Vaginal Cancer

  • Dana-Farber/Brigham and Women's Cancer Care

    Vaginal cancer forms in the tissues of the vagina. The most common type of vaginal cancer is squamous cell carcinoma, which starts in the thin, flat cells lining the vagina. Learn about vaginal cancer and find information on how we support and care for women with vaginal cancer before, during, and after treatment.

Treatment 

Whether you’ve been diagnosed with a gynecologic cancer or are at high risk of developing one, the specialists in the Susan F. Smith Center for Women's Cancers Gynecologic Oncology Program provide expert, compassionate care.

Because gynecologic cancers can have a wide range of physical and emotional effects, we’ve assembled a team of experts from many disciplines to help you and your family cope with cancer and its treatment. Our doctors and other caregivers will work closely with you to develop an individualized treatment plan suited to your situation.

As well as providing specialized medical care, we offer a range of supportive services, including nutritional counseling, emotional and spiritual support, financial advice, and complementary therapies such as acupuncture and massage.

As a major research institution, Dana-Farber is able to provide patients not only with outstanding care but also with some of the most advanced therapies available. We base our treatments on the latest scientific findings, and many patients have the opportunity to participate in clinical trials of the potential therapies of the future.

Learn more about our treatment and care for women with gynecologic cancers 

Our clinicians are experts in treating all types of gynecologic cancers, including: 

  • Cervical cancer
  • Carcinosarcomas
  • Endometrial cancer
  • Gestational trophoblastic tumor
  • Ovarian cancer
  • Epithelial ovarian cancer
  • Germ cell ovarian cancer
  • Low malignant ovarian cancer
  • Borderline ovarian cancer
  • Primary peritoneal cancer
  • Fallopian tube cancer
  • Vaginal cancer
  • Vulvar cancer
  • Choriocarcinoma
  • Molar pregnancy

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Information for: Patients | Healthcare Professionals

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).

Anatomy of the female reproductive system; drawing shows the uterus, myometrium (muscular outer layer of the uterus), endometrium (inner lining of the uterus), ovaries, fallopian tubes, cervix, and vagina.
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. 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, liver, or bone. This is the most common type of vaginal cancer.
  • 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. A rare type of adenocarcinoma is linked to being exposed to diethylstilbestrol (DES) before birth. Adenocarcinomas that are not linked with being exposed to DES are most common in women after menopause.

Age and being exposed to the drug DES (diethylstilbestrol) before birth affect a woman’s risk of vaginal cancer.

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk. 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 vaginal cancer. Some of these women develop a rare form of vaginal cancer called clear cell adenocarcinoma.
  • Having human papilloma virus (HPV) infection.
  • Having a history of abnormal cells in the cervix or cervical cancer.
  • Having a history of abnormal cells in the uterus or cancer of the uterus.
  • Having had a hysterectomy for health problems that affect the uterus.

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 pelvic exam and Pap test. When symptoms occur, they may be caused by vaginal cancer or by other conditions. Check with your doctor if you have any of the following problems:

  • Bleeding or discharge not related to menstrual periods.
  • Pain during sexual intercourse.
  • Pain in the pelvic area.
  • A lump in the vagina.
  • Pain when urinating.
  • Constipation.

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.
    Pelvic exam; drawing shows a side view of the female reproductive anatomy during a pelvic exam. The uterus, left fallopian tube, left ovary, cervix, vagina, bladder, and rectum are shown. Two gloved fingers of one hand of the doctor or nurse are shown inserted into the vagina, while the other hand is shown pressing on the lower abdomen. The inset shows a woman covered by a drape on an exam table with her legs apart and her feet in stirrups.
    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 test: 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 smear.
    Pap test; drawing shows a side view of the female reproductive anatomy during a Pap test. A speculum is shown widening the opening of the vagina. A brush is shown inserted into the open vagina and touching the cervix at the base of the uterus. The rectum is also shown. One inset shows the brush touching the center of the cervix. A second inset shows a woman covered by a drape on an exam table with her legs apart and her feet in stirrups.
    Pap test. 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.
  • 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.
  • 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 test shows abnormal cells in the vagina, a biopsy may be done during a colposcopy.

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 at diagnosis.
  • The patient's age and general health.
  • Whether the cancer has just been diagnosed or has recurred (come back).

When found in early stages, vaginal cancer can often be cured.

Treatment options depend on the following:

  • The stage and size of the cancer.
  • Whether the cancer is close to other organs that may be damaged by treatment.
  • Whether the tumor is made up of squamous cells or is an adenocarcinoma.
  • Whether the patient has a uterus or has had a hysterectomy.
  • Whether the patient has had past radiation treatment to the pelvis.

