General Information About Vaginal Cancer
Vaginal cancer is a disease in which malignant (cancer) cells form in
the vagina.
The vagina is the canal leading from the cervix (the opening of uterus) to the outside of the body. At birth, a baby passes out of the body through the vagina (also called the birth canal).
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| Anatomy of the female reproductive system. The organs in the female reproductive system include the uterus, ovaries, fallopian tubes, cervix, and vagina. The uterus has a muscular outer layer called the myometrium and an inner lining called the endometrium. |
Vaginal cancer is not common. When found in early stages, it can often be cured. There are two main types of vaginal cancer:
- Squamous cell carcinoma: Cancer that forms in squamous cells,
the thin, flat cells lining the vagina. Squamous cell vaginal cancer spreads slowly and usually stays near the vagina, but may spread to the lungs and liver. This is the most common type of vaginal cancer. It is found most often in women aged 60 or older.
- Adenocarcinoma: Cancer that begins in
glandular (secretory) cells.
Glandular cells in the lining of the vagina make and release fluids such
as mucus. Adenocarcinoma is more likely than squamous cell cancer to spread to the lungs and lymph nodes. It is found most often in women aged 30 or younger.
Age and exposure to the drug DES (diethylstilbestrol) before birth affect a woman’s risk of developing vaginal cancer.
Anything that increases your risk of getting a disease is called a risk factor. Risk factors for vaginal cancer include the following:
- Being aged 60 or older.
- Being exposed to DES while in the mother's womb. In the 1950s, the drug DES was given to some pregnant women to prevent miscarriage (premature birth of a fetus that cannot survive). Women who were exposed to DES before birth have an increased risk of developing vaginal cancer. Some of these women develop a rare form of cancer called clear cell adenocarcinoma.
- Having human papilloma virus (HPV) infection.
- Having a history of abnormal cells in the cervix or cervical cancer.
Possible signs of vaginal cancer include pain or abnormal vaginal bleeding.
Vaginal cancer often does not cause early symptoms and may be found during a routine Pap test. When symptoms occur they may be caused by vaginal cancer or by other conditions. A doctor should be consulted if any of the following problems occur:
- Bleeding or discharge not related to menstrual periods.
- Pain during sexual intercourse.
- Pain in the pelvic area.
- A lump in the vagina.
Tests that examine the vagina and other organs in the pelvis are used to detect (find) and diagnose vaginal cancer.
The following tests and procedures may be used:
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Pelvic exam: 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.
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| Pelvic exam. A doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and presses on the lower abdomen with the other hand. This is done to feel the size, shape, and position of the uterus and ovaries. The vagina, cervix, fallopian tubes, and rectum are also checked. |
- Pap smear: A procedure to collect cells from the surface of the cervix and vagina. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the cervix and vagina. The cells are viewed under a microscope to find out if they are abnormal. This procedure is also called a Pap test.
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| Pap smear. A speculum is inserted into the vagina to widen it. Then, a brush is inserted into the vagina to collect cells from the cervix. The cells are checked under a microscope for signs of disease. |
- Biopsy: The removal of cells or tissues from the vagina and cervix so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a Pap smear shows abnormal cells in the vagina, a biopsy may be done during a colposcopy.
- Colposcopy: A procedure in which a colposcope (a lighted, magnifying instrument) is used to check the vagina and cervix for abnormal areas. Tissue samples may be taken using a curette (spoon-shaped instrument) and checked under a microscope for signs of disease.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) depends on the following:
- The stage of the cancer (whether it is in the vagina only or has spread to other areas).
- The size of the tumor.
- The grade of tumor cells (how different they are from normal cells).
- Where the cancer is within the vagina.
- Whether there are symptoms.
- The patient's age and general health.
- Whether the cancer has just been diagnosed or has recurred (come back).
Treatment options depend on the following:
- The stage, size, and location of the cancer.
- Whether the tumor cells are squamous cell or adenocarcinoma.
- Whether the patient has a uterus or has had a hysterectomy.
- Whether the patient has had past radiation treatment to the pelvis.
