Treatment Options for Vaginal Cancer, by Stage and Type
The type of treatment your cancer care team recommends depends on the type of vaginal cancer you have, how far the cancer has spread, your overall health, and your preferences.
Because vaginal cancer is rare, there are no “standard” treatments that experts agree on. Most experts agree that treatment in a clinical trial should be considered for any type or stage of vaginal cancer. This way, people can get the best treatments available now and might also get treatments that are thought to be even better.
Vaginal intraepithelial neoplasia (VaIN)
VaIN is a precancerous change in cells of the vagina.
Many cases of low-grade VaIN will go away on their own, so some doctors will choose to watch them closely without starting treatment. This means you will be getting Pap tests, often with colposcopy, every few months. If the area of VaIN doesn’t go away or gets worse, treatment will be started.
High-grade VaIN is less likely to go away on its own and has a higher risk of progressing to vaginal cancer, so it is often treated.
Surgery
Surgery is usually used if:
- There is concern for invasive cancer
- The abnormal area can’t be completely seen
- A sample is needed for diagnosis
Your care team might also recommend surgery for VaIN that occurs in a single area, especially if surgery can leave the vagina intact.
Surgery could involve removing the abnormal area and a rim or edge of surrounding normal tissue (wide local excision). A partial vaginectomy (removing part of the vagina) is rarely needed to treat VaIN.
Ablation therapy and topical therapy
If the area can be seen easily and your care team is confident it is VaIN, treatments such as ablation therapy or topical therapy, such as 5-FU or imiquimod, might be recommended. In cases where there are multiple areas of VaIN or surgery would affect the function of the vagina, topical treatments might be tried first to try to avoid major surgery.
If VaIN recurs, topical treatments, such as imiquimod, might be tried.
Radiation
In rare cases, radiation might be used if other treatments were not successful or surgery is not a good option.
Follow-up
After treatment for VaIN, your care team will often watch closely for any signs of VaIN or vaginal cancer. For the first few years after treatment, follow-up exams a few times a year with Pap and HPV tests are often recommended.
Stage I
Radiation therapy is used for most stage I vaginal cancers. If the cancer is small (less than 5 mm thick and 2 cm wide), intracavitary radiation might be used alone. Interstitial radiation is an option for some tumors, but it’s not often used. For tumors that have grown more deeply or larger in diameter, intracavitary radiation might be combined with external beam radiation with or without platinum-containing (cisplatin or carboplatin) chemotherapy.
Removing part or all of the vagina (partial or radical vaginectomy) might be needed depending on the size of the cancer and where it is in the vagina. In some cases, the uterus or lymph nodes might also be removed. Reconstructive surgery to create a new vagina after treatment is an option if a large part of the vagina has been removed.
If surgery is successful in removing the cancer, that might be the only treatment needed. However, if the surgeons can see cancer cells near the edge of the removed area, treatment with radiation or a combination of radiation and chemotherapy is often recommended.
Stage II through Stage IVA
The usual treatment is chemotherapy and radiation with brachytherapy.
People who are too sick, elderly, or have other medical conditions that would not let them tolerate chemo might be treated with external beam radiation (without chemo) and brachytherapy.
Stage IVB
If the cancer has spread (metastasized) to distant sites, it is hard to treat. The goal of treatment in these cases is to treat symptoms and slow cancer growth. Because vaginal cancer is relatively uncommon, many of the treatment methods for vaginal cancer are based on studies from people with cervical cancer.
Metastatic vaginal cancers might be treated with chemotherapy, immunotherapy, targeted therapy, or a combination of these. Cancer with certain gene changes or biomarkers might have specific treatment options.
Treatment of vaginal cancer in the pelvis with external beam radiation (with or without chemotherapy) and brachytherapy might be considered.
For people with a few distant sites of metastasis, or one causing symptoms, local treatments such as ablation treatments or radiation therapy could be used.
Because there’s no standard treatment for this stage, the best option is to enroll in a clinical trial.
Recurrent vaginal cancer
If a cancer comes back after treatment, it’s called recurrent cancer.
Locoregional recurrence
Locoregional recurrence is vaginal cancer that comes back at or near the site where the cancer first started.
These cancers might be treated with radiation with or without chemotherapy or brachytherapy if surgery was tried first. If radiation was already tried, surgery, a different type or more radiation, or other therapies such as chemotherapy, targeted therapy or immunotherapy might be tried.
Distant recurrence
Vaginal cancers that come back in another part of the body, called distant recurrence, are harder to treat. If cancer is present throughout the body, the goal of treatment is often to control symptoms and slow cancer growth. Treatments such as chemotherapy, targeted therapy, or immunotherapy might be options.
Ablation treatments, surgery, or radiation might be used to treat certain areas that are causing symptoms.
Clinical trials might also provide treatment options for vaginal cancers that come back after initial treatment.
Vaginal melanoma
Vaginal melanoma is very rare, and there is no standard treatment.
If the cancer can be removed, surgery could be done to remove the abnormal area and a rim or edge of surrounding normal tissue (wide local excision) with or without a lymph node biopsy or a more extensive surgery (pelvic exenteration). Surgery might be followed by radiation or other treatments such as chemotherapy, or immunotherapy.
If surgery can’t remove the cancer, treatments such as chemotherapy, immunotherapy, and radiation have also been used. To learn more, see Treating Melanoma Skin Cancer.
Vaginal sarcoma
Vaginal sarcomas are very rare. The most common vaginal sarcoma of children and adolescents is rhabdomyosarcoma. For more information on its treatment, see Treating Rhabdomyosarcoma.
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- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
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National Cancer Institute. Vaginal Cancer Treatment (PDQ). Accessed at https://www.cancer.gov/types/vaginal/hp/vaginal-treatment-pdq on September 8, 2026.
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National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Vulvar Cancer Version 2.2026 – January 6, 2026. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/vulvar.pdf on September 22, 2026.
Last Revised: October 23, 2026
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