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:

  • 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.
  • 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).
  • PET scan (positron emission tomography scan): A procedure to find malignanttumorcells in the body. A small amount of radioactiveglucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
  • 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.
    Cystoscopy; drawing shows a side view of the lower pelvis containing the bladder, uterus, and rectum. Also shown are the vagina and anus. The flexible tube of a cystoscope (a thin, tube-like instrument with a light and a lens for viewing) is shown passing through the urethra and into the bladder. Fluid is used to fill the bladder. An inset shows a woman lying on an examination table with her knees bent and legs apart. She is covered by a drape. The doctor looks at an image of the inner wall of the bladder on a computer monitor.
    Cystoscopy. A cystoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted through the urethra into the bladder. Fluid is used to fill the bladder. The doctor looks at an image of the inner wall of the bladder on a computer monitor.
  • 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.
    Ureteroscopy; drawing shows the lower pelvis containing the right and left kidneys, ureter, bladder, and urethra. The flexible tube of a ureterscope (a thin, tube-like instrument with a light and a lens for viewing) is shown passing through the urethra into the bladder and ureter. An inset shows a woman lying on an examination table with her knees bent and legs apart. She is covered by a drape. The doctor looks at a an image of the inside of the ureter on a computer monitor.
    Ureteroscopy. A ureteroscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted through the urethra into the ureter. The doctor looks at an image of the inside of the ureter on a computer monitor.
  • 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.
  • Biopsy: A biopsy may be done to find out if cancer has spread to the cervix. A sample of tissue is removed 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 cone biopsy (removal of a larger, cone-shaped piece of tissue from the cervix and cervical canal) is usually done in the hospital. A biopsy of the vulva may also be done to see if cancer has spread there.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if vaginal cancer spreads to the lung, the cancer cells in the lung are actually vaginal cancer cells. The disease is metastatic vaginal cancer, not lung cancer.

In vaginal intraepithelial neoplasia (VAIN), abnormal cells are found in tissue lining the inside of the vagina.

These abnormal cells are not cancer. Vaginal intraepithelial neoplasia (VAIN) is grouped based on how deep the abnormal cells are in the tissue lining the vagina:

  • VAIN 1: Abnormal cells are found in the outermost one third of the tissue lining the vagina.
  • VAIN 2: Abnormal cells are found in the outermost two-thirds of the tissue lining the vagina.
  • VAIN 3: Abnormal cells are found in more than two-thirds of the tissue lining the vagina. When abnormal cells are found throughout the tissue lining, it is called carcinoma in situ.

VAIN may become cancer and spread into the vaginal wall. VAIN is sometimes called stage 0.

The following stages are used for vaginal cancer:

Stage I

In stage I, cancer is found in the vaginal wall only.

Stage II

In stage II, cancer has spread through the wall of the vagina to the tissue around the vagina. Cancer has not spread to the wall of the pelvis.

Stage III

In stage III, cancer has spread to the wall of the pelvis.

Stage IV

Stage IV is divided into stage IVA and stage IVB:

  • Stage IVA: Cancer may have spread to one or more of the following areas:
    • The lining of the bladder.
    • The lining of the rectum.
    • Beyond the area of the pelvis that has the bladder, uterus, ovaries, and cervix.
  • Stage IVB: Cancer has spread to parts of the body that are not near the vagina, such as the lung or bone.

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.

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.
    Hysterectomy; drawing shows the female reproductive anatomy, including the ovaries, uterus, vagina, fallopian tubes, and cervix. Dotted lines show which organs and tissues are removed in a total hysterectomy, a total hysterectomy with salpingo-oophorectomy, and a radical hysterectomy. An inset shows the location of two possible incisions on the abdomen: a low transverse incision is just above the pubic area and a vertical incision is between the navel and the pubic area.
    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.
  • Lymph node dissection: A surgical procedure in which lymph nodes are removed and a sample of tissue is checked under a microscope for signs of cancer. This procedure is also called lymphadenectomy. 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, bladder, cervix, vagina, and ovaries. 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 cerebrospinal fluid, 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 listing of clinical trials.

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.

Treatment Options by Stage

Vaginal Intraepithelial Neoplasia (VAIN)

Treatment of vaginal intraepithelial neoplasia (VAIN) 1 is usually watchful waiting.

Treatment of VAIN 2 and 3 may include the following:

  • Watchful waiting.
  • Laser surgery.
  • Wide local excision, with or without a skin graft.
  • Partial or total vaginectomy, with or without a skin graft.
  • Topical chemotherapy.
  • Internal radiation therapy.
  • A clinical trial of a new topical chemotherapy drug.

Stage I Vaginal Cancer

Treatment of stage Isquamous cellvaginal cancer may include the following:

  • Internal radiation therapy.
  • External radiation therapy, especially for large tumors or the lymph nodes near tumors in the lower part of the vagina.
  • Wide local excision or vaginectomy with vaginal reconstruction. Radiation therapy may be given after the surgery.
  • Vaginectomy and lymph node dissection, 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 lymph node dissection. This may be followed by vaginal reconstruction and/or radiation therapy.
  • Internal radiation therapy. External radiation therapy may also be given to the lymph nodes near tumors in the lower part of the vagina.
  • A combination of therapies that may include wide local excision with or without lymph node dissection and internal radiation therapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials 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. Talk with your doctor about clinical trials that may be right for you. 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. External radiation therapy may also be given to the lymph nodes near tumors in the lower part of the vagina.
  • Vaginectomy or pelvic exenteration. Internal and/or external radiation therapy may also be given.

