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. This information is specific for squamous cell vaginal cancer and adenocarcinoma of the vagina.

Stage 0 squamous cell cancer: The usual treatment options are laser vaporization, or local excision of the affected areas. Intracavitary radiation is rarely used; shrinkage of the vagina is a possible side effect.

Topical chemotherapy (5-FU cream) can be used but repeated applications are needed. Severe irritation of the vagina and vulva are common side effects, and other treatment methods are as successful with fewer side effects.

Sometimes surgery is needed, particularly if the cancer recurs. The surgeon would remove the entire tumor and enough surrounding normal tissue to ensure that is doesn't come back.

Stage I squamous cell cancer: 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. If it is thicker than 5 mm, wider than 2 cm (about 3/4 inch), and localized to one wall, both intracavitary and interstitial radiation may also be used.

In more widespread cases, external beam radiation will be added as well. Lesions in the upper vagina may be treated by a radical hysterectomy, bilateral radical pelvic lymph node removal, and radical or partial vaginectomy.

Removal of a part of 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. Postoperative radiation (external beam) may be needed to irradiate microscopic disease in the pelvic nodes.

Stage II squamous cell cancer: The usual treatment is a combination of intracavitary, interstitial 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 squamous cell cancer: The usual treatment is radiation therapy, which is similar to that given for stage II squamous cell vaginal cancer. Both brachytherapy and external beam radiation may be used. Curative surgery is generally not attempted. Rarely, to reduce the risk of side effects, surgery is done to move parts of the intestines away from the area of the vagina before radiation therapy begins. Chemotherapy may be combined with radiation.

Stage IVB squamous cell cancer: Radiation therapy is the usual treatment, but it is given for palliation (relief of symptoms) and is generally not expected to cure the cancer. Chemotherapy may also be given, usually in the context of a clinical trial because there is no accepted treatment.

Stage I adenocarcinoma: For cancers in the upper part of the vagina, treatment is surgical. This would be a radical hysterectomy, partial or radical vaginectomy, and removal of pelvic lymph nodes. This can be followed by reconstructive surgery as desired. Radiation therapy may be added.

For cancers lower down in the vagina, another option is combined interstitial and intracavitary radiation therapy, with external beam radiation of groin and/or pelvic lymph nodes if the lower part of the vagina is involved.

A newer approach in women wishing to preserve fertility is to combine wide local excision of the cancer, removal of pelvic and/or groin nodes, and interstitial radiation therapy. This approach is as effective as radical surgery or higher doses of radiation but has the advantage of preserving fertility in most cases. This is an important consideration because many women with vaginal adenocarcinoma are young.

Stage II, III, and IVA adenocarcinoma: The usual treatment is radiation therapy, which is similar to that given for stage II, III, or IVA squamous cell vaginal cancer. Surgery that aims to cure the cancer is generally not attempted. Occasionally, to reduce the risk of side effects, surgery is performed to move parts of the intestines away from the area of the vagina before radiation therapy begins. Chemotherapy may be used in combination with radiation

Stage IVB adenocarcinoma: Radiation therapy is the usual treatment, but it is given to relieve symptoms and is generally not expected to cure the cancer. Chemotherapy may also be given, usually in the context of a clinical trial.

Recurrent squamous cell cancer or adenocarcinoma of the vagina: If a stage I or stage II vaginal cancer recurs locally (comes back near where the original tumor was), treatment with radical surgery (such as pelvic exenteration) or with radiation therapy (if treated primarily by surgery) may be successful. If the cancer was initially treated with radiation therapy, the recurrence will probably be treated by surgery if there is no evidence of nodal or distant metastases (spread).

Surgery is the usual choice when the cancer has come back after radiation therapy. Recurrences of higher-stage cancers or distant recurrences of low-stage cancers 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 beneficial.

Melanoma: Because melanoma of the vagina is extremely rare, doctors have been unable to compare enough patients with different treatments to determine the best approach. This cancer does not respond well to chemotherapy or radiation therapy, so surgery is the main treatment.

However, doctors are not yet certain about how much surgery is needed, that is, whether removing the cancer and a margin of normal tissue is any less effective than removing the entire vagina with some tissue from nearby organs. The extent of lymph node removal is also debated. Most doctors would just sample lymph nodes for prognosis.

Patients with metastatic vaginal melanoma may benefit from participation in clinical trials of new treatments such as biologic or gene therapies. For more information on melanoma, see the ACS document on 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 a separate ACS document. Last Revised: 07/21/2006