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Stages of Vaginal Cancer
After vaginal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the vagina or to other parts of the body.
The process used to find out if cancer has spread within the vagina or to other
parts of the body is called staging. The information gathered from the
staging process determines the stage of the disease. It is important to know
the stage in order to plan treatment. The following procedures may be used in the staging process:
- Biopsy: A biopsy may be done to find out if cancer has spread to the cervix. A sample of tissue is cut from the cervix and viewed under a microscope. A biopsy that removes only a small amount of tissue is usually done in the doctor’s office. A woman may need to go to a hospital for a cone biopsy (removal of a larger, cone-shaped piece of tissue from the cervix and cervical canal). A biopsy of the vulva may also be done to see if cancer has spread there.
- Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
- Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope is inserted through the urethra into the bladder. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
- Ureteroscopy: A procedure to look inside the ureters to check for abnormal areas. A ureteroscope is inserted through the bladder and into the ureters. A ureteroscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease. A ureteroscopy and cystoscopy may be done during the same procedure.
- Proctoscopy: A procedure to look inside the rectum to check for abnormal areas. A proctoscope is inserted through the rectum. A proctoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- Lymphangiogram: A procedure used to x-ray the lymph system. A dye is injected 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.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The following stages are used for vaginal cancer:
Stage 0 (Carcinoma in Situ)
In stage 0, abnormalcells are found in tissue lining the
inside of the vagina. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
Stage I
In stage I, cancer has formed and
is found in the vagina only.
Stage II
In stage II, cancer has spread from the vagina to the tissue around the vagina.
Stage III
In 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
Stage IV is divided into stage IVA and stage IVB:
- Stage IVA: Cancer may have spread to lymph nodes in the pelvis or groin and has spread to one or both of the following areas:
- The lining of the bladder or rectum.
- Beyond the pelvis.
- Stage IVB: Cancer has spread to parts of the body that are not near the vagina, such as the lungs. Cancer may also have spread to the lymph nodes.
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Recurrent Vaginal Cancer
Recurrentvaginal cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the vagina or in other parts of the body.
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Treatment Option Overview
There are different types of treatment for patients with vaginal cancer.
Different types of treatments are available for patients with vaginal cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Three types of standard treatment are used:
Surgery
Surgery is the most common treatment of vaginal cancer. The following surgical procedures may be used:
- Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.
- Wide local excision: A surgical procedure that takes out the cancer and some of the healthy tissue around it.
- Vaginectomy: Surgery to remove all or part of the vagina.
- Total hysterectomy: Surgery to remove the uterus, including the cervix. If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision in the abdomen using a laparoscope, the operation is called a total laparoscopic hysterectomy.
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| Hysterectomy. The uterus is surgically removed with or without other organs or tissues. In a total hysterectomy, the uterus and cervix are removed. In a total hysterectomy with salpingo-oophorectomy, (a) the uterus plus one (unilateral) ovary and fallopian tube are removed; or (b) the uterus plus both (bilateral) ovaries and fallopian tubes are removed. In a radical hysterectomy, the uterus, cervix, both ovaries, both fallopian tubes, and nearby tissue are removed. These procedures are done using a low transverse incision or a vertical incision. |
- Lymphadenectomy: A surgical procedure in which lymph nodes are removed and checked under a microscope for signs of cancer. This procedure is also called lymph node dissection. If the cancer is in the upper vagina, the pelvic lymph nodes may be removed. If the cancer is in the lower vagina, lymph nodes in the groin may be removed.
- Pelvic exenteration: Surgery to remove the lower colon, rectum, and bladder. In women, the cervix, vagina, ovaries, and nearby lymph nodes are also removed. Artificial openings (stoma) are made for urine and stool to flow from the body into a collection bag.
Skin grafting may follow surgery, to repair or reconstruct the vagina. Skin grafting is a surgical procedure in which skin is moved from one part of the body to another. 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 area treated with surgery.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients 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.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can affect cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Topical chemotherapy for squamous cell vaginal cancer may be applied to the vagina in a cream or lotion.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web
site.