Check for U.S. clinical trials from NCI's list of cancer clinical trials 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. Talk with your doctor about clinical trials that may be right for you. 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 the following:

  • External radiation therapy. Internal radiation therapy may also be given.
  • Surgery (rare) followed by external radiation therapy. Internal radiation therapy may also be given.

Check for U.S. clinical trials from NCI's list of cancer clinical trials 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. Talk with your doctor about clinical trials that may be right for you. 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 the following:

  • External radiation therapy and/or internal radiation therapy.
  • Surgery (rare) followed by external radiation therapy and/or internal radiation therapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials 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. Talk with your doctor about clinical trials that may be right for you. 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 anticancerdrugs and/or radiosensitizers.

Although no anticancer drugs have been shown to help patients with stage IVB vaginal cancer live longer, they are often treated with regimens used for cervical cancer. (See the PDQ summary on Cervical Cancer Treatment.)

Check for U.S. clinical trials from NCI's list of cancer clinical trials 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. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.

Treatment Options for Recurrent Vaginal Cancer

Treatment of recurrentvaginal cancer may include the following:

  • Pelvic exenteration.
  • Radiation therapy.
  • A clinical trial of anticancerdrugs and/or radiosensitizers.

Although no anticancer drugs have been shown to help patients with recurrent vaginal cancer live longer, they are often treated with regimens used for cervical cancer. (See the PDQ summary on Cervical Cancer Treatment.)

Check for U.S. clinical trials from NCI's list of cancer clinical trials 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. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.

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:


This information is provided by the National Cancer Institute.

This information was last updated on November 21, 2013.


General Information About Vaginal Cancer

Incidence and Mortality

Estimated new cases and deaths from vaginal (and other female genital) cancer in the United States in 2013:[1]

  • New cases: 2,890.
  • Deaths: 840.

Carcinomas of the vagina are uncommon tumors comprising about 1% of the cancers that arise in the female genital system.[1][2]

Early stage tumors are often curable with local modality therapies, but there is no standard treatment of proven efficacy for metastatic disease. A large proportion (30%–50%) of women with vaginal carcinomas have had a prior hysterectomy for benign, pre-malignant, or malignant disease.[3][4]

The American Joint Committee on Cancer (AJCC) staging system indicates that tumors in the vagina that involve the cervix of women with an intact uterus are classified as cervical cancers.[5] Therefore, tumors that may have actually originated in the apical vagina but extend to the cervix would be classified as cervical cancers.

Squamous cell cancer (SCC) accounts for approximately 85% of vaginal cancer cases.[3] SCC initially spreads superficially within the vaginal wall and later invades the paravaginal tissues and the parametria. Distant hematogenous metastases occur most commonly in the lungs, and less frequently in liver, bone, or other sites.[3] SCC of the vagina is associated with a high rate of infection with oncogenic strains of human papillomavirus (HPV) and has many risk factors in common with SCC of the cervix.[6][7][8] HPV infection has also been described in a case of vaginal adenocarcinoma.[8]

Approximately 5% to 10% of cases of vaginal cancers are adenocarcinomas. A rare form of adenocarcinoma (clear cell carcinoma, described below) occurs in association with in utero exposure to diethylstilbestrol (DES), with a peak incidence at young ages (less than 30 years). However, adenocarcinomas that are not associated with DES exposure occur primarily during postmenopausal years.

The association between the clear cell carcinomas and in utero exposure to DES was first reported in 1971.[9] 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. It is extremely rare now.[3] However, women with a known history of in utero DES exposure should be carefully followed for this tumor.

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.

Rarely, melanomas (often nonpigmented), sarcomas, or small-cell carcinomas have been described as primary vaginal cancers.

Prognostic Factors

Patient prognosis depends primarily on the stage of disease, but survival is reduced among those who are older than 60 years, are symptomatic at the time of diagnosis, have lesions of the middle and lower third of the vagina, or have poorly differentiated tumors.

In addition, the length of vaginal wall involvement has been found to be associated with survival and stage of disease in vaginal SCC patients.

Non–DES-associated adenocarcinomas generally have a worse prognosis than SCC tumors, but DES-associated clear cell tumors have a relatively good prognosis.[3] The natural history, prognosis, and treatment of other primary vaginal cancers (i.e., sarcoma, melanoma, lymphoma, and carcinoid tumors) are different and are not covered in this summary.

Therapeutic options depend on tumor stage; surgery and radiation therapy are highly effective in early stages, whereas radiation therapy is the primary treatment of more advanced stages. Chemotherapy has not been shown to be curative for advanced vaginal cancer, and there are no standard drug regimens.

References:

  1. American Cancer Society.: Cancer Facts and Figures 2013. Atlanta, Ga: American Cancer Society, 2013. Available online. Last accessed January 10, 2014.

