Revised December 2011
This information should not be used to self-diagnose, or be used in place of a qualified physician’s care.
- Patients with cancer of the vagina are treated by members of the BC Cancer Agency’s Gynecology Tumour Group.
- For healthcare professional information on treating this cancer, please see our Cancer Management Guidelines.
- For newly diagnosed patients, we offer Taking it Step by Step: a guide for women diagnosed with gynecological cancer. This BC guide was created by survivors and health care professionals of the BC Cancer Agency. It covers all aspects of the patient journey.
- Vagina cancer is also called vaginal cancer or carcinoma of the vagina.
- The vagina is also known as the birth canal. It is a 3 to 4 inch muscular tube that connects the uterus (womb) with the vulva (outer genitals).
- The vagina is usually in a collapsed position with the vaginal walls touching each other.
- There are folds on the vaginal wall which allow the vagina to open and expand during sexual intercourse and vaginal childbirth.
- The vagina is lined with a thin layer of flat squamous or epithelial cells. Glands release mucus to keep the vaginal lining moist.
What causes it and who gets it?
Listed below are some of the known risk factors for this cancer. Not all of the risk factors below may cause this cancer, but they may be contributing factors.
- Vagina cancer is extremely rare. The vagina is the primary site in less than one percent of gynecologic cancers.
- Vagina cancer occurs mainly in women over fifty.
- Having a Human Papillomavirus (HPV) infection is a risk factor for vagina cancer.
- Women with a history of vaginal adenosis have an increased risk of developing clear cell carcinoma. Vaginal adenosis is an abnormality in the development of the vagina. Epithelium cells that are normally in the lining of the vagina, can instead be found on the vaginal walls. This normally occurs in women who have been exposed to Diethylstilbestrol (DES).
Diethylstilbestrol (DES)
- Diethylstilbestrol (DES) is a synthetic estrogen (female hormone).
- In British Columbia, between the years of 1950 to 1954, DES was used for pregnant women who were at a high risk of having a miscarriage.
- In the late 1960's, it was discovered that the daughters of women who had taken this drug had an increased risk of developing a rare carcinoma called clear cell adenocarcinoma of the vagina or cervix.
- Daughters are usually in their late teens and early twenties at the time of diagnosis. It is uncertain as to what the risk is for these women as they get older.
- It is recommended that daughters who were exposed to DES during their mother’s pregnancy regularly visit a colposcopy clinic.
- Statistics - Vagina cancers are very rare and statistics are not published separately for this cancer. Instead, numbers are included with a group of related cancers under "Genital Cancers".
Can I help to prevent it?
- Protect yourself against Human Papillomavirus (HPV) infections by:
- limiting the number of sexual partners you have
- using condoms
- getting a HPV vaccination
- To find out more about HPV, talk to your family physician, visit the BC HealthGuide at www.bchealthguide.org or call the BC Nurseline at 811 in B.C.
- There is also information available through Health Canada.
Screening for this cancer
- Most cases of vaginal cancer can be found through routine pelvis examinations and Pap screening.
- For information about what to expect and how to find a clinic, see pap tests.
Signs and Symptoms
There are often no symptoms of vagina cancer until it is in an advanced stage.
Some of these symptoms may include:
- Vaginal discharge
- Spotting or bleeding between periods
- Bladder discomfort or irritation
- Vaginal lesion or lump
- Pain in the pelvis, back or legs
Diagnosis
This is a list of some or all of the tests used to diagnose this type of cancer.
- Pelvic examination - the doctor examines and feels the uterus, ovaries, cervix and vagina for anything irregular.
- Pap smear – a doctor or nurse inserts an instrument called a speculum into the vagina for a clear view of the cervix. A sample of cells is collected using a small spatula or brush. The sample will be tested for cell changes.
- Colposcopy – this test uses a magnifying scope to look at the vagina and cervix to identify any signs of precancerous cell growth.
- CT scan of the pelvis and abdomen.
- Biopsy - removal of a small amount of tissue for examination.
- For more information on diagnostic tests, see our Recommended Links, Diagnosis section.
Types and Stages
Staging describes the extent of a cancer. The TNM classification system is used as the standard around the world. In general a lower number in each category means a better prognosis. The stage of the cancer is used to plan the treatment.
- T describes the site and size of the main tumour (primary);
- N describes involvement of lymph nodes;
- M relates to whether the cancer has spread (presence or absence of distant metastases).
Types
Squamous cell cancer
- Squamous cell tumours are the most common type and account for 85% of vaginal cancers.
