Risk Factors

Doctors can't always explain why one woman gets vaginal cancer and another doesn't. However, certain risk factors may make a woman more likely than others to develop vaginal cancer. A risk factor is something that may increase the chance of getting a disease.

Having a risk factor does not mean that a woman will get vaginal cancer. Many women who get vaginal cancer have none of these risk factors, and many women who have known risk factors never have cancer. A woman with one or more of these risk factors should talk with her doctor about cancer risk.

Risk factors for vaginal cancer include the following:

• Age: Vaginal cancer is more common in women over 60.
• Exposure to DES: In the 1950s, the drug DES was given to some pregnant women to prevent miscarriage. Women who were exposed to DES before birth have an increased risk of developing vaginal cancer.
• Infection with human papillomavirus (HPV): HPV can cause abnormal tissue growth (for example, warts) and other changes to cells. Infection for a long time with certain types of HPV can increase the risk of developing vaginal cancer.
• History of abnormal cells in the cervix or cervical cancer: Women who have had cervical cancer or pre-cancer have an increased risk of vaginal squamous cell cancer.

Symptoms

Early vaginal cancer may not cause symptoms and may be found during a routine Pap smear. As the cancer grows, the most common symptoms are the following:

• Abnormal vaginal bleeding—bleeding or discharge not related to menstrual periods
• Pain during sexual intercourse
• Pain in the pelvic area
• A lump in the vagina

Most often, these symptoms are not due to cancer. Women with these symptoms should tell their doctor so any health problems can be diagnosed and treated as early as possible.

Screening and Diagnosis

Women are encouraged to get regular pelvic exams and Pap tests to find abnormal changes in the vagina and surrounding tissues as early as possible. A woman should talk with her gynecologist about how often these exams are recommended for her. Read more about cancer screening here.

If symptoms suggest vaginal cancer, the doctor will try to find out what's causing the problems.

The doctor also may order one or more of the following tests:

• Physical exam and history: The doctor will check for signs of disease, such as lumps or anything else that seems unusual.
• Pelvic exam: This is an exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. The doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. A speculum is also inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test or Pap smear of the cervix is usually done. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
• Pap smear: During a Pap smear (sometimes called Pap test), the doctor or nurse gently scrapes cells from the cervix and vagina. The cells are viewed under a microscope to find out if they are abnormal.
• Biopsy: The doctor removes cells or tissues from the vagina and cervix. Tissue samples are sent to the lab and viewed under a microscope to check for cancer cells. The removal of tissue to look for cancer cells is called a biopsy. A biopsy may be done during a colposcopy.
• Colposcopy: The doctor uses a colposcope (a lighted magnifying instrument) to check the vagina and cervix for abnormal areas. The colposcope combines a bright light with a magnifying lens to make tissue easier to see. Tissue samples may be taken and checked under a microscope for signs of cancer.

Staging

If vaginal cancer is diagnosed, the doctor needs to learn the extent (stage) of the disease to help choose the best treatment.

Staging is a careful attempt to find out if cancer has spread within the vagina or to other parts of the body.

The doctor may order one or more of these staging tests:

• Biopsy: The doctor may do a biopsy to find out if cancer has spread to the cervix or vulva. The doctor cuts a sample of tissue from the cervix or vulva. Tissue samples are sent to the lab and viewed under a microscope to check for cancer cells. The removal of tissue to look for cancer cells is called a biopsy.
• Chest x-ray: An x-ray of the organs and bones inside the chest.
• Cystoscopy: The doctor inserts a cystoscope (a thin, tube-like instrument with a light and a lens for viewing) through the urethra into the bladder. The doctor uses the cystoscope to check the inside of the bladder and urethra for abnormal areas. The cystoscope may have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
• Ureteroscopy: The doctor inserts a ureteroscope (a thin, tube-like instrument with a light and a lens for viewing) through the bladder into the ureter. The doctor uses the ureteroscope to check the uterus for abnormal areas. The ureteroscope may have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
• Proctoscopy: The doctor inserts a proctoscope (a thin, tube-like instrument with a light and a lens for viewing) into the rectum. The doctor uses the proctoscope to check the rectum for abnormal areas. The proctoscope may have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
• CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of the inside of the body. The patient may receive contrast material by mouth or by injection into a blood vessel. The contrast material makes abnormal areas easier to see.
• MRI: A strong magnet linked to a computer is used to make detailed pictures of areas inside the body. Sometimes contrast material is given by injection into the blood vessel. The contrast material makes abnormal areas show up more clearly on the picture.
• Lymphangiogram: The doctor injects dye into the lymph vessels in the feet. The dye travels upward through the lymph nodes and lymph vessels, and x-rays are taken to see if there are any blockages. This test helps find out whether cancer has spread to the lymph nodes.