  2. Eifel PJ, Berek JS, Markman MA: Cancer of the cervix, vagina, and vulva. In: DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2011, pp 1311-44.

  3. Eifel P, Berek J, Markman M: Cancer of the cervix, vagina, and vulva. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. Vols. 1 & 2. 8th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2008, pp 1496-1543.

  4. 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.

  5. Vagina. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 387-9.

  6. Daling JR, Madeleine MM, Schwartz SM, et al.: A population-based study of squamous cell vaginal cancer: HPV and cofactors. Gynecol Oncol 84 (2): 263-70, 2002.

  7. Parkin DM: The global health burden of infection-associated cancers in the year 2002. Int J Cancer 118 (12): 3030-44, 2006.

  8. Ikenberg H, Runge M, Göppinger A, et al.: Human papillomavirus DNA in invasive carcinoma of the vagina. Obstet Gynecol 76 (3 Pt 1): 432-8, 1990.

  9. Herbst AL, Ulfelder H, Poskanzer DC: Adenocarcinoma of the vagina. Association of maternal stilbestrol therapy with tumor appearance in young women. N Engl J Med 284 (15): 878-81, 1971.

Stage Information for Vaginal Cancer

If the cervix is intact, biopsies are mandatory to rule out a primary carcinoma of the cervix. Carcinoma of the vulva should also be ruled out.

Definitions: FIGO

The Féderation Internationale de Gynécologie et d’Obstétrique (FIGO) and the American Joint Committee on Cancer (AJCC) have designated staging to define vaginal cancer; the FIGO system is most commonly used.[1][2] The definitions of the AJCC's T, N, and M categories correspond to the stages accepted by FIGO.

FIGO staging system (and modified World Health Organization [WHO] prognostic scoring system)

The FIGO staging system is as follows:[1]

Table 1. Carcinoma of the Vaginaa

FIGO Nomenclature

Stage I

The carcinoma is limited to the vaginal wall.

Stage II

The carcinoma has involved the subvaginal tissue but has not extended to the pelvic wall.

Stage III

The carcinoma has extended to the pelvic wall.

Stage IV

The carcinoma has extended beyond the true pelvis or has involved the mucosa of the bladder or rectum; bullous edemas as such does not permit a case to be allotted to stage IV.

IVa - Tumor invades bladder and/or rectal mucosa and/or direct extension beyond the true pelvis.

IVb - Spread to distant organs.

FIGO = Féderation Internationale de Gynécologie et d’Obstétrique.

aAdapted from FIGO Committee on Gynecologic Oncology.[1]

In addition, the FIGO staging system incorporates a modified WHO prognostic scoring system. The scores from the eight risk factors are summed and incorporated into the FIGO stage, separated by a colon (e.g., Stage II:4, Stage IV:9, etc.). Unfortunately, a variety of risk scoring systems have been published, making comparisons of results difficult.

References:

  1. FIGO Committee on Gynecologic Oncology.: Current FIGO staging for cancer of the vagina, fallopian tube, ovary, and gestational trophoblastic neoplasia. Int J Gynaecol Obstet 105 (1): 3-4, 2009.

  2. Vagina. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 387-9.

Treatment Option Overview

Roles of Radiation, Surgery, and Chemotherapy

Given the rarity of vaginal carcinoma, studies are limited to retrospective case series that may span a number of years, usually from single-referral institutions.[Level of evidence 3iiiD] Comparison of different treatment approaches is further complicated by the frequent failure of investigators to provide precise staging criteria (particularly for stage I vs. stage II disease) or criteria for the choice of treatment modality. This has led to a broad range of reported disease control and survival rates for any given stage and treatment modality.[1] In addition, given the long time span covered by these case series, there are often changes within a given case series in the available staging tests and radiation techniques, including the shift to high-energy accelerators and conformal- and intensity-modulated radiation.[2][3]

Factors to be considered in planning therapy for vaginal cancer include:

  • Stage and size of the lesion.
  • Proximity to radiosensitive organs or organs that preclude radical resection without unacceptable functional deficits (e.g., bladder, rectum, urethra).
  • Ability to retain a functional vagina.
  • Presence or absence of the uterus.
  • Whether there has been prior pelvic radiation therapy.

In a series of 100 women studied retrospectively over 30 years, 50% had undergone hysterectomy prior to the diagnosis of vaginal cancer.[4] 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.

Radiation-induced damage to nearby organs may include:[2][3]

  • Rectovaginal fistulas.
  • Vesicovaginal fistulas.
  • Rectal or vaginal strictures.
  • Cystitis.
  • Proctitis.
  • Premature menopause from ovarian damage.
  • Soft tissue or bone necrosis.

The proximity of the vagina to the bladder or rectum also limits surgical treatment options and increases short- and long-term surgical complications and functional deficits involving these organs.