Radiosensitizers
Radiosensitizers are drugs that make tumor cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more tumor cells.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
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Treatment Options by Stage
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.
Stage 0 (Carcinoma in Situ)
Treatment of stage 0 may include the following:
- Wide local excision, with or without a skin graft.
- Partial or total vaginectomy, with or without a skin graft.
- Topical chemotherapy.
- Laser surgery.
- Internal radiation therapy.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage 0 vaginal cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage I Vaginal Cancer
Treatment of stage Isquamous cellvaginal cancer may include the following:
- Internal radiation therapy, with or without external radiation
therapy to lymph nodes or large tumors.
- Wide local excision or vaginectomy with vaginal reconstruction. Radiation therapy may be given after the surgery.
- Vaginectomy and lymphadenectomy, with or without vaginal reconstruction. Radiation therapy may be given after the surgery.
Treatment of stage I vaginaladenocarcinoma may include the following:
- Vaginectomy, hysterectomy, and lymphadenectomy. This may be followed by vaginal reconstruction and/or radiation therapy.
- Internal radiation therapy, with or without external radiation
therapy to lymph nodes.
- A combination of therapies that may include wide local excision with or without lymphadenectomy and internal radiation therapy.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I vaginal cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage II Vaginal Cancer
Treatment of stage II vaginal cancer is the same for squamous cell cancer and adenocarcinoma. Treatment may include the following:
- Both internal and external radiation therapy to the vagina, with or without external radiation
therapy to lymph nodes.
- Vaginectomy or pelvic exenteration, with or without radiation therapy.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage II vaginal cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage III Vaginal Cancer
Treatment of stage III vaginal cancer is the same for squamous cell cancer and adenocarcinoma. Treatment may include both internal and external radiation therapy, with or without surgery.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III vaginal cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage IVA Vaginal Cancer
Treatment of stage IVA vaginal cancer is the same for squamous cell cancer and adenocarcinoma. Treatment may include both internal and external radiation therapy, with or without surgery.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IVA vaginal cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage IVB Vaginal Cancer
Treatment of stage IVB vaginal cancer is the same for squamous cell cancer and adenocarcinoma. Treatment may include the following:
- Radiation therapy as palliative therapy, to relieve symptoms and improve the quality of life. Chemotherapy may also be given.
- A clinical trial of chemotherapy and/or radiosensitizers.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IVB vaginal cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
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Treatment Options for Recurrent Vaginal Cancer
Treatment of recurrentvaginal cancer may include the following:
- Pelvic exenteration.
- Radiation therapy.
- A clinical trial of a new treatment.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent vaginal cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
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To Learn More About Vaginal Cancer
For more information from the National Cancer Institute about vaginal cancer, see the following:
For general cancer information and other resources from the National Cancer Institute, see the following:
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This information is provided by the National Cancer Institute.
This information was last updated on October 12, 2009.
Purpose of This PDQ Summary
This PDQ cancer information summary for health professionals provides
comprehensive, peer-reviewed, evidence-based information about the treatment of vaginal
cancer. This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment
Editorial Board.
Information about the following is included in this summary:
- Epidemiology.
- Prognosis.
- Cellular classification.
- Staging.
- Treatment options by cancer stage.
This summary is intended as a resource to inform and assist clinicians who care
for cancer patients. It does not provide formal guidelines or recommendations for making
health care decisions.
Some of the reference citations in the summary are accompanied by a
level-of-evidence designation. These designations are intended to help readers assess the
strength of the evidence supporting the use of specific interventions or approaches. The PDQ
Adult Treatment Editorial Board uses a formal evidence
ranking system in developing its level-of-evidence designations. Based on the
strength of the available evidence, treatment options are described as either “standard” or
“under clinical evaluation.” These classifications should not be used as a basis for
reimbursement determinations.
This summary is available in a patient version, written in
less technical language, and in Spanish.
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General Information
Note: Estimated new cases and deaths from vaginal (and other female genital)
cancer in the United States in 2009:[1]
- New cases: 2,160.
