From the outset, it’s important to know some key things about vaginal cancer – it’s very rare and, if you do have it, it’s often treatable. There’s no screening program for vaginal cancer but getting your regularor smear test can sometimes prevent you from getting not only cervical cancer, but vaginal cancer too – more on that later.
Vaginal cancer happens when cells in your vagina start to divide and grow out of control. Your vagina is the tube that starts inside at the neck of your womb (your cervix) and ends as a hole at the outside of your body (vaginal opening). Vaginal cancer is different to cancer on the outer part of your genitals (vulva), which is called.
Read on to find out the signs of vaginal cancer, the different types, risk factors, how you can help prevent it, plus the treatments and support available.
How common is vaginal cancer?
The latest figures show that 1,368 women in the US (or 0.6 per 100,000 women) are diagnosed with vaginal cancer every year and, in the UK, that number is around 250. More than 70% of vaginal cancers happen in women aged over 60 – it’s very rare to get it if you’re under 40.
“A cancer diagnosis for yourself or a family member can be very scary but there are lots of treatments and support available,” says Dr. Ann Naina. “Speak to your doctor so they can recommend options for you. Remember they are there to support you, so if you have particular concerns or worries they’ll be happy to discuss those with you.’
Vaginal cancer symptoms
In the early stages, vaginal cancer often doesn't show any symptoms – in fact, around 20% of women diagnosed have no symptoms at all.
See a doctor as soon as possible if you notice:
- vaginal bleeding between periods, after sex, or after the menopause
- a new lump or growth in your vagina
- ulcers and other skin changes in or around your vagina
- blood in your pee or poop
- feeling like you need to poop, even though you’ve just been
You should also see a doctor if you develop:
- Pain during sex
- any other bleeding that’s longer or heavier than usual for you
that smells or is an unusual color
- going for a pee more often than usual
- that's not going away or keeps coming back
- pelvic pain, especially when you pee or have sex
- a vaginal itch that's not going away
Could it be something else?
As it’s rare, all of the symptoms listed above can also be caused by other common conditions that aren’t vaginal cancer – an infection, for instance. If you have any of these symptoms, speak to your family doctor who can check what’s going on. It’s far more likely to be something that’s not vaginal cancer but it’s important to get checked.
Who is more likely to get vaginal cancer?
While we don't know the exact causes of vaginal cancer, it’s more common in older women. Almost 40 out of 100 (almost 40%) of new cases are in females aged 75 and over. It’s very rare in women younger than 40.
There are certain things (risk factors) that increase your chance of getting vaginal cancer but even if you have one or more of these risk factors, it’s still unlikely you’ll get vaginal cancer:
- : A group of different viruses – there are more than 100 different types – that are usually spread through sex. It’s so common that most people who are sexually active will be infected at some point in their lives. Most of the time, the virus goes away on its own and doesn’t cause problems. But like cervical cancer, HPV is thought to play a role in most cases of vaginal cancer. The risks also go up with first having sex at an early age and having more than 5 lifetime sexual partners.
- you’ve had pre-cancerous cells in your cervix or vagina: Both can be picked up through and they’re thought to be linked to having a persistent HPV infection. Left untreated, these cells could turn into cancer – which is why it’s so important to keep up-to-date with your pap smears.
- smoking: If you’re a smoker, this more than doubles your risk of getting vaginal cancer
- you’ve had cervical or womb cancer
- weakened immune system: if you have a condition that weakens your immune system such as HIV or AIDS or you have an increased risk of getting vaginal cancer. It may be that your immune system struggles to get rid of infections like HPV or it could be because of medications you need to take
- you’ve taken diethylstilbestrol (DES): This is a hormone drug that was prescribed to some pregnant women between around 1940 and 1971, to prevent miscarriage or premature labor. If your mother took it when she was pregnant with you, you’re at increased risk of vaginal cancer
Can you prevent vaginal cancer?