For patients with carcinoma of the vagina in its early stages, radiation or surgery or a combination of these treatments are standard treatment. Data from randomized trials are lacking and the choice of therapy is generally determined by institutional experience and the factors listed above. For patients with stages III and IVA disease, radiation therapy is standard and includes external-beam radiation, alone or with brachytherapy. Regional lymph nodes are included in the radiation portal. When used alone, external-beam radiation involves a 60 Gy to 70 Gy tumor dose, using shrinking fields, delivered within 6 to 7 weeks. Intracavitary brachytherapy provides insufficient dose penetration for locally advanced tumors, so interstitial brachytherapy (75 Gy–85 Gy) is used if brachytherapy is employed.[1][5]

Local control is a problem with bulky tumors. In recent years, some investigators have also used concurrent chemotherapy with agents such as cisplatin, bleomycin, mitomycin-C, floxuridine, and vincristine; but this practice has not been proven to improve outcomes.[2] It is an extrapolation from treatment approaches used in cervical cancer, based on shared etiologic and risk factors.

For patients with stage IVB or recurrent disease that cannot be managed with local treatments, current therapy is inadequate. No established anticancer drugs can be considered of proven clinical benefit, although patients are often treated with regimens used to treat cervical cancer. (Refer to the PDQ summary on Cervical Cancer Treatment for more information.)

Concurrent chemotherapy, using 5-fluorouracil or cisplatin-based therapy, and radiation are sometimes advocated, again based solely on extrapolation from cervical cancer management strategies.[6][7][8] Experience is limited to small case series and the incremental impact on survival and local control is not well defined.[Level of evidence 3iiiDiv] Because of the rarity of these patients, they should be considered candidates for clinical trials of anticancer drugs and/or radiosensitizers to attempt to improve survival or local control.

Management of the extremely rare vaginal clear cell carcinoma is generally similar to the management of squamous cell carcinoma, though techniques that preserve vaginal and ovarian function are given strong consideration in treatment planning, given the young average age at diagnosis.[9]

In light of the many uncertainties about the relative efficacy of treatment approaches, ongoing clinical trials should be discussed with patients if they are eligible. Information about ongoing clinical trials is available from the NCI Web site.

Post-therapy Surveillance

As is the case with other gynecologic malignancies, the evidence base for surveillance after initial management of vaginal cancer is weak because of a lack of randomized, or even prospective, clinical studies.[10] There is no reliable evidence that routine cytologic or imaging procedures in patients improve health outcomes beyond what is achieved by careful physical examination and assessment of new symptoms. Therefore, outside the investigational setting, imaging procedures may be reserved for patients in whom physical examination or symptoms raise clinical suspicion of a recurrence or progression.

References:

  1. Eifel PJ, Berek JS, Markman MA: Cancer of the cervix, vagina, and vulva. In: DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2011, pp 1311-44.

  2. Frank SJ, Jhingran A, Levenback C, et al.: Definitive radiation therapy for squamous cell carcinoma of the vagina. Int J Radiat Oncol Biol Phys 62 (1): 138-47, 2005.

  3. Tran PT, Su Z, Lee P, et al.: Prognostic factors for outcomes and complications for primary squamous cell carcinoma of the vagina treated with radiation. Gynecol Oncol 105 (3): 641-9, 2007.

  4. 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.

  5. Chyle V, Zagars GK, Wheeler JA, et al.: Definitive radiotherapy for carcinoma of the vagina: outcome and prognostic factors. Int J Radiat Oncol Biol Phys 35 (5): 891-905, 1996.

  6. Grigsby PW: Vaginal cancer. Curr Treat Options Oncol 3 (2): 125-30, 2002.

  7. Dalrymple JL, Russell AH, Lee SW, et al.: Chemoradiation for primary invasive squamous carcinoma of the vagina. Int J Gynecol Cancer 14 (1): 110-7, 2004 Jan-Feb.

  8. Samant R, Lau B, E C, et al.: Primary vaginal cancer treated with concurrent chemoradiation using Cis-platinum. Int J Radiat Oncol Biol Phys 69 (3): 746-50, 2007.

  9. 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.

  10. Salani R, Backes FJ, Fung MF, et al.: Posttreatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncologists recommendations. Am J Obstet Gynecol 204 (6): 466-78, 2011.

Stage 0 Vaginal Cancer

Vaginal Intraepithelial Neoplasia (VAIN) Including Squamous Cell Carcinoma In Situ

Squamous cell carcinoma in situ of the vagina is a lesion that falls within the more general category known as vaginal intraepithelial neoplasia (VAIN). VAIN, the presence of noninvasive squamous cell atypia, is associated with a high rate of human papillomavirus (HPV) infection and is thought to have a similar etiology as cervical intraepithelial neoplasia (CIN).[1][2][3] VAIN is classified by the degree of involvement of the epithelium: VAIN 1, 2, and 3 denote involvement of the upper one-third, two-thirds, and more than two-thirds of the epithelial thickness, respectively. Carcinoma in situ denotes VAIN 3 lesions that involve the full thickness of the epithelium. The FIGO staging system no longer includes vaginal carcinoma in situ (Stage 0) in its staging system, but it is retained in the AJCC staging system.[4] Vaginal carcinoma in situ is often multifocal and commonly occurs at the vaginal vault. Because it is associated with other genital neoplasia, and in some cases may be an extension of CIN, the cervix (when present) and vulva should be carefully evaluated.