- Deaths: 770.
Carcinomas of the vagina are uncommon tumors comprising 1% to 2% of gynecologic
malignancies. They can be effectively treated, and when found in early stages, are often
curable. The histologic distinction between squamous cell carcinoma and adenocarcinoma is
important because the two types represent distinct diseases, each with a different
pathogenesis and natural history. Squamous cell vaginal cancer (approximately 85% of cases)
initially spreads superficially within the vaginal wall and later invades the paravaginal
tissues and the parametria. Distant metastases occur most commonly in the lungs and
liver.[2] Adenocarcinoma (approximately 15% of cases) has a peak
incidence between 17 and 21 years of age and differs from squamous cell carcinoma by an
increase in pulmonary metastases and supraclavicular and pelvic node involvement.[3] Rarely, melanoma and sarcoma are described as primary vaginal cancers.
Adenosquamous carcinoma is a rare and aggressive mixed epithelial tumor comprising
approximately 1% to 2% of cases.
Prognosis depends primarily on the stage of disease, but survival is reduced in
patients who are greater than 60 years of age, are symptomatic at the time of diagnosis, have
lesions of the middle and lower third of the vagina, or have poorly differentiated
tumors.[4][5] In addition, the length of vaginal
wall involvement has been found to be significantly correlated to survival and stage of
disease in squamous cell carcinoma patients.[6]
Therapeutic alternatives depend on stage; surgery or radiation therapy is highly
effective in early stages, while radiation therapy is the primary treatment of more advanced
stages.[7][8] Chemotherapy has not been shown to be
curative for advanced vaginal cancer, and there are no standard drug regimens.
Clear cell adenocarcinomas are rare and occur most often in patients less than 30
years of age who have a history of in utero exposure to
diethylstilbestrol (DES). The incidence of this disease, which is highest for those exposed
during the first trimester, peaked in the mid-1970s, reflecting the use of DES in the
1950s.[3] Young women with a history of in utero
DES exposure should prospectively be followed carefully to diagnose this disease at an early
stage. In women who have been carefully followed and well-managed, the disease is highly
curable.
Vaginal adenosis is most commonly found in young women who had in
utero exposure to DES and may coexist with a clear cell adenocarcinoma, though it
rarely progresses to adenocarcinoma. Adenosis is replaced by squamous metaplasia, which occurs
naturally, and requires follow-up but not removal. The natural history, prognosis, and
treatment of other primary vaginal cancers (sarcoma, melanoma, lymphoma, and carcinoid tumors)
may be different, and specific references should be sought.[9]
References:
American Cancer Society.: Cancer Facts and Figures 2009. Atlanta, Ga:
American Cancer Society, 2009. Also available
online. Last accessed January 6, 2010.
Gallup DG, Talledo OE, Shah KJ, et al.:
Invasive squamous cell carcinoma of the vagina: a 14-year study. Obstet Gynecol 69 (5):
782-5, 1987.
Herbst AL, Robboy SJ, Scully RE, et al.:
Clear-cell adenocarcinoma of the vagina and cervix in girls: analysis of 170 registry cases.
Am J Obstet Gynecol 119 (5): 713-24, 1974.
Kucera H, Vavra N: Radiation management
of primary carcinoma of the vagina: clinical and histopathological variables associated with
survival. Gynecol Oncol 40 (1): 12-6, 1991.
Eddy GL, Marks RD Jr, Miller MC 3rd, et
al.: Primary invasive vaginal carcinoma. Am J Obstet Gynecol 165 (2): 292-6; discussion
296-8, 1991.
Dixit S, Singhal S, Baboo HA: Squamous
cell carcinoma of the vagina: a review of 70 cases. Gynecol Oncol 48 (1): 80-7, 1993.
Perez CA, Camel HM, Galakatos AE, et
al.: Definitive irradiation in carcinoma of the vagina: long-term evaluation of results. Int
J Radiat Oncol Biol Phys 15 (6): 1283-90, 1988.
