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, it's has been hard to study it well. 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 women can get the best treatments available now and may also get the treatments that are thought to be even better.

Vaginal intraepithelial neoplasia (VAIN)

VAIN in a pre-cancerous change in cells of the vagina. 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 Pap tests, often with colposcopy, every few months. If the area of VAIN doesn’t go away or gets worse, treatment is started.

VAIN 2 is less likely to go away on its own, so treatment may be started right away. Still, some doctors may just watch it closely and then start treatment later, if needed.

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 (the area of abnormal cells). Surgery might also be used if other treatments don't work 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 or edge of surrounding normal tissue. A partial vaginectomy (removing part of the vagina) is rarely needed to treat VAIN.

Stage 0 (also called VAIN 3 or carcinoma in situ [CIS])

The usual treatment options are laser vaporization, local excision, or intracavitary radiation (brachytherapy).

Topical therapy with 5-FU cream or imiquimod is also an option, but this often means treatment at least weekly for about 10 weeks.

If the cancer comes back after these treatments, surgery (partial vaginectomy) might be needed.

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 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 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. Reconstructive surgery to create a new vagina after treatment of the cancer is an option if a large part of the vagina has been removed.

If the cancer is in the upper vagina, it may be treated with surgery, such as radical hysterectomy, bilateral radical pelvic lymph node removal, and/or radical or partial vaginectomy.

After radical partial or complete vaginectomy, radiation (external beam) may be used to treat cancer cells that might have spread to lymph nodes in the groin and/or 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. Both internal and external radiation therapy may be given as well.

For cancers lower down in the vagina, external beam radiation therapy may be used, along with either interstitial or intracavitary radiation therapy. The lymph nodes in the groin and/or pelvis are often treated with external beam radiation therapy.

Stage II

The usual treatment is radiation, using both brachytherapy and external beam radiation.

Radical surgery (radical vaginectomy or pelvic exenteration) is an option for some women with stage II vaginal squamous cell cancer if it’s small and in the upper vagina. Radiation might be given after surgery. Surgery is also used to treat women who already had radiation therapy for cervical cancer and would have severe damage to normal tissues if more radiation was given.

If the tumor is in the lower third of the vagina, external radiation may be used to treat lymph nodes in the groin or pelvis.

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. Chemo might be combined with radiation to help it work better. Surgery is rarely used.

Stage IVB

Since the cancer has spread to distant sites, it can’t be cured. Radiation therapy to the vagina and pelvis might be used to ease symptoms and reduce bleeding. Chemo might also be given with the radiation. Chemo alone has not been shown to help women live longer. Because there’s no standard treatment for this stage, 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's called recurrent cancer. If it comes back in the same place it was the first time, it's called a local recurrence. If it comes back in another part of the body, like the liver or lungs, it's 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 treated with surgery before, radiation therapy is an option.

Surgery is the usual choice when the cancer comes back after radiation therapy.

Higher-stage cancers are hard to treat when they recur. They usually can’t be cured. Care focuses mostly on relieving symptoms, although taking part 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.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master's-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Di Donato V, Bellati F, Fischetti M, et al. Crit Vaginal cancer. Rev Oncol Hematol. 2012;81(3):286-295.

Gurumurthy M, Cruickshank ME. Management of vaginal intraepithelial neoplasia. J Low Genit Tract Dis. 2012;16(3):306-312.

National Cancer Institute. Vaginal Cancer Treatment (PDQ®)–Health Professional Version. February 6, 2018. Accessed at www.cancer.gov/types/vaginal/hp/vaginal-treatment-pdq on March 14, 2018.

National Cancer Institute. Vaginal Cancer Treatment (PDQ®)–Patient Version. October 13, 2017. Accessed at www.cancer.gov/types/vaginal/patient/vaginal-treatment-pdq on March 14, 2018.

 

Last Medical Review: March 19, 2018 Last Revised: March 19, 2018

American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.