Women with VAIN 1 can usually be observed carefully without ablative or surgical treatment, since the lesions often regress spontaneously. The natural history of VAIN is not known with precision because of its rarity, but patients with VAIN 3 are felt to be at substantial risk of progression to invasive cancer and are treated immediately. The intermediate grade, VAIN 2, is variously managed by careful observation or initial treatment. The treatments listed below have not been compared directly in randomized trials, so their relative efficacy is uncertain.[Level of evidence 3iiiDiv] The selection of treatment depends on patient factors, anatomic location, evidence of multifocality, and local expertise (e.g., anatomical distortion of the vaginal vault related to wall closure at the time of prior 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.[5]

Standard treatment options:

  1. Laser therapy.[6] The lesions should first be sampled adequately to rule out invasive components that could be missed with this treatment approach.
  2. Wide local excision with or without skin grafting.[7]
  3. Partial or total vaginectomy, with skin grafting for multifocal or extensive disease.[8]
  4. Intravaginal chemotherapy with 5% fluorouracil cream. This option may be useful in the setting of multifocal lesions.[6][9]
  5. Intracavitary radiation therapy.[10][11] Because of its attendant toxicity and inherent carcinogenicity, this treatment is primarily used in the setting of multifocal or recurrent disease, or when the risk of surgery is high.[1] The entire vaginal mucosa is usually treated.[12]

Imiquimod cream 5%, an immune stimulant used to treat genital warts, is an additional topical therapy that has a reported complete clinical response rate of 50% to 86% in small case series of patients with multifocal high-grade HPV-associated VAIN 2 and 3.[13] However, it is investigational, and it may have only short-lived efficacy.[14]

Current Clinical Trials

Check for U.S. clinical trials from NCI's list of cancer clinical trials 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:

  1. Eifel PJ, Berek JS, Markman MA: Cancer of the cervix, vagina, and vulva. In: DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2011, pp 1311-44.

  2. Daling JR, Madeleine MM, Schwartz SM, et al.: A population-based study of squamous cell vaginal cancer: HPV and cofactors. Gynecol Oncol 84 (2): 263-70, 2002.

  3. Smith JS, Backes DM, Hoots BE, et al.: Human papillomavirus type-distribution in vulvar and vaginal cancers and their associated precursors. Obstet Gynecol 113 (4): 917-24, 2009.

  4. Vagina. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 387-9.

  5. 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.

  6. Krebs HB: Treatment of vaginal intraepithelial neoplasia with laser and topical 5-fluorouracil. Obstet Gynecol 73 (4): 657-60, 1989.

  7. Cheng D, Ng TY, Ngan HY, et al.: Wide local excision (WLE) for vaginal intraepithelial neoplasia (VAIN). Acta Obstet Gynecol Scand 78 (7): 648-52, 1999.

  8. Indermaur MD, Martino MA, Fiorica JV, et al.: Upper vaginectomy for the treatment of vaginal intraepithelial neoplasia. Am J Obstet Gynecol 193 (2): 577-80; discussion 580-1, 2005.

  9. Stefanon B, Pallucca A, Merola M, et al.: Treatment with 5-fluorouracil of 35 patients with clinical or subclinical HPV infection of the vagina. Eur J Gynaecol Oncol 17 (6): 534, 1996.

  10. Chyle V, Zagars GK, Wheeler JA, et al.: Definitive radiotherapy for carcinoma of the vagina: outcome and prognostic factors. Int J Radiat Oncol Biol Phys 35 (5): 891-905, 1996.

  11. Graham K, Wright K, Cadwallader B, et al.: 20-year retrospective review of medium dose rate intracavitary brachytherapy in VAIN3. Gynecol Oncol 106 (1): 105-11, 2007.

  12. 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.

  13. Iavazzo C, Pitsouni E, Athanasiou S, et al.: Imiquimod for treatment of vulvar and vaginal intraepithelial neoplasia. Int J Gynaecol Obstet 101 (1): 3-10, 2008.

  14. Haidopoulos D, Diakomanolis E, Rodolakis A, et al.: Can local application of imiquimod cream be an alternative mode of therapy for patients with high-grade intraepithelial lesions of the vagina? Int J Gynecol Cancer 15 (5): 898-902, 2005 Sep-Oct.

Stage I Vaginal Cancer

The treatments listed below have not been directly compared in randomized trials.[Level of evidence 3iiiD] Because of differences in patient selection, local expertise, and staging criteria, it is difficult to determine whether there are differences in disease control rates.