Pride GL, Schultz AE, Chuprevich TW, et
al.: Primary invasive squamous carcinoma of the vagina. Obstet Gynecol 53 (2): 218-25, 1979.
Sulak P, Barnhill D, Heller P, et al.:
Nonsquamous cancer of the vagina. Gynecol Oncol 29 (3): 309-20, 1988.
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Stage Information
Cervical biopsies are mandatory to rule out carcinoma of the cervix. Carcinoma of
the vulva should also be ruled out.
Stages are defined by the Federation Internationale de Gynecologie et
d’Obstetrique (FIGO) and the American Joint Committee on Cancer’s (AJCC) TNM
classification.[1] The definitions of the T categories correspond to the
stages accepted by the FIGO and both systems are included for comparison.
TNM Definitions
TNM Categories/FIGO Stages
Primary tumor (T)
- TX: Primary tumor cannot be assessed
- T0: No evidence of primary tumor
- Tis/ 0: Carcinoma in situ
- T1/I: Tumor confined to vagina
- T2/II: Tumor invades paravaginal tissues but not to pelvic wall*
- T3/III: Tumor extends to pelvic wall*
- T4/IVA: Tumor invades mucosa of the bladder or rectum and/or extends beyond the
true pelvis (Bullous edema is not sufficient evidence to classify a tumor as T4.)
*Pelvic wall is defined as muscle, facia, neurovascular structures, or
skeletal portions of the bony pelvis.
Regional lymph nodes (N)
- NX: Regional nodes cannot be assessed
- N0: No regional lymph node metastasis
- N1/IVB: Pelvic or inguinal lymph node metastasis
Distant metastasis (M)
- MX: Distant metastasis cannot be assessed
- M0: No distant metastasis
- M1/IVB: Distant metastasis
AJCC Stage Groupings
Stage 0
Stage I
Stage II
Stage III
- T1, N1, M0
- T2, N1, M0
- T3, N0, M0
- T3, N1, M0
Stage IVA
Stage IVB
References:
Vagina. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual.
6th ed. New York, NY: Springer, 2002, pp 251-257.
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Treatment Option Overview
Factors to be considered in planning therapy for vaginal cancer are:
- Stage, size, and location of the lesion.
- Presence or absence of the uterus.
- Whether there has been prior pelvic radiation therapy.
In a large series of women studied retrospectively for 30 years, 50% had
undergone hysterectomy prior to the diagnosis of vaginal cancer.[1] In
this posthysterectomy group, 31 of 50 (62%) women developed cancers limited to the upper third
of the vagina. In women who had not previously undergone hysterectomy, upper vaginal lesions
were found in only 17 of 50 (34%) women. The lymphatics may drain to pelvic or inguinal nodes
or both, depending on tumor location, and consideration should be given to these areas in
treatment planning. The proximity of the vagina to the bladder or rectum limits treatment
options and increases complications involving these organs. For patients with carcinoma of the
vagina in its early stages, standard treatment applied by gynecologic oncologists or radiation
oncologists is highly effective. For patients with stages III and IVA disease, radiation
therapy alone is standard. For patients with stage IVB disease, current therapy is inadequate,
and no established anticancer drugs can be considered standard treatment. Considering the
rarity of such patients, they should be considered candidates for clinical trials using
anticancer drugs and/or radiosensitizers to attempt to improve survival or local control.
Information about ongoing clinical trials is available from the NCI Web site.
References:
Stock RG, Chen AS, Seski J: A 30-year
experience in the management of primary carcinoma of the vagina: analysis of prognostic
factors and treatment modalities. Gynecol Oncol 56 (1): 45-52, 1995.
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Stage 0 Vaginal Cancer
Squamous Cell Carcinoma In Situ
This disease is usually multifocal and commonly occurs at the vaginal vault.
Because vaginal intraepithelial neoplasia (VAIN) is associated with other genital
neoplasias, the cervix (when present) and vulva should be carefully examined. The treatments
listed below produce equivalent cure rates. The selection of treatment depends on patient
factors and local expertise (e.g., anatomical distortion of the vaginal vault [related to
wall closure at the time of hysterectomy] requires excision for technical reasons to exclude
the possibility of invasion by buried disease). Lesions with hyperkeratosis respond better
to excision or laser vaporization than to fluorouracil.[1]
Standard treatment options:
- Wide local excision with or without skin grafting.
