Vaginal Cancer 101: Types, Causes, Symptoms and Treatment Options

Vaginal cancer is one of the rarest gynaecological cancers, making up less than 1% of all cancers in women. It commonly affects those over the age of 60 and often develops without early warning signs. Because of this, many cases are discovered during routine pelvic exams rather than through noticeable symptoms. The disease usually begins in the lining of the vagina and can take years to grow, often linked to chronic HPV infection or a history of cervical abnormalities. Other risk factors, such as smoking and certain hormonal exposures before birth, may also play a role in its development. This blog covers the causes, types, symptoms, and treatment options, beginning with a look at vaginal cancer in detail.

What is Vaginal Cancer?

Vaginal cancer is a malignant growth that starts in the tissues of the vagina, most often in the thin layer of cells lining its inner wall. This type of cancer is classified as primary when it begins in the vagina itself, which is rare, or secondary when it spreads from nearby organs such as the cervix, uterus, or bladder. Among the different forms, squamous cell carcinoma is the most common and usually develops in the upper part of the vagina. Less frequently, vaginal cancer can arise from glandular cells, connective tissues, or melanocytes, leading to other types such as adenocarcinoma, sarcoma, or melanoma. The cancer is staged based on how far it has spread from the vaginal wall to surrounding tissues or distant organs. As the condition progresses, it can invade nearby structures like the bladder, rectum, or pelvic wall. 

What are the Types of Vaginal Cancer?

Vaginal cancer can develop from different types of cells found in the vaginal tissue. The classification depends on the type of cell where the cancer begins. Each type behaves differently and may require a different approach to treatment.

Squamous Cell Carcinoma

This is the most common type of vaginal cancer, accounting for nearly 90 percent of all primary vaginal cancer cases. It begins in the squamous cells, which form the thin, flat layer that lines the inside of the vagina. The cancer typically develops slowly and may not cause symptoms in the early stages. Over time, it can spread to nearby structures such as the cervix, bladder, or rectum if left untreated. This type is usually seen in postmenopausal women and has a strong link to long-term HPV infection.

Adenocarcinoma

Adenocarcinoma starts in the glandular cells of the vagina, which are responsible for producing fluids such as mucus. It is less common than squamous cell carcinoma but tends to behave more aggressively. This type is more likely to spread to nearby lymph nodes and distant organs. It often affects older women and may not be detected early due to its location deeper within the vaginal wall. A rare subtype, known as clear cell adenocarcinoma, has been associated with exposure to diethylstilbestrol (DES) in the womb.

Melanoma

Melanoma of the vagina develops from melanocytes, the cells that give skin and mucous membranes their colour. It usually appears as a dark-coloured growth or lesion, often in the lower third or outer part of the vagina. Vaginal melanoma is extremely rare but tends to spread quickly through the bloodstream or lymphatic system. Diagnosis is often delayed as the appearance of the tumour can be mistaken for a benign mole or skin change. This type requires prompt and aggressive treatment due to its rapid progression.

Sarcoma

Sarcoma begins in the connective tissues of the vagina, such as muscle, fat, or blood vessels. It accounts for a very small number of vaginal cancer cases and is more likely to affect younger individuals, including adolescents and women under 40. There are different subtypes of vaginal sarcoma, including leiomyosarcoma and rhabdomyosarcoma, each with its own behaviour and growth pattern. These tumours are often fast-growing and may form a noticeable mass or cause discomfort in the pelvic area. 

What Causes Vaginal Cancer?

