The vagina is a three- to four-inch tube that begins at the vulva (the external genitals), and ends at the cervix, the lower part of the uterus. A thin layer called the epithelium lines the walls of the vagina. The vaginal wall underneath the epithelium contains connective tissue, muscle tissue, lymph vessels, and nerves.

There are several types of vaginal cancer:

• Squamous cell carcinomas begin in the epithelial lining of the vagina. They tend to occur in the upper area near the cervix. These cancers develop over many years from precancerous changes called vaginal intraepithelial neoplasia (often abbreviated as VAIN). Squamous cell carcinomas account for 85% to 90% of all vaginal cancers.



• Adenocarcinomas typically develop in women older than 50. This cancer accounts for about 5% to 10% of all vaginal cancers.
• Melanoma is a cancer that develops from pigment-producing cells called melanocytes. Typically, these cancers are found on sun-exposed skin, but they can form on the vagina or other internal organs. Melanomas account for about 2% to 3% of all vaginal cancers.
• Sarcomas are cancers that form deep in the wall of the vagina. The most common vaginal sarcoma, leiomyosarcoma, typically affects women older than 50. About 2% to 3% of vaginal cancers are sarcomas.

Risk Factors

Risk factors increase the odds of getting a disease but do not always mean a disease will occur. Here are some vaginal cancer risk factors:

• Age: More than two-thirds of women diagnosed with the most common vaginal cancer, squamous cell carcinoma, are 60 years old or older.
• Diethylstilbestrol (DES) use: DES is a hormonal drug that was prescribed between 1940 and 1971 to some women thought to be at increased risk for miscarriages. About 1 out of every 1,000 women whose mothers took DES while pregnant with them developed clear cell adenocarcinoma of the vagina or cervix.
• Human papillomavirus (HPV) infection: About 65% to 80% of pre-cancerous vaginal intraepithelial neoplasias (VAIN) contain the HPV virus. Different HPV types cause different warts in various parts of the body, including the female and male genital organs. Passed during sexual contact, these HPV types have been strongly associated with vaginal cancers.
• History of cervical cancer: Having cervical cancer or cervical pre-cancerous conditions (cervical intraepithelial neoplasia or cervical dysplasia) increases risk of developing vaginal squamous cell cancer. This is because cervical and vaginal cancers have similar risk factors, such as HPV infection.
• Smoking: Tobacco use may play a role in vaginal cancers, particularly in younger women, as it does for cervical cancer.
• HIV infection: The virus that causes AIDS also increases the risk of vaginal cancer.

Symptoms of Vaginal Cancer

Although some early vaginal cancers may produce symptoms, others cause no symptoms until after they have reached an advanced stage. Pre-cancerous vaginal intraepithelial neoplasia (VAIN) do not usually produce any symptoms, but fortunately, most cases of VAIN and early invasive vaginal cancer can be found by routine Pap testing.

Most women with invasive vaginal cancer have one or more of the following symptoms:

• Abnormal vaginal bleeding (often after intercourse)
• Abnormal vaginal discharge
• A mass that can be felt
• Pain during intercourse
• Painful urination
• Constipation
• Continuous pain in the pelvis

Many of these symptoms may result from less serious conditions and don’t necessarily indicate cancer. Discuss persistent issues with a doctor, and remember, the sooner patients receive a correct diagnosis, the more effective treatment can be.

Early Detection and Prevention

When vaginal cancer is found early, many patients have a good prognosis. Most cases can be found by routine Pap testing. Here are other ways to help prevent and detect vaginal cancer early:

• Get women’s health exams yearly. During a routine pelvic exam, the doctor feels the ovaries and uterus for size, shape, and consistency, which might help detect irregularities.
• Discuss family history with your doctor. If vaginal cancer runs in your family, tell your doctor. It may increase your risk.
• See your doctor right away if you have symptoms. Although it may not mean cancer, express your concerns about persistent issues. Don’t be afraid to get a second opinion.

Diagnosis of Vaginal Cancer

If a pap smear shows abnormalities or if your doctor suspects a problem, he or she may request these diagnostic tests:

• Biopsy: In this procedure, a local anesthetic is used to numb the area and a small piece of tissue is removed. At a laboratory, a pathologist views the tissue under a microscope to determine if cancer is present.
• Colposcopy: In this procedure, an instrument with magnifying lenses is used to view the cervix and the walls of the vagina.

Staging and Treatment

Staging is the process of determining the extent of a cancer and where it is in the body. Vaginal cancers at varying stages have different prognoses and treatments.

Treatment options depend on the cancer’s stage, the patient’s general health, plans for bearing children, and other personal considerations. These are common treatments for vaginal cancer:

• Surgery
• Radiation therapy
• Chemotherapy in combination with radiation (to treat advanced disease)

The patient and her cancer health care team will determine the best treatment options.