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National Cancer Institute

PDQ® bullet Treatment  bullet Patients

Vaginal cancer


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is cancer of the vagina?
STAGE EXPLANATION
Stages of cancer of the vagina
Stage 0 or carcinoma in situ
Stage I
Stage II
Stage III
Stage IVA
Stage IVB
Recurrent
TREATMENT OPTION OVERVIEW
How cancer of the vagina is treated
Treatment by stage
STAGE 0 VAGINAL CANCER
STAGE I VAGINAL CANCER
STAGE II VAGINAL CANCER
STAGE III VAGINAL CANCER
STAGE IVA VAGINAL CANCER
STAGE IVB VAGINAL CANCER
RECURRENT VAGINAL CANCER
TO LEARN MORE

OVERVIEW OF PDQ


What is PDQ?

PDQ is a computer system that gives up-to-date information on cancer and its prevention, detection, treatment, and supportive care. It is a service of the National Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses, and other health care professionals.

To ensure that it remains current, the information in PDQ is reviewed and updated each month by experts in the fields of cancer treatment, prevention, screening, and supportive care. PDQ also provides information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ summary for health professionals on this cancer.


How to use PDQ

PDQ can be used to learn more about current treatment of different kinds of cancer. You may find it helpful to discuss this information with your doctor, who knows you and has the facts about your disease. PDQ can also provide the names of additional health care professionals who specialize in treating patients with cancer.

Before you start treatment, you also may want to think about taking part in a clinical trial. PDQ can be used to learn more about these trials. A clinical trial is a research study that attempts to improve current treatments or finds information on new treatments for patients with cancer. Clinical trials are based on past studies and information discovered in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help patients with cancer. Information is collected about new treatments, their risks, and how well they do or do not work. When clinical trials show that a new treatment is better than the treatment currently used as "standard" treatment, the new treatment may become the standard treatment. Listings of current clinical trials are available on PDQ. Many cancer doctors who take part in clinical trials are listed in PDQ.

To learn more about cancer and how it is treated, or to learn more about clinical trials for your kind of cancer, call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will be available to answer cancer-related questions.

PDQ is updated whenever there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.


DESCRIPTION


What is cancer of the vagina?

Cancer of the vagina, a rare kind of cancer in women, is a disease in which cancer (malignant) cells are found in the tissues of the vagina. The vagina is the passageway through which fluid passes out of the body during menstrual periods and through which a woman has babies. It is also called the "birth canal." The vagina connects the cervix (the opening of the womb or uterus) and the vulva (the folds of skin around the opening to the vagina).

There are two types of cancer of the vagina: squamous cell cancer (squamous carcinoma) and adenocarcinoma. Squamous carcinoma is usually found in women between the ages of 60 and 80. Adenocarcinoma is more often found in women between the ages of 12 and 30.

Young women whose mothers took DES (diethylstilbestrol) are at risk for getting tumors in their vaginas. Some of them get a rare form of cancer called clear cell adenocarcinoma. The drug DES was given to pregnant women between 1945 and 1970 to keep them from losing their babies (miscarriage).

A doctor should be seen if there are any of the following: bleeding or discharge not related to menstrual periods, difficult or painful urination, and pain during intercourse or in the pelvic area. Also, there is still a chance of developing vaginal cancer in women who have had a hysterectomy.

A doctor may use several tests to see if there is cancer. The doctor will usually begin by giving the patient an internal (pelvic) examination. The doctor will feel for lumps and will then do a Pap smear. Using a piece of cotton, a brush, or a small wooden stick, the doctor will gently scrape the outside of the cervix and vagina in order to pick up cells. Some pressure may be felt, but usually with no pain.

If cells that are not normal are found, the doctor will need to cut a small sample of tissue (called a biopsy) out of the vagina and look at it under a microscope to see if there are any cancer cells. The doctor should look not only at the vagina, but also at the other organs in the pelvis to see where the cancer started and where it may have spread. The doctor may take an x-ray of the chest to make sure the cancer has not spread to the lungs.

The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in the vagina or has spread to other places) and the patient's general state of health.


STAGE EXPLANATION


Stages of cancer of the vagina

Once cancer of the vagina has been found (diagnosed), more tests will be done to find out if the cancer has spread from the vagina to other parts of the body (staging). A doctor needs to know the stage of the disease to plan treatment. The following stages are used for cancer of the vagina:


Stage 0 or carcinoma in situ

Stage 0 cancer of the vagina is a very early cancer. The cancer is found inside the vagina only and is in only a few layers of cells.


Stage I

Cancer is found in the vagina, but has not spread outside of it.


Stage II

Cancer has spread to the tissues just outside the vagina, but has not gone to the bones of the pelvis.


