changes in the cervix and vagina if the Pap test shows abnormal cells. If abnormal tissue is found, a vaginal biopsy is performed to extract cell samples to be examined for cancer in a lab.

• A biopsy is the only way to be certain that it's cancer. A small piece of tissue from the suspicious area is removed, and a pathologist will then look at the tissue sample under a microscope to see if cancer or precancer is present.

• A CT scan can provide information about the size, shape, and position of a tumor, and can see if the cancer has spread to other organs.

• MRI images are particularly useful in examining pelvic tumors. They may show enlarged lymph nodes in the groin.

• A positron emission tomography (PET) scan is not often used in women with early vaginal cancer, but may be helpful in finding areas of cancer spread for more advanced cancers.

Treatment

Treatment for vaginal cancer depends on the type of cell, the stage of cancer, and your age. The stages of vaginal cancer are classified as follows:¹¹

• Stage I: The cancer is located in the vagina and has not spread.

• Stage II: The cancer has expanded through the vaginal wall, but hasn't reached the pelvic sidewall.

• Stage III: The cancer can be of any size with positive lymph nodes in the pelvis or groin or it might be growing into the pelvic wall, may be growing into the lower third of the vagina, and/or has blocked the flow of urine with or without positive lymph nodes. It did not spread to distal sites or organs.

• Stage IVA: The cancer is growing into the bladder or rectum or is growing out of the pelvis. It may or may not have spread to the lymph nodes in the pelvis or groin. It has not spread to any distant sites.

• Stage IVB: The cancer has spread to organs such as the lungs, liver, or bones. It can be any size and may or may not have grown into nearby structures or organs. It may or may not have spread to nearby lymph nodes. 

The three standard types of treatment for vaginal cancer include surgery, chemotherapy, and radiation therapy.

 How Cancer Is Treated

Chemotherapy

Chemotherapy uses anticancer drugs that may be given intravenously, by mouth, or applied to the skin. Since vaginal cancer is rare, not enough research has been done to identify the best chemo drugs for this type of cancer. Most often, healthcare providers use the same types of drugs that are used for cervical cancer. Drugs that have been used include:¹²

• Cisplatin

• Carboplatin

• Fluorouracil (5-FU)

• Paclitaxel (Taxol)

• Docetaxel (Taxotere)

• Irinotecan 

 Long Term Side Effects of Chemotherapy for Cancer

Radiation Therapy

Vaginal cancer can be treated with external beam radiation therapy and internal radiation therapy (also known as intracavity brachytherapy).¹³ A combination of the two with or without low doses of chemotherapy is commonly used for vaginal cancer. With external beam radiation therapy, radiation is delivered from outside the body. It can shrink tumors so they can be easier to remove with surgery. Internal radiation therapy places a cylinder containing radioactive material inside the vagina to deliver radiation. When given this way, the radiation mainly affects the tissue in contact with the cylinder. 

 Long-Term Side Effects of Radiation Therapy

Surgery

 Possible surgery may include:⁴ 

• Laser surgery uses a laser beam to cut a surface lesion. This is commonly used to treat early nonadvanced types of cancer and precancer. It is not used to treat invasive cancer.¹⁴

• A local excision (also called a wide excision) removes the tumor along with healthy surrounding tissue. This is appropriate for VAIN and small stage I cancers.

• A vaginectomy either removes part of (partial) or the entire vagina (total).

• Total hysterectomy includes removing the uterus and the cervix.

• Lymph node dissection in which the lymph nodes are removed and examined if they’re cancerous. If the cancer appears in the upper portion of the vagina, the pelvic lymph nodes may be removed. If the cancer is in the lower area of the vagina, the lymph nodes in the groin may be removed.

• Trachelectomy removes the cervix, but leaves the uterus intact.

Once the cancer is removed, you may receive radiation therapy to kill any remaining cancer cells or to keep them from developing.⁴

Prognosis

Survival rates are estimated by using the percentage of women with the same type and stage of cancer and whether they’ve survived after 5 years.

For women with vaginal cancer that is localized (limited to the vaginal wall), the 5-year survival rate is 69%. For those with regional vaginal cancer (the cancer has spread to nearby organs and the lymph nodes), the survival rate is 57%, and for women with distant vaginal cancer (the cancer has spread to lungs, bones, or liver), the survival rate is 26%.¹⁵

Note that these percentages apply only to the stage of the cancer when it is first diagnosed, and doesn’t apply if the cancer changes, spreads, or recurs after treatment. These numbers also don't take everything into account. Other factors such as age, general health, the type of vaginal cancer, and treatment response all affect a person's prognosis.

Coping

After receiving a cancer diagnosis, you may feel overwhelmed and frightened, but also worried about financial issues from having to take time off from work to dealing with insurance to handling the expensive cost of treatments.

Ask your healthcare team questions, so you’re prepared for each step of the process. If finances are becoming a burden during this troubling time, several organizations can help with medical costs. 

Finally, and most importantly, don't forget your emotional well-being. Numerous organizations provide one-on-one counseling, but can also help you find a safe support network with other cancer patients facing similar difficulties.