Vaginal cancer is a rare malignancy that forms in the tissues of the vagina. It accounts for a small fraction of gynecological cancers, and most cases are diagnosed in women over 60. The most common form, squamous cell carcinoma, makes up the large majority of cases, while adenocarcinoma accounts for less than 10%. Because early-stage vaginal cancer often produces no symptoms at all, it’s frequently discovered during routine pelvic exams or Pap tests.
Types of Vaginal Cancer
Squamous cell carcinoma is by far the most common type. It develops in the thin, flat cells lining the vaginal surface and tends to grow slowly. It’s strongly linked to HPV infection and typically occurs in the upper portion of the vagina.
Adenocarcinoma, the second most common type, arises from glandular cells. The most well-known variant is clear cell adenocarcinoma, which gained attention in the 1970s when researchers linked it to prenatal exposure to DES (diethylstilbestrol), a synthetic hormone prescribed to pregnant women from the 1940s through 1971. Women exposed to DES in the womb carry roughly 40 times the risk of developing clear cell adenocarcinoma compared to unexposed women, though the cancer remains rare even in this group, affecting about 1 in 1,000 DES daughters.
Other subtypes exist but are exceedingly uncommon. These include melanoma of the vagina, sarcomas that arise from the connective tissue, and metastatic cancers that originated elsewhere in the body and spread to the vagina.
Symptoms to Recognize
Most vaginal cancers produce no symptoms in their earliest stages. When symptoms do appear, the most common is abnormal vaginal bleeding: bleeding after menopause, bleeding between periods, or periods that are heavier or longer than usual. Unusual vaginal discharge that isn’t related to an infection is another early sign.
As the cancer grows, it can press on nearby structures. This may cause pelvic pain, particularly during urination or sex. Some women notice changes in bathroom habits, including blood in the urine or stool, urinating more frequently, or constipation. A mass or lump that can be felt in the vagina is possible but typically indicates more advanced disease.
HPV and Other Risk Factors
HPV is the dominant risk factor. About 75% of vaginal cancers are caused by human papillomavirus, with HPV 16 and HPV 18 responsible for the majority of HPV-related cases. The virus causes cellular changes in the vaginal lining that can, over years or decades, progress from precancerous lesions to invasive cancer.
Other factors that increase risk include a history of cervical cancer or cervical precancer, smoking, a weakened immune system (from HIV or immunosuppressive medications), and prior radiation therapy to the pelvic area. Age is also a factor: most diagnoses occur after age 60.
How Vaginal Cancer Is Diagnosed
The diagnostic process usually begins after an abnormal Pap test, a positive HPV test, or a suspicious finding during a pelvic exam. The next step is colposcopy, a procedure where a doctor uses a magnifying instrument to closely examine the vaginal walls and cervix. A dilute vinegar or iodine solution is often applied to make abnormal tissue easier to see.
If anything looks concerning during colposcopy, the doctor takes a biopsy, removing a small piece of tissue for examination under a microscope. This is the only way to confirm whether cancer is present and, if so, what type it is.
Once cancer is confirmed, imaging tests help determine how far it has spread. CT scans show the tumor’s size and position and can reveal whether lymph nodes are involved. MRI provides detailed images of soft tissue and helps map the cancer’s relationship to the bladder, rectum, and pelvic walls. A chest X-ray checks for spread to the lungs.
Stages of Vaginal Cancer
Vaginal cancer is staged using the FIGO system, which describes how far the cancer has grown beyond the vagina:
- Stage I: Cancer is limited to the vaginal wall.
- Stage II: Cancer has invaded the tissue surrounding the vagina but has not reached the pelvic sidewall.
- Stage III: Cancer extends to the pelvic wall, involves the lower third of the vagina, or is blocking a kidney. Lymph node involvement may be present.
- Stage IV: Cancer has spread into the bladder or rectum, or to distant sites like the lungs or bones.
Treatment Options
Radiation therapy is the primary treatment for most vaginal cancers, especially in advanced stages. It typically combines two approaches: external beam radiation, which targets the tumor from outside the body, and brachytherapy, which delivers radiation directly inside the vagina using a specialized applicator. For superficial tumors, brachytherapy alone may be sufficient. For thicker tumors, a combination of both methods is standard.
Chemotherapy is often given alongside radiation to make the treatment more effective. This approach was adopted based on strong evidence from cervical cancer treatment, since the two cancers share similar biology due to their common HPV origins.
Surgery plays a more limited role because the vagina sits so close to the bladder, rectum, and urethra. It’s generally reserved for small Stage I tumors, typically under 2 centimeters, located in the upper vagina. Depending on the tumor’s location, procedures range from a local excision to removal of part or all of the vagina, sometimes combined with hysterectomy. Even among patients with early-stage disease treated surgically, about 25% need follow-up radiation because of findings like cancer cells at the surgical edges or involved lymph nodes.
Survival Rates by Stage
Overall five-year survival for vaginal cancer is about 58%, but outcomes vary widely depending on stage at diagnosis. An analysis of national cancer registry data found five-year survival rates of 76% for Stage I, 62% for Stage II, 53% for Stage III, and 23% for Stage IV. These numbers underscore how much early detection matters: cancer caught while still confined to the vagina has more than three times the survival rate of cancer that has spread to distant organs.
Prevention Through HPV Vaccination
Because three-quarters of vaginal cancers are driven by HPV, vaccination offers a powerful form of prevention. The nine-valent HPV vaccine, recommended for adolescents and young adults, has shown 100% efficacy against high-grade vaginal precancerous lesions related to the HPV types it targets in clinical trials. Against the five additional HPV types covered by the newer vaccine (beyond the original four), efficacy against vulvar and vaginal disease was 94%.
Routine Pap tests and HPV screening also play a role in prevention by catching precancerous changes before they progress. Women who have had a hysterectomy for reasons unrelated to cancer are sometimes told they no longer need Pap tests, but those with a history of HPV or vaginal precancer should continue screening based on their doctor’s guidance.