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 involves getting repeat Pap tests often with colposcopy as 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 treated using topical therapy (like 5-FU or imiquimod) or laser treatment, Rarely, surgery is used to remove the lesion. It may be chosen to 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 with 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)

The usual treatment options are laser vaporization, or local excision of the affected areas. Intracavitary radiation may be used; shrinkage of the vagina is a possible side effect.

Topical chemotherapy (5-FU cream) can be used but repeated applications are needed. This treatment can cause severe irritation of the vagina and vulva.

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 is doesn't come back.

Stage I

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 is used. Interstitial radiation is an option for some tumors, but it is not often used Intracavitary radiation may be combined with external beam radiation for larger tumors.

Lesions in the upper vagina may also be treated by a radical hysterectomy, bilateral radical pelvic lymph node removal, and radical or partial vaginectomy.

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.

Following a radical partial of complete vaginectomy, postoperative radiation (external beam) may be needed 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. This would be 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.

Another approach is to combine surgery and radiation. Surgery is done to remove the cancer (a wide local radical excision) and the lymph nodes draining the cancer (the pelvic and/or groin nodes). The cervix, uterus, and ovaries are left in place. Then intracavitary or interstitial radiation therapy is given. This works as well as radical surgery or higher doses of radiation in treating the cancer. The advantage of this approach is that in most cases the ovaries continue to function and the woman is still able to bear children. This is an important consideration because many women with vaginal adenocarcinoma are young.

Stage II

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 is small and in the upper vagina. It is 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 with radiation may also be used to treat stage II disease.

Stage III or IVA

The usual treatment is radiation therapy, often with both brachytherapy and external beam radiation. Curative surgery is generally not attempted. Chemotherapy may be combined with radiation to help it work better.

Stage IVB

Since the cancer has spread to distant sites, it cannot be cured. Patients often receive radiation therapy to the vagina and pelvis to improve symptoms and reduce bleeding. . Chemotherapy may also be given, but it has not been shown to help patients live longer. Because there is no accepted treatment, 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 cannot 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 chemotherapy may be used. Again, a clinical trial is a good option.

Melanoma

Just as for melanomas found elsewhere in the body, 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 have 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 found on the skin of an arm or leg would be treated. Another option is to remove the entire vagina with 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, but this disease rarely responds well to chemotherapy. Radiation therapy may also be used for melanoma that has spread. It is 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. For more information on melanoma, see our document Melanoma Skin Cancer, which discusses the biology and treatment of melanoma and the role of lymph node surgery and treatment of advanced disease.

Rhabdomyosarcoma

Treatment of rhabdomyosarcoma is discussed in our separate document, Rhabdomyosarcoma.

Last Medical Review: 12/30/2008
Last Revised: 09/14/2009