The exact cause of vaginal cancer is not fully understood, but certain risk factors can increase the chances of developing the condition. These factors may affect how cells in the vaginal lining behave, leading to abnormal growth over time. Key risk factors include:

• Human papillomavirus (HPV) infection: Long-term infection with high-risk types of HPV is one of the strongest known links to vaginal cancer. It can cause changes in the vaginal cells that may become cancerous
• Age: Most cases are diagnosed in individuals over the age of 60. The risk tends to rise with age as cell changes accumulate over time.
• Exposure to diethylstilbestrol (DES): Those exposed to DES before birth, due to their mother taking the drug during pregnancy, have a higher chance of developing clear cell adenocarcinoma of the vagina.
• History of cervical cancer or cervical pre-cancer: Previous cervical abnormalities, especially those linked to HPV, may raise the risk of developing vaginal cancer later in life.
• Smoking: Tobacco use can weaken the immune system and make it harder for the body to clear HPV infections, which may lead to cancerous changes in vaginal tissue.
• Weakened immune system: Conditions like HIV or the use of medications that suppress immune function may lower the body’s ability to control abnormal cell growth and fight off infections.

Not all individuals with these risk factors will develop vaginal cancer, but understanding them can help guide decisions around screening and prevention.

What are the Signs and Symptoms of Vaginal Cancer?

In the early stages, vaginal cancer may not cause any symptoms, which can make it difficult to detect. As the condition progresses, certain signs may begin to appear. These symptoms often affect the vaginal or pelvic area and may be mistaken for other common conditions. Any unusual changes should be assessed by a medical professional, especially if they persist. Common signs and symptoms include:

• Unusual vaginal bleeding, especially after menopause or between periods
• Vaginal discharge that is watery, bloody, or has a foul smell
• A lump or growth in the vagina that can be felt or seen
• Pain or discomfort during sexual activity
• Pelvic or vaginal pain that does not go away
• Difficulty or pain when passing urine
• Constipation or a feeling of pressure in the rectum

Some of these symptoms may be linked to other health conditions, but their presence should not be ignored. Early evaluation can help detect the cause and allow for timely treatment if needed.

How is Vaginal Cancer Diagnosed?

Diagnosing vaginal cancer usually begins with a physical examination and a review of symptoms. If there are signs that suggest a possible problem, further tests are carried out to confirm the presence of cancer and determine its type and stage.

Pelvic Examination

Diagnosis often begins with a pelvic examination. During this exam, the doctor visually inspects and gently feels the vaginal walls, cervix, uterus, and surrounding areas to check for any lumps, thickened areas, or changes in texture. A speculum may be used to hold the vaginal walls open for a clearer view. If there is any bleeding, discharge, or visible growth, further evaluation is usually advised.

Colposcopy

If the pelvic exam shows anything unusual, a colposcopy may be recommended. This involves using a special device called a colposcope, which works like a microscope with a light, to examine the vagina and cervix in detail. A mild solution may be applied to the vaginal walls during this procedure to highlight abnormal areas. Colposcopy helps the doctor identify the best spot to take a tissue sample from, if needed.

Biopsy

A biopsy is essential for confirming the diagnosis. During this test, a small sample of tissue is taken from the area that looks abnormal. The procedure may be done in the clinic and usually causes only mild discomfort. The sample is sent to a laboratory, where a pathologist examines the cells under a microscope to check for cancer. The biopsy also helps determine the specific type of vaginal cancer, which is important for planning treatment.

Imaging Tests

If cancer is confirmed, imaging tests are used to check how far it has spread. An MRI scan provides detailed images of the pelvic organs and soft tissues. A CT scan may be used to look for signs of cancer in the abdomen, pelvis, or lungs. A PET scan can help detect cancer in lymph nodes or distant organs. These scans help stage the cancer, which means determining how advanced it is and whether it has spread beyond the vagina.

Blood Tests

Although blood tests do not diagnose vaginal cancer directly, they are often done to assess general health and check how well organs such as the liver and kidneys are functioning. If treatment involves surgery or chemotherapy, blood test results help guide those decisions. In some cases, doctors may also check for tumour markers, though these are not specific to vaginal cancer.

A combination of these steps gives a clearer picture of the condition and helps in forming an effective treatment plan. Early testing is important, especially when symptoms do not go away or if there is a history of related health conditions.

What Treatment Options are Available for Vaginal Cancer?

Treatment for vaginal cancer depends on several factors, including the type and stage of the cancer, its size, location, and the patient’s overall health. The main goals are to remove or destroy the cancer cells and prevent the disease from spreading, while preserving as much normal function as possible. Different treatment methods may be used alone or in combination.

