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What is vaginal cancer?

Vaginal cancer (also known as cancer of the vagina) is cancer that starts in the vagina (primary vaginal cancer). It should not be confused with cancer that has spread to the vagina from another site in the body (also known as secondary vaginal cancer).

There are several types of primary vaginal cancer:

  • Squamous cell carcinoma (SCC) which starts in the thin, flat (squamous) cells lining the vagina. This is the most common vaginal cancer and accounts for about 85% of cases.
  • Adenocarcinoma which develops from the glandular (mucus-producing cells of the vagina and makes up between 5% and 10% of vaginal cancers.
  • Vaginal (mucosal) melanoma which starts in the cells that give skin its colour (melanocytres). It is a rare form of vaginal cancer.
  • Sarcoma, a rare form of vaginal cancer that develops from muscle, fat and other tissue deep in the wall of the vagina.

Vaginal cancer is one of the rarest types of cancer affecting the female reproductive system. It is more common in women over the age of 60, however, vaginal cancer, particularly adenocarcinoma, can occur in younger women.

It is estimated that there will be 98 new cases of vaginal cancer in 2020.



Vaginal cancer symptoms

There are often no obvious signs of vaginal cancer, however symptoms may include:

  • pain in the pelvic area or rectum

  • a lump in the vagina

  • blood in the urine or passing urine frequently or during the nightchange in urine colour – dark, rusty or brown

  • bloody vaginal discharge not related to a menstrual period

  • pain during, or bleeding after sexual intercourse..



Causes of vaginal cancer

Some factors that can increase your risk of vaginal cancer include:

  • a precancerous condition called vaginal intraepithelial neoplasia (VAIN) that often has no symptoms

  • human papillomavirus (HPV)

  • smoking tobacco

  • previous radiation therapy to the pelvis

  • previous diagnosis of cervical cancer

  • if your mother was prescribed diethylstilbestrol (DES), an artificial form of the female hormone oestrogen during pregnancy (between 1939 and 1971)..



Diagnosis of vaginal cancer

Physical examination

It is standard practice for your doctor to examine your vagina, groin and pelvic area. This includes an internal physical examination in which the doctor uses an instrument called a speculum to open your vaginal walls to see your vagina and cervix. If you feel uncomfortable about this examination a nurse may be present during the examination, and you can ask for a family member to be present.

Cervical screening test

You may undergo a cervical screening test to check the cells inside the vagina and cervix as part of the physical examination. Results may show early cell changes in the vaginal lining.

Colposcopy and biopsy

During the examination, your doctor may perform a colposcopy using a magnifying instrument called a colposcope to look at your vagina, cervix and vulva. Your doctor may also take a tissue sample (called a biopsy) to check for cell abnormalities.

Further tests

If the tests described above show that you have vaginal cancer, further tests may be needed to find out if the cancer cells have spread to other parts of the body. These tests may include a blood test, chest x-ray, cystoscopy, proctoscopy, and CT and MRI scans.

After a diagnosis of vaginal cancer 

After a diagnosis you may experience a range of emotions such as shock, disbelief, anxiety and confusion. This is normal and there is no right or wrong response to a diagnosis of vaginal cancer.  

Talk to your specialist about your treatment options, what potential side effects there are and about any practical concerns such as travelling for treatment and out-of-pocket costs. Take as much time as you can so you can feel comfortable about your decisions.  



Treatment for vaginal cancer

Staging

Based on the results of the tests, your doctor will tell you the stage of the cancer. Staging describes the size of the cancer and if and how far it has spread beyond the vagina.

Your doctor may also tell you the grade of the cancer cells. This gives you an idea of how quickly the cancer may develop.

Knowing the stage and grade of the cancer helps your medical team decide on the most appropriate treatment. Treatment may involve radiation therapy, surgery and/or chemotherapy.

Radiation therapy (radiotherapy)

Radiation therapy (also known as radiotherapy) is a common treatment for vaginal cancer that uses radiation, such as x-rays, to kill or damage cancer cells. Radiation therapy can also be used to control symptoms of advanced cancer. This is called palliative radiation therapy.

Surgery

The cancer may need to be removed with an operation. Surgery will aim to remove all of the cancer along with some of the surrounding healthy tissue (called a margin). This helps reduce the risk of the cancer coming back. Some lymph nodes in your pelvis may also be removed.

Chemotherapy

Chemotherapy uses drugs to kill or slow the growth of cancer cells. It is usually given if the vaginal cancer is advanced or returns after treatment and may be combined with surgery or radiation therapy.

Chemotherapy may be given as tablets or by injection into a vein (intravenously). You will usually have a number of treatment sessions, followed by a break.

Palliative care

In some cases of vaginal cancer, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer without trying to cure it.

As well as slowing the spread of vaginal cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiation therapy, chemotherapy or other drug therapies.

Treatment Team

Depending on your treatment, your treatment team may consist of a number of different health professionals, such as:
  • GP (General Practitioner)- looks after your general health and works with your specialists to coordinate treatment.
  • Gynaecologist- specialises in treating diseases of the female reproductive system.
  • Radiation oncologist- prescribes and coordinates radiation therapy treatment.
  • Medical oncologist- prescribes and coordinates the course of chemotherapy.
  • Gynaecological oncologist- diagnoses and treats cancers of the female reproductive system
  • Reconstructive (plastic) surgeon- performs any complex reconstructive surgery that restores or repairs the body's appearance and function.
  • Cancer care coordinators- coordinate your care, liaise with the multidisciplinary team and support you and your family throughout treatment.
  • Dietitian- recommends an eating plan to follow while you are in treatment and recovery.
  • Other allied health professionals- such as social workers, pharmacists and counsellors..


Screening for vaginal cancer

There is currently no national screening program for vaginal cancer available in Australia.



Preventing vaginal cancer

There are no known lifestyle measures to prevent vaginal cancer, however not smoking may reduce your risk.



Prognosis for vaginal cancer

Prognosis means the expected outcome of a disease. An individual's prognosis depends on the type and stage of cancer, as well as their age and general health at the time of diagnosis.

You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for any doctor to predict the exact course of your disease. In most cases, the earlier vaginal cancer is diagnosed, the better the chances of successful treatment.



Sources

  • Understanding Vulvar and Vaginal Cancers, Cancer Council Australia © 2020. Last medical review of source booklet: October 2020. 
  • Australian Institute of Health and Welfare (AIHW). Australian Cancer Incidence and Mortality (ACIM) books. Canberra: AIHW. 

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