The vagina or birth canal is a muscular tube that extends from the cervix to the vulva. Primary vaginal cancer occurs when abnormal cells develop in the vagina. Cancer can also spread from other parts of the body to the vagina. This is known as secondary vaginal cancer and is more common than primary vaginal cancer.¹

There are several different types of primary vaginal cancer: 

• Squamous cell carcinoma Develops in the flat thin squamous cells that line the vagina. It’s the most common type of vaginal cancer¹.
• Adenocarcinoma Develops from the glandular cells of the vagina.
• Sarcoma A rare type of vaginal cancer that develops in muscle and tissue in the vaginal walls.

Symptoms may include:

• unexplained bleeding between periods
• bloody or malodorous vaginal discharge
• pain during sex or bleeding after sex
• a lump or swelling in the vagina
• pain in the pelvic area
• blood in the urine or pain during urination
• urine that’s a dark or reddish brown
• bloody vaginal discharge
• persistently itchy vagina

Having any of these symptoms doesn’t mean you have vaginal cancer, but you should see your doctor for a check-up.

HPV (human papillomavirus) infections are the most common cause of vaginal cancer². HPV is a common sexually transmitted infection. However, not everyone with HPV will develop vaginal cancer.

Cervical screening tests (formerly PAP smears) can help identify HPV infections. It’s recommended that people with a cervix have 5-yearly tests from the age of 25 to 74.

Some other factors that appear to increase the risk of vaginal cancer include:

• smoking³
• previous radiation therapy to the pelvis⁴
• people whose mother was given DES during pregnancy. This artificial form of oestrogen was used between 1939 and 1971⁵

The HPV vaccine, Gardasil 9, gives almost 100% protection against 9 HPV types⁶.

It’s currently given free in Australian secondary schools to children aged 12-13 as part of the National Immunisation Program. Ask your GP for more information.

Your GP may ask to examine your vagina and your pelvic area. They will probably refer you to a specialist if they’re concerned about your symptoms and risk factors for vaginal cancer.

Tests may include:

• Cervical Screening Test – a doctor or nurse will insert a speculum (a small instrument) into your vagina to hold it open and then take a swab of cells for analysis in a laboratory.
• Colposcopy – Your doctor will use a magnifying device called a colposcope to examine your cervix, vagina and vulva. As with cervical screening, the doctor will insert a speculum (a small instrument) into your vagina to hold it open, but the colposcope does not enter your body.
• Biopsy - While the doctor performs a colposcopy, they may also do a biopsy. This procedure involves taking tissue samples from your vagina, usually with a local anaesthetic. It takes just a few minutes, and sometimes you may need stitches afterwards. The samples will be sent to a laboratory for analysis.

If you are diagnosed with vaginal cancer, your doctor will explain which of the four stages you have and how far your cancer has progressed. Stage 1 is the least advanced, and Stage 4 is the most advanced. Vaginal cancer can also be graded from 1 to 3 according to how quickly it is expected to grow. 

Treatments for vaginal cancer

The treatment for vaginal cancer will depend on how advanced it is and whether you would like to have children. Treatments that may be offered include:

• chemotherapy
• radiation therapy
• surgery

We understand that a cancer diagnosis can be emotional and life-changing. It’s natural to feel disbelief, anxiety, sadness, anger and loneliness. At GenesisCare, we strive to strengthen your confidence, settle your emotions and create care experiences that give you the best possible outcomes.

Our care team will know your name and get to know who you are as a person. We don’t want you to feel alone when you’re with GenesisCare. Your nursing team and oncology team are here to support you before, during and after your cancer treatment. We are here to guide you to get you the support you need from experts such as psychologists, exercise physiologists, physiotherapists and dietitians.

Please contact your local GenesisCare centre for more details on the services available. View a list of our centres here.

Whether you experience side effects and how severe they are, depends on the type and dose of chemotherapy treatment you are given and your reaction from one treatment cycle to the next. Most side effects are short-term and can be managed. These may include:

• fatigue
• nausea or vomiting
  
• constipation or diarrhoea
• hair loss
• easily bruising or bleeding
• weight changes
• skin changes
• dryness during sex
• permanent or temporary menopause
• potential infertility
• changes in your menstrual cycle
• mood changes

These symptoms tend to improve gradually once treatment stops. Talk to your doctor or nurse if you feel upset or anxious about how long treatment is taking or the impact of side effects.

• Get as much rest as possible
  
• Aim for a wholefood, varied diet, but we also encourage you to eat foods that interest you rather than what you think you should eat
• Appetite changes are common, and you may experience taste changes or nausea. Help manage this by eating small, frequent snacks and avoiding smells that make you nauseous
• Drink lots of water
• Reach out to support groups and others who have had chemotherapy
• Ask your team about topical treatments for your skin if you have irritation or pain
• Stay out of the sun as much as possible throughout your treatment
• Record your side effects in a diary or journal
• Take some gentle exercise, such as walking, if you feel up to it. Light to moderate exercise can reduce treatment-related fatigue and improve your mood. Plan your exercise for times in the day when you know you have more energy
• It is important to acknowledge when you are fatigued and rest when you need to
• Ask for and accept help from family, friends and neighbours
• Be open with employers about your treatment and discuss flexible working options if you need them

General side effects include:

• soreness and swelling around the treatment area
• tiredness and lethargy for a few weeks after you finish

Specific side effects (depending on the area being treated):

• bladder or bowel changes
• vaginal discharge
• menopause

Most of these side effects will ease soon after treatment is finished. Your team will discuss any long-term considerations with you, depending on the tumour type.

General side effects include:

• swelling and pain
• constipation
• build-up of fluid in the skin
• menopause if your ovaries are removed
• abdominal pain
• vaginal narrowing

Other information, resources and support services are available to assist you during your cancer journey. These include:

Cancer Council Australia

13 11 20

cancer.org.au

Australian Cancer Research Foundation

02 9223 7833

acrf.com.au

References

1. Cancer of the vagina.  https://doi.org/10.1002/ijgo.12610. https://obgyn.onlinelibrary.wiley.com/doi/10.1002/ijgo.12610
2. Large contribution of human papillomavirus in vaginal neoplastic lesions: A worldwide study in 597 samples. https://www.sciencedirect.com/science/article/abs/pii/S0959804914008703
3. Mutagenicity and Carcinogenicity. https://www.sciencedirect.com/topics/medicine-and-dentistry/vagina-cancer
4. Pelvic Radiation Therapy Induced Vaginal Stenosis: A Review of Current Modalities and Recent Treatment Advances. Published online 2021 Apr 1. doi: 10.3390/medicina57040336. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066324/
5. Women exposed to DES in the womb face increased cancer risk. https://www.nih.gov/news-events/news-releases/women-exposed-des-womb-face-increased-cancer-risk
6. Women exposed to DES in the womb face increased cancer risk. https://www.nih.gov/news-events/news-releases/women-exposed-des-womb-face-increased-cancer-risk