While you can’t completely stop yourself getting vaginal cancer, there are things you can do to lower your risk:
- book a pap smear: Yes, it’s one of those things that’s so easy to put off (along with tackling the ‘hand wash-only’ pile!) but staying up to date with cervical screenings is important because of the link between HPV, abnormal cervical/vagina cells and vaginal cancer. There’s no screening program for vaginal cancer because it’s so rare but, as your nurse routinely examines your vagina during a pap smear, it could pick up changes such as thickening, ulcers or pre-cancerous cells, which may point to, or increase your risk of getting, vaginal cancer
- reduce your risk of getting HPV: Using condoms can lower your chances of getting HPV. However, they’re not foolproof as they don’t cover all the skin around your genitals
- HPV vaccine: In the US, all girls and boys aged 11 and 12 are offered the HPV vaccine, while in the UK it is recommended for 12 and 13 year olds. The vaccine protects against high-risk HPV viruses – doctors think that, in future, there will be a drop in vaginal cancer rates thanks to the vaccine
- quit smoking: using cigarettes can weaken your immune system over time, which can make it harder to fight off HPV – smoking more than doubles your risk of getting vaginal cancer
Different types of vaginal cancer
Squamous cell carcinoma (SCC)
- this is the main type of vaginal cancer
- it usually appears as small lumps or ulcers in the upper part of your vagina, close to your cervix
- 9 in 10 vaginal cancers are this type
- it’s more common over the age of 60
Other much rarer types of vaginal cancer include:
- starts in the glandular cells, which lubricate your vagina. Although it’s extremely rare
- 10% of vaginal cancer diagnoses are adenocarcinomas – this type is most likely to be diagnosed in younger women under 30
- very rare – accounts for around 3% of all vaginal cancers
- starts in the cells that produce pigment (these give your skin its color). It’s more common if you’re over 50 but still very rare – accounts for about 3% of vaginal cancers
Stages of vaginal cancer
If you’re diagnosed with vaginal cancer it’s staged with numbers 1-4 and, generally, the lower the number the less the cancer has spread.
The stage tells you where the cancer is, how far it has grown from where it started, and whether it has spread. The grade gives you an idea of how quickly the cancer could develop. Both of these factors help to determine the kinds of treatment your doctors will recommend.
- stage 1: cancer is in your vagina only
- stage 2: cancer has grown through the wall of your vagina
- stage 3: cancer has spread to the wall of your pelvis or your nearby lymph nodes, or both
- stage 4a: cancer has spread to other nearby organs such as your bladder or rectum
- stage 4b: cancer has spread to organs further away, such as your lungs
When to see a doctor
As soon as you spot any of the symptoms mentioned above, see your family doctor. It may well not be vaginal cancer as this is rare but some of these symptoms could also be signs of other serious conditions. Your doctor can check and, if it is cancer, the earlier you catch it the better your chances of successful treatment.
You know how it is – you get into the doctor’s room and everything you wanted to say disappears from your mind. Follow these strategies before and during your appointment to get the most from it:
- make a note of your symptoms, including when they started and how often you have them
- write down anything you’ve found makes your symptoms better or worse
- tell your family doctor if you’re worried about cancer – it doesn’t sound silly and you’re not wasting their time
- ask a friend or relative along for moral support – they could also make notes for you and ask the doctor questions if you’d find that helpful
What happens at my appointment?
Your doctor will ask you questions about your symptoms and will have a look at your vagina. In some cases, they may do an internal examination of your vagina to check for any lumps or swellings.
Depending on your symptoms and the outcome of the physical examination, your doctor may reassure you, offer some treatment for any possible other causes such as an infection or refer you to a specialist (gynecologist) for more tests.
Diagnosing vaginal cancer
Vaginal cancer is usually diagnosed through a biopsy – this is where a small piece of tissue is taken from an area of your vagina that looks abnormal. The biopsy is then looked at under a microscope for anything suspicious.