Squamous Cell Carcinoma

Standard treatment options for superficial lesions less than 0.5 cm thick:

  1. Radiation therapy.[1][2][3][4] These tumors may be amenable to intracavitary brachytherapy alone,[1] but some centers nearly always begin with external-beam radiation therapy (EBRT).[2] EBRT is required for bulky lesions or lesions that encompass the entire vagina).[1] For lesions of the lower third of the vagina, elective radiation therapy is often administered to the patient's pelvic and/or inguinal lymph nodes.[1][2]
  2. Surgery.[5] 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 is often added.[6]

Standard treatment options for lesions greater than 0.5 cm thick:

  1. Surgery.[5] 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.[6][7] 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.[6]
  2. Radiation therapy.[1][2][3][4] EBRT [2] and/or combination of interstitial and intracavitary therapy to a dose of at least 75 Gy to the primary tumor.[1][8] 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]

Adenocarcinoma

Standard treatment options:

  1. 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.[6] In cases with close or positive surgical margins, adjuvant radiation therapy is often given.[6][7]
  2. 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][9]
  3. Combined local therapy in selected cases, which may include wide local excision, lymph node sampling, and interstitial therapy.[10]

Current Clinical Trials

Check for U.S. clinical trials from NCI's list of cancer clinical trials 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:

  1. 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.

  2. Frank SJ, Jhingran A, Levenback C, et al.: Definitive radiation therapy for squamous cell carcinoma of the vagina. Int J Radiat Oncol Biol Phys 62 (1): 138-47, 2005.

  3. Tran PT, Su Z, Lee P, et al.: Prognostic factors for outcomes and complications for primary squamous cell carcinoma of the vagina treated with radiation. Gynecol Oncol 105 (3): 641-9, 2007.

  4. Lian J, Dundas G, Carlone M, et al.: Twenty-year review of radiotherapy for vaginal cancer: an institutional experience. Gynecol Oncol 111 (2): 298-306, 2008.

  5. Tjalma WA, Monaghan JM, de Barros Lopes A, et al.: The role of surgery in invasive squamous carcinoma of the vagina. Gynecol Oncol 81 (3): 360-5, 2001.

  6. 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.

  7. 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.

  8. Andersen ES: Primary carcinoma of the vagina: a study of 29 cases. Gynecol Oncol 33 (3): 317-20, 1989.

  9. Chyle V, Zagars GK, Wheeler JA, et al.: Definitive radiotherapy for carcinoma of the vagina: outcome and prognostic factors. Int J Radiat Oncol Biol Phys 35 (5): 891-905, 1996.

  10. 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.

Stage II Vaginal Cancer

The treatments listed below have not been directly compared in randomized trials.[Level of evidence 3iiiD] As a result of differences in patient selection, local expertise, and staging criteria, it is difficult to determine whether there are differences in disease control rates. Radiation therapy is the most common treatment for patients with stage II vaginal cancer.

Squamous Cell Carcinoma

Standard treatment options:

  1. 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][2][3][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][5]
  2. Radical surgery (radical vaginectomy or pelvic exenteration) with or without radiation therapy.[6][7][8]

Adenocarcinoma

Standard treatment options:

  1. 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][5][9]
  2. Radical surgery (radical vaginectomy or pelvic exenteration) with or without radiation therapy.[7]

Current Clinical Trials

Check for U.S. clinical trials from NCI's list of cancer clinical trials 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:

  1. 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.

  2. Frank SJ, Jhingran A, Levenback C, et al.: Definitive radiation therapy for squamous cell carcinoma of the vagina. Int J Radiat Oncol Biol Phys 62 (1): 138-47, 2005.

  3. Tran PT, Su Z, Lee P, et al.: Prognostic factors for outcomes and complications for primary squamous cell carcinoma of the vagina treated with radiation. Gynecol Oncol 105 (3): 641-9, 2007.

  4. Lian J, Dundas G, Carlone M, et al.: Twenty-year review of radiotherapy for vaginal cancer: an institutional experience. Gynecol Oncol 111 (2): 298-306, 2008.

  5. Andersen ES: Primary carcinoma of the vagina: a study of 29 cases. Gynecol Oncol 33 (3): 317-20, 1989.

  6. 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.

  7. 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.

  8. Tjalma WA, Monaghan JM, de Barros Lopes A, et al.: The role of surgery in invasive squamous carcinoma of the vagina. Gynecol Oncol 81 (3): 360-5, 2001.

  9. Chyle V, Zagars GK, Wheeler JA, et al.: Definitive radiotherapy for carcinoma of the vagina: outcome and prognostic factors. Int J Radiat Oncol Biol Phys 35 (5): 891-905, 1996.

Stage III Vaginal Cancer

Squamous Cell Carcinoma

Standard treatment options:

  1. External-beam radiation therapy (EBRT) alone, or in combination with interstitial, intracavitary radiation.[1][2][3][4] For example, EBRT for a period of 5 to 6 weeks (including the 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][2][5]
  2. Rarely, surgery may be combined with the above.[6]

Adenocarcinoma

Standard treatment options:

  1. Combination of interstitial, intracavitary, and EBRT as described for squamous cell cancer.[1][5]
  2. Rarely, surgery may be combined with the above.[6]

Current Clinical Trials

Check for U.S. clinical trials from NCI's list of cancer clinical trials 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:

  1. 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.

