Frequently Asked Questions about Vaginal Cancer

Q: What is vaginal cancer?
A: Vaginal cancer is cancer that starts in the vagina. It is less common than other types of reproductive cancers. The vagina is a three- to four-inch-long tube. It connects a woman’s womb, called the uterus, to the outside of her body. A thin cell layer called the epithelium lines the walls of the vagina. This layer is made up of squamous epithelial cells.

Nearly 90% of vaginal cancers begin in the epithelium. They are called vaginal squamous cell carcinomas. These are other less common types of vaginal cancer.

• Adenocarcinomas
• Malignant melanoma
• Sarcomas

Q: Who gets vaginal cancer?
A: Most women diagnosed with vaginal cancer are older than 60. It rarely occurs in women younger than 40.

Q: What are the risk factors for vaginal cancer?
A: Certain factors can make one woman more likely to get vaginal cancer than another woman. These are called risk factors. A woman can have all of the risk factors and still not get the disease. Or she can have no known risk factors and still get vaginal cancer. Doctors are not exactly sure what causes vaginal cancer, but these are some things that may increase risk.

• Age. Women over the age of 60 are more at risk for vaginal squamous cell carcinoma.
• HPV infection. Women infected with the human papillomavirus (HPV) may be at higher risk of getting vaginal squamous cell cancer. High-risk sexual behavior, such as having many sexual partners, can increase a woman’s risk for HPV infection, which causes genital warts. The risk is even higher if a woman with HPV has a suppressed immune system from HIV/AIDS or another immune system problem. This makes it more difficult for the body to fight the HPV infection.
• Cervical or vulvar cancer. The cervix is the lower end of the uterus. The vulva forms the external sex organs. The vagina lies between these two organs. Having cervical or vulvar cancer increases the risk for squamous cell carcinoma of the vagina. Having precancerous conditions of the cervix may also increase this risk. This is thought to be true because cervical and vaginal cancers share similar risk factors.
• Smoking. As with many other cancers, smoking may increase the risk of vaginal cancer.
• DES. Women whose mothers took the drug diethylstilbestrol (DES) when pregnant with them may be more at risk for getting clear cell adenocarcinoma of the vagina.
• Vaginal adenosis. This is a change in cells lining the vagina. This change makes them look more like cells found in areas of the uterus. Adenosis happens in almost all women who were exposed to DES while in utero. In women not exposed to DES who have adenosis, the risk for clear cell adenocarcinoma is not known.

Q: What are the symptoms of vaginal cancer
A: A woman can have vaginal cancer without having any symptoms. Early vaginal cancers may not produce symptoms. Women with invasive vaginal cancer that is spreading may have these symptoms.

• Vaginal bleeding after menopause
• Vaginal bleeding after intercourse
• Vaginal discharge that is abnormal
• A mass in the vagina that can be felt
• Pain during sex
• Pain when urinating
• Constipation
• Constant pain in the pelvis

These symptoms do not mean that a person definitely has vaginal cancer. Other things could cause them. A woman should talk to her doctor if she is having any of these symptoms.

Q: How is vaginal cancer diagnosed?
A: The doctor asks questions about a woman’s symptoms, personal and family history, and risk factors for vaginal cancer. The doctor will also do a physical exam, including a Pap test and pelvic exam, to check for signs of the cancer. The doctor may order more than one of these tests to help make the diagnosis.

• Human papillomavirus (HPV) test
• Colposcopy
• Biopsy, if something suspicious is found in the physical exam or the colposcopy

Q: Should every woman get a second opinion for a diagnosis of vaginal cancer?
A: Many people with cancer get a second opinion from another doctor. There are many reasons to get one. Here are some of those reasons.

• Not feeling comfortable with the treatment decision
• Being diagnosed with a rare type of cancer
• Having several options for how to treat the cancer
• Not being able to see a cancer expert

A woman may have a hard time deciding which treatment to have. It may help to have a second doctor review the diagnosis and treatment options before starting treatment. It is important to remember that, in most cases, a short delay in treatment will not lower the chance that it will work. Some health insurance companies even require that a person with cancer seek a second opinion, and many other companies will pay for a second opinion if asked.

Q: How can someone get a second opinion for vaginal cancer?
A: There are many ways to get a second opinion.

• Ask a primary care doctor. He or she may be able to suggest a specialist. If possible, you should work with a doctor who specializes in dealing with cancer. This special doctor is called a gynecologic oncologist. Never be afraid to ask for a second opinion.
• Call the Gynecologic Cancer Foundation (GCF). The GCF hotline is 1-800-444-4441. It can assist callers in finding a gynecologic oncologist for a second opinion. You can also search for a gynecologic oncologist by your zip code using the Find A Doctor tool on the WCN site, developed by GCF.
• Call the National Cancer Institute’s Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237). They have information about treatment facilities. These include cancer centers and other programs supported by the National Cancer Institute.
• Consult The Official ABMS Directory of Board Certified Medical Specialists. This book by the American Board of Medical Specialists lists doctors by state. It gives their specialty, background, and training. You can find it at most public libraries. You can also view it online at www.abms.org.
• Seek other options. Check with a local medical society, a nearby hospital or medical school, or a support group to get names of doctors who can provide a second opinion. Or ask other people who’ve had cancer who they might suggest.

Q: How is vaginal cancer treated?
A: Treatment for vaginal cancer is either local or systemic. Local treatments remove, destroy, or control the cancer cells in one certain area. Surgery and radiation are local treatments and are the most commonly used to treat vaginal cancer. Systemic treatments are used to destroy or control cancer cells throughout the whole body. Chemotherapy is a systemic treatment. A woman may have just one treatment or a combination of treatments.

Q: What’s new in vaginal cancer research?
A: Cancer research should give you hope. Doctors and researchers around the world are learning more about vaginal cancer. They are looking for and studying ways to prevent it. They are also finding better ways to detect and treat this cancer.

Researchers are studying positron-emission tomography (PET) scanning for improved detection of vaginal cancer. They have found that PET scans may do a better job than computed tomography (CT scans) of finding vaginal cancer in lymph nodes and other parts of the body. Other research studies are looking at human papillomavirus (HPV) vaccines, genes for controlling cancer growth, and best ways to use radiation therapy. Studies are also looking at the use of a special kind of light, called photodynamic therapy, for treating vaginal cancer. And surgeons are developing new ways to repair the vagina after surgery to remove cancer.

Q: What are clinical trials?
A: Clinical trials are studies of new kinds of cancer treatments. Doctors use clinical trials to learn how well new treatments work and what their side effects are. Promising treatments are ones that work better or have fewer side effects than the current treatments. People who participate in these studies get to use treatments before the U.S. Food and Drug Administration (FDA) approves them for the general public. People who join trials also help researchers learn more about cancer and help future cancer patients.