- Partial or total vaginectomy with skin grafting for multifocal or extensive
disease.
- Intravaginal chemotherapy with 5% fluorouracil cream. Instillation of 1.5 g weekly
for 10 weeks has been found to be as effective as more frequent use.[2]
- Laser therapy.[2]
- Intracavitary radiation therapy delivering 60 Gy to 70 Gy to the
mucosa.[3][4] The entire vaginal mucosa should
be treated.[5]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical
Trials Registry that are now accepting patients with stage 0 vaginal cancer. The list of clinical trials can be further narrowed
by location, drug, intervention, and other criteria.
General information about clinical trials is also available from
the NCI Web
site.
References:
Wright VC, Chapman W: Intraepithelial
neoplasia of the lower female genital tract: etiology, investigation, and management. Semin
Surg Oncol 8 (4): 180-90, 1992 Jul-Aug.
Krebs HB: Treatment of vaginal
intraepithelial neoplasia with laser and topical 5-fluorouracil. Obstet Gynecol 73 (4):
657-60, 1989.
Perez CA, Camel HM, Galakatos AE, et
al.: Definitive irradiation in carcinoma of the vagina: long-term evaluation of results. Int
J Radiat Oncol Biol Phys 15 (6): 1283-90, 1988.
Woodman CB, Mould JJ, Jordan JA:
Radiotherapy in the management of vaginal intraepithelial neoplasia after hysterectomy. Br J
Obstet Gynaecol 95 (10): 976-9, 1988.
Perez CA, Garipagaoglu M: Vagina. In: Perez CA, Brady LW, eds.: Principles
and Practice of Radiation Oncology. 3rd ed. Philadelphia, Pa: Lippincott-Raven Publishers,
1998, pp 1891-1914.
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Stage I Vaginal Cancer
Squamous Cell Carcinoma
The treatments listed below produce equivalent cure rates. The selection of
treatment depends on patient factors and local expertise.
Standard treatment options for superficial lesions less than 0.5 cm thick:
- Intracavitary radiation therapy. In most instances, 60 Gy to 70 Gy prescribed to
0.5 cm is delivered to the tumor for 5 to 7 days (external-beam radiation therapy [EBRT]
is required for bulky lesions).[1] For lesions of the lower third of
the vagina, elective radiation therapy of 45 Gy to 50 Gy is given to pelvic and/or
inguinal lymph nodes.[1]
- Surgery. Wide local excision or total vaginectomy with vaginal reconstruction,
especially in lesions of the upper vagina. In cases with close or positive surgical
margins, adjuvant radiation therapy should be considered.[2]
Standard treatment options for lesions greater than 0.5 cm thick:
- Surgery. In lesions of the upper third of the vagina, radical vaginectomy and
pelvic lymphadenectomy should be performed. Construction of a neovagina may be performed
if feasible and if desired by the patient.[2][3]
In lesions of the lower third, inguinal lymphadenectomy should be performed. In cases with
close or positive surgical margins, adjuvant radiation therapy should be
considered.[2]
- Radiation therapy. Combination of interstitial (single-plane implant) and
intracavitary therapy to a dose of at least 75 Gy to the primary tumor. In addition to
brachytherapy, EBRT is advocated for poorly differentiated or infiltrating tumors that may
have a higher probability of lymph node metastasis.[1][4] For lesions of the lower third of the vagina, elective radiation therapy of
45 Gy to 50 Gy is given to the pelvic and/or inguinal lymph nodes.[1]
Adenocarcinoma
Standard treatment options:
- Surgery. Because the tumor spreads subepithelially, total radical vaginectomy and
hysterectomy with lymph node dissection are indicated. The deep pelvic nodes are dissected
if the lesion invades the upper vagina, and the inguinal nodes are removed if the lesion
originates in the lower vagina. Construction of a neovagina may be performed if feasible
and if desired by the patient.[2] In cases with close or positive
surgical margins, adjuvant radiation therapy should be considered.[2][3]
- Intracavitary and interstitial radiation as previously described for squamous cell
cancer.[1] For lesions of the lower third of the vagina, elective
radiation therapy of 45 Gy to 50 Gy is given to the pelvic and/or inguinal lymph
nodes.[1]
- Combined local therapy in selected cases, which may include wide local excision,
lymph node sampling, and interstitial therapy.[5]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical
Trials Registry that are now accepting patients with stage I vaginal cancer. The list of clinical trials can be further narrowed
by location, drug, intervention, and other criteria.