  2. Frank SJ, Jhingran A, Levenback C, et al.: Definitive radiation therapy for squamous cell carcinoma of the vagina. Int J Radiat Oncol Biol Phys 62 (1): 138-47, 2005.

  3. Tran PT, Su Z, Lee P, et al.: Prognostic factors for outcomes and complications for primary squamous cell carcinoma of the vagina treated with radiation. Gynecol Oncol 105 (3): 641-9, 2007.

  4. Lian J, Dundas G, Carlone M, et al.: Twenty-year review of radiotherapy for vaginal cancer: an institutional experience. Gynecol Oncol 111 (2): 298-306, 2008.

  5. Chyle V, Zagars GK, Wheeler JA, et al.: Definitive radiotherapy for carcinoma of the vagina: outcome and prognostic factors. Int J Radiat Oncol Biol Phys 35 (5): 891-905, 1996.

  6. 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.

Stage IVA Vaginal Cancer

Squamous Cell Carcinoma

Standard treatment options:

  1. Combination of interstitial, intracavitary, and external-beam radiation therapy (EBRT).[1][2][3][4][5]
  2. Rarely, surgery may be combined with the above.[6]

Adenocarcinoma

Standard treatment options:

  1. Combination of interstitial, intracavitary, and EBRT.[1][2]
  2. Rarely, surgery may be combined with the above.[7]

Current Clinical Trials

Check for U.S. clinical trials from NCI's list of cancer clinical trials 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:

  1. 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.

  2. Chyle V, Zagars GK, Wheeler JA, et al.: Definitive radiotherapy for carcinoma of the vagina: outcome and prognostic factors. Int J Radiat Oncol Biol Phys 35 (5): 891-905, 1996.

  3. Frank SJ, Jhingran A, Levenback C, et al.: Definitive radiation therapy for squamous cell carcinoma of the vagina. Int J Radiat Oncol Biol Phys 62 (1): 138-47, 2005.

  4. Tran PT, Su Z, Lee P, et al.: Prognostic factors for outcomes and complications for primary squamous cell carcinoma of the vagina treated with radiation. Gynecol Oncol 105 (3): 641-9, 2007.

  5. Lian J, Dundas G, Carlone M, et al.: Twenty-year review of radiotherapy for vaginal cancer: an institutional experience. Gynecol Oncol 111 (2): 298-306, 2008.

  6. 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.

  7. 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.

Stage IVB Vaginal Cancer

Current therapy is of unclear benefit for patients with Stage IVB disease. No established anticancer drugs can be considered of proven clinical benefit, although patients are often treated with regimens used to treat cervical cancer. (Refer to the PDQ summary on Cervical Cancer Treatment for more information.)

Concurrent chemotherapy using 5-fluorouracil or cisplatin-based therapy and radiation is sometimes advocated, and, again, this is based solely on extrapolation from cervical cancer management strategies.[1][2][3] Experience is limited to small case series and the incremental impact on survival and local control is not well defined.[Level of evidence 3iiiDiv] Considering the rarity of these patients, they should be considered candidates for clinical trials to improve survival or local control. Information about ongoing clinical trials is available from the NCI Web site.

Squamous Cell Carcinoma

Standard treatment options:

  • Radiation (for palliation of symptoms) with or without chemotherapy.

Adenocarcinoma

Standard treatment options:

  • Radiation (for palliation of symptoms) with or without chemotherapy.

Current Clinical Trials

Check for U.S. clinical trials from NCI's list of cancer clinical trials 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.

References:

  1. Grigsby PW: Vaginal cancer. Curr Treat Options Oncol 3 (2): 125-30, 2002.

  2. Dalrymple JL, Russell AH, Lee SW, et al.: Chemoradiation for primary invasive squamous carcinoma of the vagina. Int J Gynecol Cancer 14 (1): 110-7, 2004 Jan-Feb.

  3. Samant R, Lau B, E C, et al.: Primary vaginal cancer treated with concurrent chemoradiation using Cis-platinum. Int J Radiat Oncol Biol Phys 69 (3): 746-50, 2007.

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 had tumor recurrence in the central pelvis.[1] Most recurrences occur in the first 2 years after treatment. In centrally recurrent vaginal cancers, some patients may be candidates for pelvic exenteration or radiation therapy.

No established anticancer drugs can be considered of proven clinical benefit, although patients are often treated with regimens used to treat cervical cancer. (Refer to the PDQ summary on Cervical Cancer Treatment for more information.) If eligible, patients should be offered the option of participation in one of the ongoing clinical trials. Information about ongoing clinical trials is available from the NCI Web site.

Current Clinical Trials

Check for U.S. clinical trials from NCI's list of cancer clinical trials 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:

  1. 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.


This information is provided by the National Cancer Institute.

This information was last updated on February 21, 2013.

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