Stages of Vaginal Cancer

Stage 0: Abnormal cells are found only in the tissue lining the inside of the vagina. These abnormal cells may become cancer and spread into nearby normal tissue. The doctor may call this carcinoma in situ.

Stage I: Cancer is found in the vagina only.

Stage II: Cancer has spread from the vagina to the tissue around the vagina.

Stage III: Cancer has spread from the vagina to the lymph nodes in the pelvis or groin, or to the pelvis, or both.

Stage IV: Cancer has spread to lymph nodes in the pelvis or groin, to the lining of the bladder or rectum, or to other parts of the body.

Treatment

At Huntsman Cancer Institute, vaginal cancer is treated by a team of specialists, including gynecologic oncologists (doctors who specialize in cancers of the female reproductive system), surgeons, medical oncologists (doctors who treat cancer with medicine), radiation oncologists (doctors who treat cancer with radiation), nurses, dietitians, and social workers.

Common treatment options for vaginal cancer include the following:

• Surgery
• Chemotherapy
• Radiation therapy
• Clinical trials

A patient may have a combination of treatments. The treatment that's right for each patient depends on many factors:

• The stage of the cancer
• The size of the tumor
• Where the cancer is in the vagina
• What type of vaginal cancer the patient has (squamous cell or adenocarcinoma)
• The grade of the tumor cells (how different they are from normal cells)
• Whether the cancer has spread to lymph nodes
• Whether the cancer has spread to other parts of the body
• Whether the patient has a uterus or has had a hysterectomy
• The patient's symptoms
• The patient's age and general health

The health care team can describe all of the treatment choices, the expected results of each, and the possible side effects. Because cancer therapy often damages healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may even change from one treatment session to the next.

Surgery

Surgery is the most common treatment for vaginal cancer. One of the following surgical procedures may be used:

• Laser surgery: The doctor uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts to remove abnormal tissue.
• Wide local excision: A surgeon cuts out the cancer and some of the healthy tissue around it.
• Vaginectomy: A surgeon removes all or part of the vagina.
• Total hysterectomy: A surgeon removes the uterus and cervix. The ovaries may also be removed.
• Lymph node dissection (lymphadenectomy): A surgeon removes lymph nodes in the pelvis or groin. A sample of the removed tissue is sent to the lab and checked under a microscope for signs of cancer.
• Pelvic exenteration: A surgeon removes the cervix, vagina, ovaries, nearby lymph nodes, the lower colon, rectum, and bladder. Artificial openings (stoma) are made for urine and stool to flow from the body into a collection bag.

After surgery, the doctor may do skin grafting to repair or reconstruct the vagina. A piece of healthy skin is taken from a part of the body that is usually hidden, such as the buttock or thigh, and used to repair or rebuild the vagina.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, the patient may be given radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Chemotherapy

Chemotherapy uses drugs to kill and control cancer cells. Chemotherapy may be taken by mouth or injected into a vein or muscle. Topical chemotherapy for squamous cell vaginal cancer may be applied to the vagina in a cream or lotion. Learn more about this treatment in our introduction to chemotherapy video.

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells. Radiation therapy only affects cells in the treated area.

Doctors use two types of radiation therapy to treat vaginal cancer. Some people receive both types:

• External radiation: The radiation comes from a large machine outside the body. The machine aims beams of radiation at the cancer. Patients go to a hospital or clinic for treatment. This type of treatment uses computers to closely target the cancer, which protects healthy tissue near the vagina.
• Internal radiation therapy (brachytherapy): Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the vagina.

Clinical trials

These studies discover and evaluate new and improved cancer treatments. Patients are encouraged to talk with their doctors about participating in a clinical trial or any questions regarding research studies. For more information, also visit HCI's clinical trials website.

Support

When you or someone you love is diagnosed with cancer, concerns about treatments and side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, work, or normal daily life.

There are several places you can go for support:

• Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
• The Cancer Learning Center has hundreds of free brochures and more than 3,000 books, DVDs, and CDs available for checkout. You can browse the library, perform Internet research, or talk with a cancer information specialist. Call 801-581-6365 or toll free 1-888-424-2100, or e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
• Our Patient and Family Support Services offer emotional support and resources for coping with cancer and its impact on daily life to Huntsman Cancer Institute (HCI) patients and their families.
• The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers many programs to increase the quality of life and well-being of HCI patients and their families.