Treatment Options, by Stage and Type of Vaginal Cancer
The type of treatment your cancer care team will recommend depends on the type of vaginal cancer you have and how far the cancer has spread. This section summarizes the choices available according to the stage of your cancer.
Vaginal intraepithelial neoplasia (VAIN)
Many cases of low-grade VAIN (VAIN 1) will go away on their own, so some doctors will choose to watch them closely without starting treatment. This means getting repeat Pap tests – often with colposcopy if needed. If the area of VAIN doesn’t go away or gets worse, treatment is started. VAIN 2 is not likely to go away on its own, so treatment is usually started right away.
VAIN is often treated using topical therapy (like 5-FU or imiquimod) or laser treatment. When there are many areas of VAIN, intracavitary radiation (brachytherapy) may be used. Sometimes, surgery is used to remove the lesion. Surgery may be chosen if other treatments fail or if the doctor wants to be sure that the area isn’t invasive cancer. Surgery may involve a wide local excision, removing the abnormal area and a rim of surrounding normal tissue. A partial vaginectomy (removal of part of the vagina) is rarely needed to treat VAIN.
Stage 0 (VAIN 3 or CIS)
Topical chemotherapy with 5-FU cream is also an option, but this requires treatment at least weekly for 10 weeks. This treatment can severely irritate the vagina and vulva. Topical immunotherapy with imiquimod may also be used.
If the cancer comes back again after these treatments, surgery (partial vaginectomy) may be needed. The surgeon would remove the entire tumor and enough surrounding normal tissue to ensure that it doesn’t come back.
Squamous cell cancers: Radiation therapy is used for most stage I vaginal cancers. If the cancer is less than 5 mm thick (about 3/16 inch), intracavitary radiation may be used alone. Interstitial radiation is an option for some tumors, but it’s not often used. For tumors that have grown more deeply, intracavitary radiation may be combined with external beam radiation.
Removing part or the entire vagina is an option for some cancers (partial or radical vaginectomy). Reconstructive surgery to create a new vagina after treatment of the cancer is an option if a large portion of the vagina has been removed.
If the cancer is in the upper vagina, it may be treated by a radical hysterectomy, bilateral radical pelvic lymph node removal, and radical or partial vaginectomy.
Following a radical partial or complete vaginectomy, postoperative radiation (external beam) may be used to treat tiny deposits of cancer cells that have spread to lymph nodes in the pelvis.
Adenocarcinomas: For cancers in the upper part of the vagina, the treatment is surgery: a radical hysterectomy, partial or radical vaginectomy, and removal of pelvic lymph nodes. This can be followed by reconstructive surgery if needed or desired. Radiation therapy may be given as well.
For cancers lower down in the vagina, one choice is to give both either interstitial or intracavitary radiation therapy and external radiation beam therapy. The lymph nodes in the groin and/or pelvis are treated with external beam radiation therapy.
The usual treatment is radiation, using a combination of brachytherapy and external beam radiation.
Radical surgery (radical vaginectomy or pelvic exenteration) is an option for some patients with stage II vaginal squamous cell cancer if it’s small and in the upper vagina. It’s also used to treat women who have already had radiation therapy for cervical cancer and who would not be able to tolerate additional radiation without severe damage to normal tissues.
Chemotherapy (chemo) with radiation may also be used to treat stage II disease.
Giving chemo to shrink the cancer before radical surgery may be helpful.
Stage III or IVA
The usual treatment is radiation therapy, often with both brachytherapy and external beam radiation. Curative surgery is generally not attempted. Chemo might be combined with radiation to help it work better.
Since the cancer has spread to distant sites, it can’t be cured. Patients often receive radiation therapy to the vagina and pelvis to improve symptoms and reduce bleeding. . Chemo might also be given, but it has not been shown to help patients live longer. Because there’s no accepted treatment for this stage, often the best option is to enroll in a clinical trial.
Recurrent squamous cell cancer or adenocarcinoma of the vagina
If a cancer comes back after treatment it is called recurrent. If the cancer comes back in the same area as it was in the first place, it is called a local recurrence. If it comes back in another area (like the liver or lungs), it is called a distant recurrence.
A local recurrence of a stage I or stage II vaginal cancer may be treated with radical surgery (such as pelvic exenteration). If the cancer was originally treated with surgery, radiation therapy is an option. Surgery is the usual choice when the cancer has come back after radiation therapy.
Higher-stage cancers are difficult to treat when they recur. They usually can’t be cured by currently available treatments. Care focuses mostly on relieving symptoms, although participation in a clinical trial of new treatments may be helpful.
For a distant recurrence, the goal of treatment is to help the woman feel better. Surgery, radiation, or chemo may be used. Again, a clinical trial is a good option.
Surgery is the main treatment for vaginal melanoma. Because vaginal melanoma is very rare, it hasn’t been well studied. Doctors are still not certain about how much tissue needs to be removed to give the best chance of cure. One choice is to remove the cancer and a margin of the normal tissue around it. This is how a melanoma on the skin of an arm or leg would be treated. Another option is to remove the entire vagina and some tissue from nearby organs. Some (or all) of the lymph nodes that drain the area of the tumor are also removed and checked for cancer spread.
There are a few drugs that can be helpful in treating metastatic melanoma. These and other treatments are discussed in more detail in Melanoma Skin Cancer. Radiation therapy may also be used for melanoma that has spread. It’s most often used for spread to the brain or spinal cord. A good option for women with metastatic vaginal melanoma is to receive treatment as a part of a clinical trial.
Treatment of rhabdomyosarcoma is discussed in Rhabdomyosarcoma.
Last Medical Review: June 17, 2014 Last Revised: February 16, 2016