Treatment options for vaginal cancer

The two main treatments for vaginal cancer are radiotherapy and surgery. You may also have chemotherapy alongside radiotherapy.

This page is about the treatment of vaginal cancer. Your treatment could be different if you have abnormal cells in the inner lining of the vagina. This is vaginal intraepithelial neoplasia or VAIN. 

Deciding what treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

Most people are referred to a specialist MDT. You might go to a different hospital if there isn't a specialist MDT at your local hospital.

The team may include:

• a surgeon who specialises in cancer of the womb, ovaries, cervix and vagina

• cancer specialists (oncologists) who treat cancer with cancer drugs (medical oncologist) and radiotherapy (clinical oncologist)

• a nurse who specialises in cancer of the womb, ovaries, cervix and vagina (gynaecology specialist nurse)

• a pathologist who examines any cancer or tissue the surgeon removes

• a radiologist who looks at your scans and x-rays

The treatment that is best for you will depend on:

• the type of vaginal cancer you have

• how far it has grown or spread (the stage)

• where the cancer is in your vagina

• any previous treatment you might have had

• whether the cancer has spread to another part of the body (this spread is also called secondary cancer or metastases)

• your general health and level of fitness

The MDT will discuss your treatment, its benefits and the possible side effects with you. They may suggest a treatment on its own, or a combination of treatments, depending on your situation.

Treatment overview

The main treatments are:

• radiotherapy

• surgery

• chemotherapy and radiotherapy together (chemoradiotherapy)

• chemotherapy

Radiotherapy

Radiotherapy uses high energy rays to destroy cancer cells. You might have radiotherapy in one or more of the following situations:

• as your main treatment

• to treat vaginal cancer if you can't have surgery

• to help stop cancer coming back after surgery

• to treat the lymph nodes near the vagina

• to treat vaginal cancer that couldn't be completely removed with surgery

• as a combination treatment with chemotherapy (chemoradiotherapy)

You might have external radiotherapy, internal radiotherapy (brachytherapy) or both.

External radiotherapy directs radiation at the cancer from a machine outside of the body. Internal radiotherapy uses a radioactive source or implant that is placed inside the vagina.

Surgery

You might have surgery for vaginal cancer. The type of operation you have depends on the size and position of the cancer.  Your surgeon and specialist nurse will explain the surgery that is best for you.

There are different operations for vaginal cancer. These include:

• wide local excision - removal of the cancer and a border of healthy cells around it

• vaginectomy – removal of the vagina along with surrounding tissues

• radical hysterectomy – removal of your womb, cervix, upper part of your vagina, and the surrounding tissues

If you need to have your vagina removed, you might have a new vagina made using tissue from other parts of your body. This is called vaginal reconstruction. Talk to your surgeon early on if this is something you would like to consider. You will need a referral to a plastic surgeon for this specialist operation.

You might have surgery called a pelvic exenteration. You have this if your cancer has spread to surrounding tissues or come back after treatment. This involves a hysterectomy as well as removal of the vagina, bladder, rectum (back passage), and part of your bowel. 

This is a big operation that is not suitable for everyone. It is important that you are fit enough to make a good recovery. 

Removing lymph nodes

During the operation your surgeon usually removes some or all of the lymph nodes  from around your vagina. These are from your pelvis or groin. 

A pathologist checks the lymph nodes to see if they contain cancer cells. Knowing whether cancer is present helps your doctor work out the stage of your disease. They can then decide on further treatment. 

Chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in your bloodstream. You usually have chemotherapy alongside the radiotherapy treatment. This is called chemoradiotherapy.  

Giving these treatments together can lower the risk of the cancer coming back.

Your doctor may suggest chemotherapy on its own if your cancer has come back after treatment with radiotherapy or surgery. You may also have it if the cancer has spread from where it started to another part of the body. This is advanced vaginal cancer. 

This may help to relieve symptoms and slow the growth of your cancer, but unfortunately it won’t cure it.

Doctors might recommend chemotherapy before surgery for a rare type of vaginal cancer called sarcoma.

Treatment by stage

Stage 1 vaginal cancer

Radiotherapy is often the first treatment you have for stage 1 vaginal cancer. This might be internal radiotherapy or external radiotherapy. In some situations, you may have both. 

Your doctor might recommend you have surgery first. The type of surgery you have depends on where the cancer is. You may have radiotherapy after surgery.

You might have chemotherapy alongside radiotherapy (chemoradiotherapy).

Stage 2, stage 3 and stage 4A vaginal cancer

Radiotherapy is usually the main treatment. This might be internal radiotherapy or external radiotherapy. Or you may have both. 

You might also have chemotherapy alongside radiotherapy (chemoradiotherapy). 

Your doctor might recommend surgery if radiotherapy isn't a suitable treatment for you. 

Stage 4B vaginal cancer

Stage 4B vaginal cancer is also called advanced vaginal cancer.

Treatment aims to control the cancer and maintain a good quality of life. You might have:

• chemotherapy

• radiotherapy

• symptom control, such as pain relief

Clinical trials

Your doctor may ask if you’d like to take part in a clinical trial.

Doctors and researchers do trials to:

• improve treatment
• reduce the side effects of treatment
• develop new treatments

Getting a second opinion

Treatment decisions can be complicated and confusing. You can ask for a second opinion if you would like to get another doctor's view about your treatment. This means going to see another specialist. They will need to see all your test results and x-rays. 

Having a second opinion doesn't usually mean that the new doctor takes over your treatment and care. They discuss with you and your current doctor which is the best treatment approach to take.

If you want to get a second opinion, your doctor will usually be happy to arrange it for you. It can take time to arrange though and it might mean that your treatment is delayed for a while.

It is worth discussing your treatment again with your current specialist first. Once you have heard why they are suggesting particular treatments for you, you might feel that you don't need a second opinion.

It is always a good idea to jot down a few questions before you go to the hospital for an appointment with your specialist. It can be difficult to remember everything you want to ask once you get there. Writing down your questions beforehand can help you to feel more confident during the discussion.