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Types and grades

There are a number of different types of vaginal cancer. The grade of a cancer gives doctors an idea of how fast growing it is.

The type of cancer you have depends on the specific type of cell that the cancer developed from. To find this out, your doctor takes a tissue sample (biopsy). They send this to the laboratory to look at the cells under a microscope.

Squamous cell carcinoma

Squamous cell cancers:

  • are the most common type of vaginal cancer
  • are most likely to develop in the upper third of the vagina, closest to the cervix
  • usually grow slowly over many years

More than 8 out of 10 vaginal cancers (80%) are squamous cell cancer. Squamous cells are the flat, skin like cells that cover the surface of the vagina. The tumours look like small lumps (nodules) or sores (ulcers).

Before squamous cell cancer develops, there may be pre cancerous changes to the cells. These cell changes are called vaginal intraepithelial neoplasia (VAIN).

Verrucous carcinoma is a rare type of squamous cell vaginal cancer. It looks like a large wart and is a slow growing tumour that rarely spreads to other parts of the body. It is usually curable with surgery.

Adenocarcinoma

Adenocarcinomas of the vagina:

  • are much rarer than squamous cell vaginal cancer
  • start in the gland cells (adenomatous cells) in the lining of the vagina
  • can occur in young women

Around 1 in 10 vaginal cancers (10%) are adenocarcinomas. This type of cancer can be harder to diagnose than squamous cell cancer. The cancer is more likely to be hidden inside the vaginal canal. It’s sometimes difficult for doctors to tell whether this type of cancer started in the vagina, or in a nearby organ and then spread into the vagina.

There are 4 main types of adenocarcinoma of the vagina.

Clear cell vaginal cancer:

  • is a rare type
  • only occurs in young women whose mothers took the diethylstilbestrol (DES) drug when they were pregnant

Up until 1970, DES was sometimes given to women to stop them having a miscarriage. 

Clear cell cancers of the vagina usually develop in women in their teens or twenties, but there are reports of women being diagnosed in their early forties. As it’s now more than 40 years since DES was used in pregnancy, these cancers are becoming even rarer.

Papillary cancers can grow throughout the connective tissues that surround the vagina and hold it in place. They are less likely than other types of vaginal cancer to spread into nearby lymph nodes.

Mucinous adenocarcinomas get their name from the pools of mucus that you can see around the cancer cells when you look at them under a microscope.

Adenosquamous cancers of the vagina are made up of a combination of squamous cells and gland cells. They are also called mixed epithelial tumours. They are very rare. Only between 1 and 2 out of every 100 women (1 to 2%) with vaginal cancer have this type. They are often quickly growing tumours.

Sarcoma

Sarcomas are cancers that start in the body’s connective tissues – the tissues that form the structure of the body, such as bone, muscle, fat and cartilage. Sarcomas of the vagina are extremely rare and account for only about 3 out of every 100 vaginal cancers (3%). These cancers tend to grow quite quickly.

Different types of sarcoma can start in the vagina, including leiomyosarcoma and rhabdomyosarcoma. These are both muscle tumours. About two thirds of vaginal sarcomas are leiomyosarcomas. It's possible to have other types of sarcoma, such as mixed Mullerian sarcoma, but these are extremely rare.

Embryonal rhabdomyosarcoma

Embryonal rhabdomyosarcoma is also called sarcoma botryoides. It is a very rare type of vaginal sarcoma. It only develops in girls up to the age of 6 years. It is usually recognised by soft nodules that fill the vagina and sometimes show outside the vagina. They look a bit like bunches of grapes.

This is a very quickly growing cancer and is difficult to treat. But the outcome for girls with this cancer is getting better with an intensive combination of treatment including surgery, chemotherapy and radiotherapy.

Melanoma

Melanoma develops from the cells in the skin that produce pigment, which gives the skin its colour. Only about 3 out of every 100 vaginal cancers (3%) are melanomas. They are most likely to develop in the lower third of the vagina.

Vaginal melanomas are more common in women in their 50’s. But doctors have recorded cases in women as young as 22 and as old as 83.

Small cell

Small cell cancer is also called oat cell carcinoma because the cancer cells are a distinctive oat shape. Small cell vaginal cancers are extremely rare. Doctors have reported fewer than 30 cases worldwide.

Grading of your cancer

Grading is a way of dividing cancer cells into groups depending on how much the cells look like normal cells. This gives your doctor an idea of how quickly or slowly the cancer might grow and whether it is likely to spread.

Grade 1

The cells look very like normal cells. They are also called low grade or well differentiated. They tend to be slow growing and are less likely to spread than higher grade cancer cells.

Grade 2

The cells look more abnormal and are more likely to spread. This grade is also called moderately differentiated or moderate grade.

Grade 3

The cells look very abnormal and not like normal cells. They tend to grow quickly and are more likely to spread. They are called poorly differentiated or high grade.

Last reviewed: 
14 Oct 2013
  • Cancer: Principles and practice of oncology (10th edition)
    VT DeVita, TS Lawrence, SA Rosenberg
    Lippincott, Williams and Wilkins, 2015

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