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Vagina

This information should not be used for self-diagnosis or in place of a qualified physician's care.

Revised Feb 2016

The basics
  • Guidelines for treating this cancer have been developed by the Gynecology Tumour Group.
  • For health professional information on treating this cancer, please see our Cancer Management Guidelines (Vagina).
  • 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 BC Cancer. 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 50.
  • 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?

  • Limit the number of sexual partners you have.
  • Use condoms.
  • Get an HPV vaccination before beginning sexual activity.
HPV Vaccination
  • A vaccine is available that protects against two types of human papillomaviruses that can cause vaginal cancer.
  • The vaccine is recommended for girls and women between the ages of 9 and 26 years before they come in contact with HPV.
  • The vaccine may also benefit women who are sexually active and have not yet been infected with HPV. The vaccine prevents HPV infection but it does not get rid of it once the infection occurs.
  • For more information call your local public health unit or speak to your family physician. You can also find information at www.immunizebc.ca.
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 Screening BC.

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 & staging

Diagnosis

These are tests that may be 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 tests used to diagnose cancer, see our Recommended Websites, Diagnostic Tests section.
 

Types and Stages

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
Staging describes the extent of a cancer. The stage of the cancer is used to plan the treatment. 

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

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 are covered on our website.
  • You will be returned to the care of your family doctor or your specialist for regular follow-up. If you do not have a family physician, please discuss this with your BC Cancer oncologist or nurse.
  • Follow-up testing is based on your type of cancer and your individual circumstances.
  • Life after Cancer focuses on the issues that cancer survivors can face.
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