Vaginal cancer

How common is vaginal cancer?

Vaginal cancer is a rare cancer, accounting for less than 1% of all new cancer cases in the UK. In 2014, there were 250 new cases diagnosed in the UK, and it is estimated that 1 in every 1270 women will be diagnosed with vaginal cancer during their lifetime.

What are the risk factors?

Little is known about the risk factors for vaginal cancer, mainly because the disease is so rare. The most important risk factor, accounting for 63% of all cases in the UK, is infection with human papillomavirus (HPV). Because HPV is also a major risk factor for cervical cancer, vaginal cancer rates are higher among cervical cancer survivors than among women who have never had cervical cancer. The risk of vaginal cancer is also increased in women with weakened immune systems, for example because of human immunodeficiency virus (HIV) infection, possibly because this makes it more difficult to clear HPV infections.

How is vaginal cancer diagnosed?

The symptoms of vaginal cancer include:

• bleeding between periods, after sex, or after the menopause
• smelly or blood-stained vaginal discharge
• pain during sexual intercourse
• a lump or growth in the vagina
• persistent itching in the vagina.

However, about 1 in 5 women with vaginal cancer don’t have any symptoms. In these women, the disease is diagnosed when early vaginal cancer or abnormal cells in the lining of the vagina (vaginal intraepithelial neoplasia, or VAIN) are detected during routine cervical smearing.

Diagnostic tests for vaginal cancer include a pelvic examination and colposcopy. Colposcopy is an examination of the vagina using a special magnifying instrument called a colposcope. The procedure takes about 10-15 minutes, and is usually painless, although taking a biopsy may cause some brief discomfort.

In some cases, it might be necessary to take a sample of the vaginal tissue (a biopsy) to look for any abnormal cells. Depending on how the sample is taken, this may be done under local anaesthetic in an outpatient clinic, or it may be necessary to have a general anaesthetic.

How is vaginal cancer treated?

Vaginal cancer is mainly treated by radiotherapy, alone or with chemotherapy, or by surgery. Your doctors will discuss the different options with you, to help you make the right choice for you.

Radiotherapy may be used instead of surgery to treat vaginal cancer, or it may be used in women who have already undergone surgery for vaginal cancer to prevent the disease coming back in the lymph nodes (this is called adjuvant radiotherapy). It may also be used if it was not possible to remove all of the cancer during surgery, for example, if the cancer was close to important structures in the body. Radiotherapy may be given either as a beam of radiation delivered from a machine called a linear accelerator (external radiotherapy), or as a radioactive source that is inserted into the vagina (internal radiotherapy, or brachytherapy). Typically, external radiotherapy is given over consecutive daily sessions of about 25 minutes from Monday to Friday. Internal radiotherapy may be given over 2 or more outpatient sessions or during a short hospital stay.

VAIN can be treated by local excision in the vagina. This is usually done under general anaesthetic.

The type of surgery used to treat vaginal cancer will depend on the size of the cancer, its location within the vagina, and on how far it has spread. For small early cancers, an operation called a wide local excision, in which the affected skin is removed together with an area of healthy skin around it, may be sufficient. In other cases, however, it may be necessary to remove part or all of the vagina (partial or total vaginectomy). If the cancer has spread through the vaginal wall, a radical hysterectomy may be needed, in which the vagina is removed together with the uterus, ovaries, supporting structures, and the surrounding lymph nodes. In rare cases, it may be necessary to remove other organs, such as the bladder or part of the bowel, in a procedure called a total pelvic exenteration.

Chemotherapy for vaginal cancer is usually given together with radiotherapy (this is called chemoradiation). However, chemotherapy may be used alone in some women with advanced vaginal cancer, in order to shrink the cancer or reduce symptoms. A number of different chemotherapy drugs may be used, alone or in combination.