Treatment by vaginal cancer stage
This section gives a brief outline of the treatments used for the most common types of vaginal cancer.
Treatment by vaginal cancer stage
Vaginal intraepithelial neoplasia – VAIN (Stage 0)
VAIN is graded as VAIN 1, 2, or 3. VAIN 1 does not usually need treatment, but you will have regular check ups. Treatments for VAIN 2 and 3 include laser treatment, surgery, creams or radiotherapy.
Stage 1 vaginal cancer
Radiotherapy is the first treatment for many women with stage 1 vaginal cancers. You may have chemotherapy treatment alongside radiotherapy. If the cancer is on the upper part of your vagina then it is sometimes necessary to have surgery to remove the womb.
Stage 2, 3 and 4A vaginal cancer
Stage 2, 3 and 4A cancer of the vagina are all treated in a similar way. Radiotherapy is the main treatment – usually both internal radiotherapy and external radiotherapy. Some women have chemotherapy treatment alongside radiotherapy. You might be offered surgery if you have had previous radiotherapy treatment.
Stage 4B vaginal cancer
Stage 4B means that the cancer has spread to another part of your body. Treatment cannot usually cure the cancer. But radiotherapy can relieve symptoms such as pain, swelling or bleeding. Your specialist may also suggest chemotherapy to control symptoms.
If vaginal cancer comes back after treatment, further treatment will depend on whether you have had radiotherapy or surgery in the past.
You can view and print the quick guides for all the pages in the treating vaginal cancer section.
VAIN (vaginal intraepithelial neoplasia) is not cancer. But there are areas of abnormal cells in the lining of the vagina that could become cancerous. Some doctors call it precancer. VAIN is graded as VAIN 1, 2, or 3. VAIN 1 means that one third of the thickness of the surface layer of the vaginal lining contains abnormal cells. VAIN 3 means the full thickness of the lining of the vagina has abnormal cells.
Women who have VAIN 1 do not usually need any treatment. The cancerous cells often disappear after a while. Your doctor will arrange regular check ups to make sure this has happened.
If you have VAIN 2 or 3 your doctor may recommend treating the abnormal cells. This aims to prevent cancer developing. Treatments for VAIN include
A laser is a very strong, hot beam of light that burns away the abnormal cells. Your doctor will use local anaesthetic to numb the area. You may also have several biopsies taken before the laser treatment. Your doctor sends the biopsy samples to the laboratory so that the cells can be examined.
You might have surgery, especially if the abnormal cells have come back or you have had a hysterectomy in the past. Your doctor may cut out the abnormal cells and some surrounding healthy tissue. This is called a wide local excision. The doctor sends the tissue to the laboratory and a pathologist looks at the cells under a microscope.
Sometimes the surgeon removes the area of abnormal cells with a small loop of wire that has an electric current. This is called loop diathermy or LEEP. It can cut out tissue and stop bleeding at the same time. The surgeon also removes a surrounding area of healthy tissue to lower the risk of the abnormal cells coming back.
Creams are not standard treatment for VAIN and are usually used as part of clinical trials. Sometimes a chemotherapy cream is used, usually fluorouracil. But this needs to be applied often and can irritate the delicate skin of the vagina. So it is not used very often. Newer creams being tested for VAIN include
- Imiquimod cream (Aldara) – an antiviral drug that boosts the immune system to destroy the abnormal cells
- Cidofovir – an antiviral drug
You might have radiotherapy if the precancerous cells have come back after treatment. Or you may have it if the abnormal cells are in several areas of your vagina. Radiotherapy is not commonly used and is not a standard treatment for VAIN. You usually have this as internal radiotherapy (brachytherapy). This means a radioactive object called a source is put inside your vagina, to treat the local area. You may have this treatment over several hours or a few days. There is information about having this type of treatment in the section about radiotherapy for vaginal cancer.
Radiotherapy is the first treatment for many women with squamous cell or adenocarcinoma stage 1 vaginal cancers. Internal radiotherapy is used to treat small tumours on the inner lining of the vagina. If the tumour is in the deeper vaginal tissues then external radiotherapy may be used as well. You may also have chemotherapy treatment alongside radiotherapy.
Some women with stage 1 cancer need to have surgery. If the cancer is on the upper part of your vagina it is sometimes necessary to remove the womb. This operation is called radical hysterectomy. You will have lymph nodes removed from around the womb and part of the vagina taken away (radical partial vaginectomy).
If the cancer is in the lower or middle part of your vagina you may need to have the whole of your vagina removed (total vaginectomy). Your surgeon may then surgically make a new vagina for you. This is called vaginal reconstruction. You will probably have external radiotherapy after surgery to try to make sure that any cancer cells left behind are destroyed.
Doctors are trying to develop a new treatment for women who are young and want to keep their fertility. It involves removing less vaginal tissue than usual and then having internal radiotherapy. The research so far seems to show that this will be as successful as radical surgery or very high doses of radiotherapy for treating cancer of the vagina. But it isn't standard treatment in the UK at the moment.
Stage 2, 3 and 4A vaginal cancer are all treated in a similar way. Radiotherapy is the main treatment and usually both internal radiotherapy and external radiotherapy are used. You may also have chemotherapy treatment alongside radiotherapy.
You might be offered surgery if you have had previous radiotherapy treatment to the pelvic area. There is a limit to the amount of radiotherapy you can have to any one part of the body. Too much can cause damage to healthy tissues. In rare cases, your doctor may suggest that you have an operation to move the bowel out of the radiotherapy treatment area to protect it. You would normally only need to have this done in the following situations
- You need particularly high radiotherapy doses
- You have had surgery to your bowel in the past, which has left you with internal scar tissue called adhesions
Stage 4B means that the cancer has spread to another part of your body. This stage is not usually curable. But radiotherapy can relieve symptoms such as pain, swelling or bleeding. Your specialist may suggest chemotherapy if you are fit enough to have the treatment. If there is a suitable clinical trial running, your specialist may ask you to join it. Your specialist will only suggest this if they know that you would receive suitable treatment within the trial. Vaginal cancer is rare and so it is quite difficult to research. Taking part in the trial may help to improve treatment in the future for other women with vaginal cancer.
Surgery is the main treatment for vaginal melanoma. Radiotherapy and chemotherapy generally do not work well for melanoma. Because this type of vaginal cancer is so rare, it has been difficult to find out which type of surgery is the best. The aim of the surgery is to remove all of the melanoma cells. But doctors don't know if they need to remove the whole of the vagina. Or whether it is just as good to remove only the melanoma, with a surrounding border of healthy tissue that is free of cancer cells. This border is called a healthy margin. It also isn't clear how many lymph nodes they need to remove.
It may seem rather frightening to hear that doctors don't know how much treatment is best. But your doctors will make sure you have enough treatment to be as safe as possible. Their concern is that some women could have too much treatment and that would cause unnecessary side effects. Future research may lead to smaller operations for this type of cancer.
Your treatment will depend on whether you have had radiotherapy or surgery in the past.
If you had radiotherapy for stage 1 or 2 vaginal cancer the first time round, and the cancer came back in the same place, your doctors will probably suggest surgery. Depending on where the cancer is, you may need quite a big operation, such as pelvic exenteration.
Treatment to control symptoms is called palliative treatment. It will not cure your cancer, but it may help to control it for a time. If your cancer has spread too far to be cured, or has come back after it was first treated, you may have radiotherapy, chemotherapy, or both. The treatment can help to control any symptoms caused by the cancer. It aims to make you more comfortable.
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