Stage III

Cancer has spread to the bones of the pelvis. Cancer cells may also have spread to other organs and the lymph nodes in the pelvis. (Lymph nodes are small bean-shaped structures that are found throughout the body. They produce and store cells that fight infection.)


Stage IVA

Cancer has spread into the bladder or rectum.


Stage IVB

Cancer has spread to other parts of the body, such as the lungs.


Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the vagina or in another place.


TREATMENT OPTION OVERVIEW


How cancer of the vagina is treated

Treatments are available for all patients with cancer of the vagina. There are three kinds of treatment:

Surgery is the most common treatment of all stages of cancer of the vagina. A doctor may take out the cancer using one of the following:

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes into the area where the cancer cells are found (internal radiation). Radiation may be used alone or after surgery.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells outside the vagina. In treating vaginal cancer, chemotherapy may also be put directly into the vagina itself, which is called intravaginal chemotherapy.


Treatment by stage

Treatment of cancer of the vagina depends on the stage of the disease, the type of disease, and the patient's age and overall condition.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in most parts of the country for most stages of cancer of the vagina. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


STAGE 0 VAGINAL CANCER

Treatment may be one of the following:

1. Surgery to remove all or part of the vagina (vaginectomy). This may be followed by skin grafting to repair damage done to the vagina.

2. Internal radiation therapy.

3. Laser surgery.

4. Intravaginal chemotherapy.


STAGE I VAGINAL CANCER

Treatment of stage I cancer of the vagina depends on whether a patient has squamous cell cancer or adenocarcinoma.

If squamous cancer is found, treatment may be one of the following:

1. Internal radiation therapy with or without external beam radiation therapy.

2. Wide local excision. This may be followed by the rebuilding of the vagina. Radiation therapy following surgery may also be performed in some cases.

3. Surgery to remove the vagina with or without lymph nodes in the pelvic area (vaginectomy and lymph node dissection).

If adenocarcinoma is found, treatment may be one of the following:
1. Surgery to remove the vagina (vaginectomy) and the uterus, ovaries, and fallopian tubes (hysterectomy). The lymph nodes in the pelvis are also removed (lymph node dissection). This may be followed by the rebuilding of the vagina. Radiation therapy following surgery may also be performed in some cases.

2. Internal radiation therapy with or without external beam radiation therapy.

3. In selected patients, wide local excision and removal of some of the lymph nodes in the pelvis followed by internal radiation.


STAGE II VAGINAL CANCER

Treatment of stage II cancer of the vagina is the same whether a patient has squamous cell cancer or adenocarcinoma.

Treatment may be one of the following:

1. Combined internal and external radiation therapy.

2. Surgery, which may be followed by radiation therapy.


STAGE III VAGINAL CANCER

Treatment of stage III cancer of the vagina is the same whether a patient has squamous cell cancer or adenocarcinoma.

Treatment may be one of the following:

1. Combined internal and external radiation therapy.

2. Surgery may sometimes be combined with radiation therapy.


STAGE IVA VAGINAL CANCER

Treatment of stage IVA cancer of the vagina is the same whether a patient has squamous cell cancer or adenocarcinoma.

Treatment may be one of the following:

1. Combined internal and external radiation therapy.

2. Surgery may sometimes be combined with radiation therapy.


STAGE IVB VAGINAL CANCER

If stage IVB cancer of the vagina is found, treatment may be radiation to relieve symptoms such as pain, nausea, vomiting, or abnormal bowel function. Chemotherapy may also be performed. A patient may also choose to participate in a clinical trial.


RECURRENT VAGINAL CANCER

If the cancer has come back (recurred) and spread past the female organs, a doctor may take out the cervix, uterus, lower colon, rectum, or bladder (exenteration), depending on where the cancer has spread. The doctor may give the patient radiation therapy or chemotherapy.

A patient may also choose to participate in a clinical trial of chemotherapy or radiation therapy.


TO LEARN MORE

TO LEARN MORE..... CALL 1-800-4-CANCER

To learn more about cancer of the vagina, call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By dialing this toll-free number, you can speak with a trained information specialist who can answer your questions.

The Cancer Information Service also has booklets about cancer that are available to the public and can be sent on request. The following general booklets on questions related to cancer may be helpful:

Taking Time: Support for People with Cancer and the People Who Care About
Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again
What You Need To Know About Cancer

There are many other places where people can get information about cancer treatment and services. The social service office at a hospital can be checked for local and national agencies that help with getting information about finances, getting to and from treatment, getting care at home, and dealing with problems.

For more information from the National Cancer Institute, please write to this address:

National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580

Date Last Modified: 08/1998


If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.


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