General information about clinical trials is also available from
the NCI Web
site.
References:
Perez CA, Camel HM, Galakatos AE, et
al.: Definitive irradiation in carcinoma of the vagina: long-term evaluation of results. Int
J Radiat Oncol Biol Phys 15 (6): 1283-90, 1988.
Stock RG, Chen AS, Seski J: A 30-year
experience in the management of primary carcinoma of the vagina: analysis of prognostic
factors and treatment modalities. Gynecol Oncol 56 (1): 45-52, 1995.
Rubin SC, Young J, Mikuta JJ: Squamous
carcinoma of the vagina: treatment, complications, and long-term follow-up. Gynecol Oncol 20
(3): 346-53, 1985.
Andersen ES: Primary carcinoma of the
vagina: a study of 29 cases. Gynecol Oncol 33 (3): 317-20, 1989.
Senekjian EK, Frey KW, Anderson D, et
al.: Local therapy in stage I clear cell adenocarcinoma of the vagina. Cancer 60 (6):
1319-24, 1987.
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Stage II Vaginal Cancer
Squamous Cell Carcinoma
Radiation therapy is the standard treatment for patients with stage II vaginal
carcinoma.
Standard treatment options:
- Combination of brachytherapy and external-beam radiation therapy (EBRT) to deliver
a combined dose of 70 Gy to 80 Gy to the primary tumor volume.[1] For
lesions of the lower third of the vagina, elective radiation therapy of 45 Gy to 50 Gy is
given to the pelvic and/or inguinal lymph nodes.[1][2]
- Radical surgery (radical vaginectomy or pelvic exenteration) with or without
radiation therapy.[3][4]
Adenocarcinoma
Standard treatment options:
- Combination of brachytherapy and EBRT to deliver a combined dose of 70 Gy to 80 Gy
to the primary tumor.[1] For lesions of the lower third of the vagina,
elective radiation therapy of 45 Gy to 50 Gy is given to the pelvic and/or inguinal lymph
nodes.[1][2]
- Radical surgery (radical vaginectomy or pelvic exenteration) with or without
radiation therapy.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical
Trials Registry that are now accepting patients with stage II vaginal cancer. The list of clinical trials can be further
narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from
the NCI Web
site.
References:
Perez CA, Camel HM, Galakatos AE, et
al.: Definitive irradiation in carcinoma of the vagina: long-term evaluation of results. Int
J Radiat Oncol Biol Phys 15 (6): 1283-90, 1988.
Andersen ES: Primary carcinoma of the
vagina: a study of 29 cases. Gynecol Oncol 33 (3): 317-20, 1989.
Rubin SC, Young J, Mikuta JJ: Squamous
carcinoma of the vagina: treatment, complications, and long-term follow-up. Gynecol Oncol 20
(3): 346-53, 1985.
Stock RG, Chen AS, Seski J: A 30-year
experience in the management of primary carcinoma of the vagina: analysis of prognostic
factors and treatment modalities. Gynecol Oncol 56 (1): 45-52, 1995.