After diagnosis you may also have imaging tests – such as x-rays and magnetic resonance imaging (MRI) scans – to help your doctors build up a picture of the cancer and whether it has spread.
Treatment for vaginal cancer
The main treatment for vaginal cancer is radiation therapy, but you may also have surgery and chemotherapy – it all depends on what type of vaginal cancer you have and what stage it’s at. In some cases, you may need a combination. Here are some common treatment approaches:
- there are two types of stage 1 vaginal cancer – squamous cell carcinoma and adenocarcinoma. Treatment may include radiation therapy and/or surgery, depending on where your cancer is
- radiation therapy is the usual treatment (sometimes alongside chemotherapy)
- surgery may also be an option for stage 2 vaginal cancer if you have squamous cell carcinoma and the tumor is small and in the upper part of your vagina
Stage 3 and 4a
- radiation therapy is the usual treatment, possibly as well as chemotherapy
- you would be unlikely to have surgery
- because the vaginal cancer has spread to organs further away, it can’t be cured
- you might have radiation therapy and chemotherapy to ease your symptoms
Help and support – you’re not alone
Whether you have a diagnosis of vaginal cancer, you’re concerned about symptoms, or if you’re dealing with the diagnosis of a friend or loved one, there is lots of support out there. Here are just some examples:
- runs a cancer support helpline and offers advice and information
- is there for anyone who has been diagnosed with cancer in the US
- in the UK offers emotional and practical support to those living with cancer and their loved ones. You can talk on the phone or via online chat
- is for gynecological cancers like vaginal cancer. You can call its nurse-led support line, or email them, to go through any gynecological symptoms you’re experiencing or worries you may have
Coping with your diagnosis and treatment
When you’re dealing with the reality of vaginal cancer, you may feel lots of different emotions – shock, confusion, anger, and even relief if you’ve been waiting for a diagnosis for a long time. You might feel differently from one moment to the next – it’s all normal. Add to that the physical and emotional toll of having treatment and vaginal cancer can feel like a lot to deal with. Here are some strategies that may help:
- it’s good to talk: There’s nothing wrong with asking for help. Seek out friends or family members you feel comfortable opening up to about how you’re feeling, or you might prefer to speak to a professional counselor or psychologist. Speak to the team at your cancer center for more information on counseling options
- take small steps: Set yourself achievable goals each day. It’s not about thinking big. If you say to yourself ‘I will go for a short walk today if I’m up to it’ and you manage to, that’s something to celebrate
- focus on the now: Try to take each day as it comes and focus on things to be grateful for.
- find some stress relief: dealing with cancer treatment and the recovery process is stressful so try to do things you find calming such as relaxation, meditation, or or spending time with people who make you feel good
- Joining support groups – offers support in the US and Cancer Research has a list of specific in the UK.
What is the vaginal cancer survival rate?
Because vaginal cancer is one of the less common cancers, the survival rate is harder to work out than for other, more common types of cancer.
How long you, or a loved one, will live for after diagnosis with vaginal cancer depends on different factors, including the stage your vaginal cancer is at and their overall health. For more information, visit the websites of the American Cancer Society or Cancer Research UK.
Your health question answered
Q. Does vaginal cancer run in families?
A. If a close female relative is diagnosed with vaginal cancer – your mum, sister, aunt or grandmother – that in itself is hard to deal with and you would also understandably be worried about whether this increases your risk of getting it, too. However, there doesn’t seem to be any concrete evidence yet that vaginal cancer runs in families.
“Being diagnosed with and treated for vaginal cancer is very likely to change how you feel about sex and may affect your relationship. It's hard to know exactly how you’ll feel after treatment or what emotional effects your diagnosis will have, but it's important to know there's plenty of support. Your doctor and specialist nurse can guide you through it and refer you to a counselor who can also help you talk about it openly on your own or with your partner,” says Dr. Adiele Hoffman.