Surgery

Surgery is often the first choice for treating early-stage vaginal cancer. The aim is to remove the cancerous tissue completely while preserving as much healthy tissue as possible. Depending on the size and location of the tumour, different types of surgery may be performed. 

For small tumours, local excision may be enough to remove the affected area. For larger or more invasive tumours, partial or complete removal of the vagina (vaginectomy) might be necessary. In some cases, nearby lymph nodes are also removed to check if the cancer has spread. Surgery may sometimes involve removal of surrounding organs if the cancer has grown beyond the vaginal walls.

Radiotherapy

Radiotherapy uses focused high-energy rays to destroy cancer cells. It can be given externally using a machine (external beam radiotherapy) or internally by placing radioactive sources close to the tumour inside the vagina (brachytherapy). Radiotherapy may be used alone for certain cases or combined with surgery. It is especially helpful for tumours that are difficult to remove surgically or for patients who are not fit for surgery. Treatment is usually given over several weeks and can cause side effects such as skin irritation, fatigue, or changes in bladder or bowel habits.

Chemotherapy

Chemotherapy involves the use of drugs to kill cancer cells or stop their growth. It is mainly used for advanced vaginal cancer that has spread beyond the vagina or in combination with radiotherapy to increase treatment effectiveness. Chemotherapy drugs can be given orally or through injections into a vein. Side effects vary but may include nausea, hair loss, fatigue, and increased risk of infection. The combination of chemotherapy and radiotherapy is called chemoradiation and is often the preferred option for certain advanced cancers.

Targeted Therapy and Immunotherapy

Targeted therapy and immunotherapy are newer treatment approaches that focus on specific aspects of cancer cells or the body's immune response. Targeted therapy aims to block molecules involved in cancer growth or spread. Immunotherapy helps the immune system recognise and attack cancer cells more effectively. These treatments are not yet commonly used for vaginal cancer but may be considered in clinical trials or for cases that do not respond to standard treatments.

Supportive and Palliative Care

Alongside active cancer treatments, supportive care plays a vital role in managing symptoms and improving comfort. This includes pain management, treatment of side effects, nutritional support, and emotional counselling. Palliative care focuses on quality of life and may be provided at any stage of the illness to help patients cope with physical and psychological challenges.

Consult Today

Persistent symptoms in the vaginal or pelvic area are often overlooked or mistaken for minor issues. When these changes continue without a clear cause, they may point to something more serious. Ignoring them can lead to delays in diagnosis and limit treatment options. Seeking a timely evaluation is not just precautionary; it is necessary. At Max Hospital, gynaecologic oncologists assess such concerns with care and clinical accuracy. Booking a consultation at the earliest sign of symptoms ensures that nothing important goes unnoticed.

Frequently Asked Questions

Is vaginal cancer hereditary?

Vaginal cancer is rarely inherited. Most cases are linked to factors such as HPV infection or past exposure to certain medications. A family history of cancer may prompt earlier monitoring, but it is not considered a direct cause.

Can vaginal cancer come back after treatment?

Yes, there is a risk of recurrence, especially in later-stage cancers. Regular follow-up visits, often involving pelvic exams and imaging, help detect any signs of return at an early stage.

Does vaginal cancer affect fertility or sexual health?

Some treatments can affect fertility or cause changes in sexual function. Radiotherapy or extensive surgery may lead to dryness, discomfort, or early menopause. These effects vary by case and are usually discussed before treatment begins.

How often are follow-up check-ups needed after treatment?

Follow-up usually starts every 3 to 6 months for the first few years, then becomes less frequent over time. These visits help track recovery and address any concerns early.

Are vaginal creams or products safe to use during recovery?

Not all products are suitable during or after treatment. Some may cause irritation or interfere with healing. It is best to check with the treating doctor before using any creams or hygiene products.

Are support services available for emotional recovery?

Yes, counselling and support groups are available at many hospitals, including Max Hospital. These services help patients manage emotional stress and adjust during and after treatment.