Top
Stage III Vaginal Cancer
Squamous Cell Carcinoma
Standard treatment options:
- Combination of interstitial, intracavitary, and external-beam radiation therapy
(EBRT). EBRT for a period of 5 to 6 weeks (including pelvic nodes) followed by an
interstitial and/or intracavitary implant for a total tumor dose of 75 Gy to 80 Gy and a
dose to the lateral pelvic wall of 55 Gy to 60 Gy.[1]
- Rarely, surgery may be combined with the above.[2]
Adenocarcinoma
Standard treatment options:
- Combination of interstitial, intracavitary, and EBRT as described for squamous
cell cancer.[1]
- Rarely, surgery may be combined with the above.[2]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical
Trials Registry that are now accepting patients with stage III vaginal cancer. The list of clinical trials can be further
narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from
the NCI Web
site.
References:
Perez CA, Camel HM, Galakatos AE, et
al.: Definitive irradiation in carcinoma of the vagina: long-term evaluation of results. Int
J Radiat Oncol Biol Phys 15 (6): 1283-90, 1988.
Boronow RC, Hickman BT, Reagan MT, et
al.: Combined therapy as an alternative to exenteration for locally advanced vulvovaginal
cancer. II. Results, complications, and dosimetric and surgical considerations. Am J Clin
Oncol 10 (2): 171-81, 1987.
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Stage IVA Vaginal Cancer
Squamous Cell Carcinoma
Standard treatment options:
- Combination of interstitial, intracavitary, and external-beam radiation therapy
(EBRT).[1]
- Rarely, surgery may be combined with the above.[2]
Adenocarcinoma
Standard treatment options:
- Combination of interstitial, intracavitary, and EBRT.[1]
- Rarely, surgery may be combined with the above.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical
Trials Registry that are now accepting patients with stage IVA vaginal cancer. The list of clinical trials can be further
narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from
the NCI Web
site.
References:
Perez CA, Camel HM, Galakatos AE, et
al.: Definitive irradiation in carcinoma of the vagina: long-term evaluation of results. Int
J Radiat Oncol Biol Phys 15 (6): 1283-90, 1988.
Boronow RC, Hickman BT, Reagan MT, et
al.: Combined therapy as an alternative to exenteration for locally advanced vulvovaginal
cancer. II. Results, complications, and dosimetric and surgical considerations. Am J Clin
Oncol 10 (2): 171-81, 1987.
Top
Stage IVB Vaginal Cancer
Squamous Cell Carcinoma
Patients should be considered candidates for one of the ongoing clinical trials
to improve therapeutic results. Standard treatment is inadequate.
Standard treatment options:
- Radiation (for palliation of symptoms) with or without chemotherapy.
Adenocarcinoma
Patients should be considered candidates for one of the ongoing clinical trials
to improve therapeutic results.
Standard treatment options:
- Radiation (for palliation of symptoms) with or without chemotherapy.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical
Trials Registry that are now accepting patients with stage IVB vaginal cancer. The list of clinical trials can be further
narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from
the NCI Web
site.
Top
Recurrent Vaginal Cancer
Recurrence carries a grave prognosis. In a large series only five of fifty
patients with recurrence were salvaged by surgery or radiation therapy. All five of these
salvaged patients originally presented with stage I or II disease and failed in the central
pelvis.[1] Most recurrences are in the first 2 years after treatment. In
centrally recurrent vaginal cancers, some patients may be candidates for pelvic exenteration
or radiation therapy. Neither cisplatin nor mitoxantrone has significant activity in recurrent
or advanced squamous cell cancer. There is no standard chemotherapy.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical
Trials Registry that are now accepting patients with recurrent vaginal cancer. The list of clinical trials can be further
narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from
the NCI Web
site.
References:
Stock RG, Chen AS, Seski J: A 30-year
experience in the management of primary carcinoma of the vagina: analysis of prognostic
factors and treatment modalities. Gynecol Oncol 56 (1): 45-52, 1995.
Top
More Information
About PDQ
Additional PDQ Summaries
Important:
This information is intended mainly for use by doctors and other
health care professionals. If you have questions about this topic, you can ask your doctor, or
call the Cancer Information Service at 1-800-4-CANCER
(1-800-422-6237).
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This information is provided by the National Cancer Institute.
This information was last updated on July 1, 2009.