Vaginal cancer

What is vaginal cancer?

Vaginal cancer is more common in women over 60 years, although it can occur in younger women. This is particularly the case for adenocarcinoma (from the glandular cells), which usually affects women under 20.

It’s estimated that around 98 women develop vaginal cancer each year, which accounts for 0.1% of all newly diagnosed female cancers.

Primary vaginal cancer starts in the vagina and is rare. There are several types of vaginal cancer:

• Squamous cell carcinoma (SCC) – This is the most common form of vaginal cancer and accounts for 85% of cases. It starts in the thin, flat (squamous) cells that line the vagina and most commonly affects women aged between 50 and 70
• Adenocarcinoma – Making up between 5% and 10% of vaginal cancers, this type begins in the mucus-producing (glandular) cells of the vagina and usually affects women under 20, but can occur in women over 20
• Vaginal (mucosal) melanoma – A rare form of vaginal cancer that begins in the cells that give skin its colour (melanocytes). These cancers are not related to UV radiation from the sun
• Sarcoma – Also rare, this type of cancer occurs in the muscle, fat and other tissue deep in the wall of the vagina.

Secondary vaginal cancer is more common than primary vaginal cancer due to spread into the vagina from other parts of the body, usually the cervix, but also endometrial, vulva, bladder or lower bowel cancers.

What increases your risk of vaginal cancer?

The exact cause of vaginal cancer isn’t known, but known risk factors include:

• human papillomavirus (HPV)
• having a precancerous condition called vaginal intraepithelial neoplasia (VIN)
• having previous cervical cancer or pre-cervical cancer
• smoking
• exposure in utero to Diethylstilbestrol (DES), a drug given to women from the 1940s-1970s to prevent miscarriage, which increased the risk of the rare clear cell adenocarcinoma of the vagina and cervix (1 case per 1000 women born between 1938-1974, exposed when their mothers were pregnant and given DES)
• previous radiation to the pelvic area, although this complication is very rare.

Just because you have risk factors, doesn’t mean you will get vaginal cancer. However, some women who develop this type of cancer don’t have any risk factors at all. If you’re concerned about your risk, speak to your doctor.

What are the signs and symptoms of vaginal cancer?

There are usually no symptoms in the early stages of vaginal cancer. However, some symptoms may include:

• an unusual lump inside your vagina
• bloody discharge not related to your period
• pain during sex
• bleeding after sex
• pain in the pelvic area or rectum
• blood in the urine, passing urine frequently or during the night, or a change in the colour of your urine (dark or rusty brown).

These symptoms may be due to other conditions and not related to vaginal cancer. However, if you notice any of them, visit your doctor.

How is vaginal cancer diagnosed?

Your doctor will initially ask questions about your symptoms, health history and family health history. A physical examination will then be conducted, including a pelvic examination to check the inside of your vagina for lumps and swelling. They may also feel your groin and pelvic area for swollen glands, along with your rectum.

Other tests used to diagnose vaginal cancer include a cervical screening test, as part of the physical examination, to check the cells inside the vagina and cervix.

Sometimes vaginal cancer is detected through regular cervical screening.

Referral to a gynaecological oncologist

If your assessment and investigations suggest vaginal cancer is a possibility, ask your doctor for an immediate referral to a gynaecological oncologist. Gynaecological oncologists are specialist gynaecologists who treat cancers such as vaginal cancer.

If tests show that you may have vaginal cancer, further tests may be used to check if the cancer has spread (metastasised) to other parts of the body. These may include:

• a colposcopy, where your doctor will use a magnifying instrument called a colposcope to look closely at your vagina, cervix and vulva. A sample of tissue (biopsy) may also be taken and sent away for testing
• cystoscopy, (to examine the bladder and urethra) and proctoscopy (to check inside the rectum)
• chest X-ray and blood tests
• other imaging tests such as computerised tomography (CT) and magnetic resonance imaging (MRI) scans.

Treatment for vaginal cancer

Treatment for vaginal cancer depends on the extent of the cancer. It may include any of, or a combination of, the following:

• surgery
• radiotherapy
• chemotherapy (only in advanced stages of the cancer).

Prevention of vaginal cancer

There are no proven ways to prevent vaginal cancer, and there is no national screening program in Australia. In most cases, early detection and diagnosis lead to good outcomes, which is why it’s important to see your doctor if you feel something isn’t quite right.

When to see your doctor

It’s important to see your doctor if you notice any of the symptoms listed above, or anything else that is unusual.

Further information about vaginal cancer can be found at:

• Cancer Council Australia - Understanding Vulvar and Vaginal Cancer booklet
• Cancer Australia.

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at July 2021.