- Squamous cell cancers develop slowly. When normal cells begin to change in the surface layer of the vagina (epithelium) they are described as being pre-cancerous. This condition is called vaginal intraepithelial neoplasia (VAIN).
- This type usually occurs in older women.
Adenocarcinomas
- This is cancer that starts in the gland cells of the vaginal lining.
- Adenocarcinomas account for 5% of vaginas cancers.
- This type usually occurs in older women.
Clear Cell Adenocarcinoma
- This type of cancer usually occurs in young women who were exposed to the drug diethylstilbestrol (DES) in the womb.
Melanomas
- Melanoma is a type of cancer that forms on the skin of the vagina. It usually affects the lower or outer part of the vagina.
- Melanomas account for 3% of vagina cancers.
- This type usually occurs in older women.
Sarcomas
- A sarcoma is a cancer that begins in the cells of bones, muscles or connective tissue. It forms deep in the wall of the vagina, not on the surface.
- Sarcomas account for 3% of vaginal cancers.
Endodermal sinus tumours
- Endodermal sinus tumours account for 1% of vaginal cancers.
- This type usually occurs in infants.
Stages
| |
Stage 0 |
Carcinoma in situ |
|
Stage I |
The cancer is limited to the vaginal wall |
|
Stage II |
The cancer has spread to the subvaginal tissue, but has not spread into the pelvic wall |
|
Stage III |
Cancer has spread to the pelvic wall |
|
Stage IV |
The cancer has spread beyond the pelvis or has involved the mucosa of the bladder or rectum; or has spread to distant organs |
Treatment
Cancer therapies can be highly individualized – your treatment may differ from what is described below.
Pre-invasive Vaginal Cancer
- Laser therapy, surgery and radiation are used as primary treatments of preinvasive (dysplasia) lesions.
- If the preinvasive lesion (dysplasia) is confined to one area it may be lasered or surgically removed. A skin graft may be needed to fill in the space, when surgery is used.
- A vaginectomy is surgical removal or all or part of the vagina.
Invasive Vaginal Cancer
- Invasive cancers require either radiation therapy or radical surgery.
- Invasive cancer in the entrance and lower half of the vagina may require a radical vulvectomy (surgical removal of the vulva) and vaginectomy (surgical removal or all or part of the vagina).
- Radiation therapy may be used if the cancer is inoperable because it has spread or because of the general medical condition of the patient.
- Invasive cancer in the upper half of the vagina is treated with a combination of intracavitary irradiation (radioactive material is placed directly into the vagina) and external beam pelvic irradiation (a machine aims radiation at the pelvis).
- Vagina sarcomas are treated with surgery when possible. Radiation therapy and chemotherapy may also be used.
- In advanced cancers, radiation therapy may be used alone or in combination with chemotherapy to relieve symptoms.
- Young women may be encouraged to take estrogen and progestogen replacement.
- If the woman does not have a uterus, estrogen is recommended but there is no need for a progestogen.
Follow-up after Treatment
- Guidelines for follow-up after treatment has ended have been developed by the BC Cancer Agency and are listed on our website.
- You will be returned to the care of your family doctor or your specialist for regular follow-up.
- Follow-up testing is based on your type of cancer and your individual circumstances.
- The BCCA Survivorship Research Centre focusses on the issues that cancer survivors can face.
Coping with Cancer
The Coping with Cancer section of our website is a joint project among different BC Cancer Agency departments and programs. This website section provides information and links that can help cancer patients with the physical, emotional, psychological and practical aspects of care. Each cancer experience is different, but in one way or another, many cancer patients share the same needs.
The effects of cancer and its treatment can present unique challenges: from practical concerns like money and housing, to emotional concerns like anxiety and grief. If you need support with the practical and emotional impacts of cancer, or in managing symptoms and side effects you can use the information in Coping with Cancer to connect to these resources.
Search our library catalogue
- The BC Cancer Agency Library has many resources about cancer, coping, talking to children, etc. Please visit the Library in your Centre, call a librarian, or visit the Library online to see the many resources available.
- Automatically get a bibliography of books, videos and other items available through our library.
Recommended websites
The BC Cancer Agency has selected and evaluated these useful websites for your further information.
Vaginal Cancer
Sexuality and Fertility
Websites for cancer survivors, and how to stay healthy after treatment.
Videos
View videos on cancer-related topics that the BC Cancer Agency produces.
How can I help with research at BCCA?
BC Cancer Agency patients are very helpful when it comes to the fight against cancer. Here are a few ways that you can help:
This information has been reviewed and approved by a member of the Gynecology Tumour Group.