Vaginal Cancer: Symptoms, Types, Causes and Treatment

Vaginal cancer is a rare but significant gynecologic malignancy that affects thousands of women worldwide each year. Because it is often overshadowed by other reproductive tract cancers, awareness of its symptoms, causes, and treatment options is crucial for early detection and optimal care. This article draws on the latest research to provide a comprehensive, human-centered guide to vaginal cancer, covering its symptoms, different types, underlying causes, and current treatment strategies.

Symptoms of Vaginal Cancer

Understanding the symptoms of vaginal cancer is essential for early detection and improved outcomes. Many symptoms are subtle or mistaken for less serious conditions, making awareness especially important for women and healthcare providers.

Symptom	Description	Frequency/Significance	Source(s)
Vaginal Bleeding	Unusual bleeding (esp. after sex or menopause)	Most common initial symptom	3 6 12
Vaginal Discharge	Watery or blood-tinged discharge	Often present, may be mild	3 6
Pain	Pelvic or vaginal pain, often late	Associated with advanced disease	1 3 5
Mass/Lump	Palpable growth in the vagina	Sometimes detected on exam	3 6

Table 1: Key Symptoms

Common Symptoms and Warning Signs

Vaginal cancer frequently presents with subtle symptoms, particularly in its early stages. The most common and earliest sign is unusual vaginal bleeding, especially after intercourse, between periods, or after menopause. Other symptoms include watery or blood-tinged vaginal discharge, which may be mild or persistent. As the disease progresses, women may experience pelvic or vaginal pain, and sometimes notice a mass or lump within the vaginal canal during self-examination or routine gynecologic visits 3 6 12.

Sexual and Pelvic Floor Symptoms

Women affected by gynecologic cancers, including vaginal cancer, often report symptoms affecting sexual health and pelvic floor function. These can include pain during intercourse, vaginal dryness, and discomfort, which may be exacerbated by cancer treatments like surgery or radiation. Such symptoms significantly impact quality of life and highlight the importance of comprehensive care 1.

When to Seek Medical Advice

Because symptoms can overlap with benign conditions (such as infections or hormonal changes), persistent or unexplained vaginal bleeding, discharge, or discomfort should always prompt medical evaluation. Early diagnosis can lead to more effective and less invasive treatment options.

Types of Vaginal Cancer

Vaginal cancer is not a single entity but comprises several distinct types, each with its own risk factors, typical age of onset, and treatment considerations. Understanding these differences is key to personalized care and prognosis.

Type	Age Group	Key Risk Factors/Features	Source(s)
Squamous Cell Carcinoma	Women over 60	HPV infection, prior cervical disease	2 3 4 6
Adenocarcinoma	Younger women (esp. <30)	DES exposure in utero	4 5 6
Melanoma	Middle-aged/older women	Rare, aggressive	3
Sarcoma	Children/teens (esp. embryonal rhabdomyosarcoma)	Very rare, distinct behavior	3 5

Table 2: Main Types of Vaginal Cancer

Squamous Cell Carcinoma

The vast majority of vaginal cancers (about 70-90%) are squamous cell carcinomas. These cancers arise from the thin, flat cells lining the vagina and mainly affect women over the age of 60. Persistent infection with high-risk human papillomavirus (HPV) types is a leading risk factor. Many women diagnosed with this type have a history of cervical precancer or cancer 2 3 4 6.

Adenocarcinoma

Adenocarcinoma accounts for 2-4% of vaginal cancers and is more likely to occur in younger women, particularly those exposed to diethylstilbestrol (DES) in utero—a synthetic estrogen prescribed to some pregnant women between the 1940s and 1970s. This exposure has declined, making this type even rarer today 4 5 6.

Other Rare Types

• Melanoma: Vaginal melanomas are rare and typically aggressive. They tend to affect older women and have a poorer prognosis.
• Sarcoma: Vaginal sarcomas, such as embryonal rhabdomyosarcoma, are extremely rare and most often seen in children or adolescents. Their treatment and prognosis differ significantly from other vaginal cancers 3 5.

Histologic Subtypes and Staging

Each subtype is staged using the FIGO (International Federation of Gynecology and Obstetrics) system, which helps guide treatment and assess prognosis. Imaging (MRI, PET-CT) is often used to determine the full extent of disease and plan therapy 6.

Causes of Vaginal Cancer

Vaginal cancer develops through a complex interplay of infectious, environmental, and host factors. Some of these are modifiable, offering opportunities for prevention.

Cause/Risk Factor	Mechanism/Influence	Notable Details	Source(s)
HPV Infection	Oncogenic viral integration	Major cause of squamous cell carcinoma	2 4 6 8
DES Exposure	Hormonal disruption in utero	Strongly linked to adenocarcinoma	4
Smoking	Carcinogen exposure	Increases risk, esp. with HPV	2
Prior Anogenital Cancer	Field effect, shared risk	Prior cervical/vulvar cancers raise risk	2 4 5
Immunosuppression	Impaired immune surveillance	Organ transplant, HIV, therapy	4
Vaginal Dysbiosis	Microbiome imbalance	May increase HPV persistence/progression	7 9

Table 3: Key Causes and Risk Factors

Human Papillomavirus (HPV) Infection

HPV is the single most important risk factor for vaginal cancer, particularly the squamous cell type. High-risk HPV strains (notably HPV-16) can integrate into vaginal epithelial cells, leading to precancerous changes and, over time, invasive cancer. Studies show a strong association between HPV infection, sexual behavior (such as multiple partners or early onset of sexual activity), and increased risk 2 4 6 8.

Diethylstilbestrol (DES) Exposure

DES, a synthetic estrogen, was once prescribed to prevent pregnancy complications. Women exposed to DES in utero have a markedly increased risk of vaginal adenocarcinoma, often diagnosed in their teens or twenties. With the discontinuation of DES, this type has become less common 4.

Other Environmental and Medical Factors

• Smoking: Smoking doubles the risk of vaginal cancer, particularly when combined with other risk factors like HPV infection 2.
• Prior Gynecologic Cancer: Having a history of cervical, vulvar, or other anogenital cancers increases the likelihood of developing vaginal cancer, possibly due to a "field effect" or shared risk factors 2 4 5.
• Immunosuppression: Women with weakened immune systems—due to HIV, organ transplantation, or immunosuppressive therapy—are at heightened risk 4.
• Chronic Irritation: Long-term use of vaginal pessaries or chronic inflammation (e.g., from untreated infections) may play a role 4.

Microbiome and Vaginal Dysbiosis

Emerging research highlights the role of the vaginal microbiome in modulating cancer risk. A healthy, Lactobacillus-dominated vaginal environment may protect against HPV infection and persistence. In contrast, dysbiosis—an imbalance of vaginal flora—can increase susceptibility to HPV acquisition, persistence, and the development of precancerous and cancerous lesions 7 9.

Genetic and Host Factors

Individual genetic susceptibility and host immune response also contribute, but these are less well understood and remain areas of active research 2 4.

Treatment of Vaginal Cancer

Treatment of vaginal cancer depends on the type, stage, size, and location of the tumor, as well as patient age and overall health. Due to its rarity, optimal management strategies are often adapted from cervical cancer protocols, and treatment is best individualized by a multidisciplinary team.

Stage/Type	Main Treatment(s)	Key Details/Outcomes	Source(s)
Early (Stage I/II)	Surgery and/or Radiotherapy	Similar survival; surgery for small tumors	5 11 12 13
Advanced (Stage III/IV)	EBRT + Brachytherapy ± Chemotherapy	Higher recurrence; brachytherapy improves survival	5 10 11 12 13
Adenocarcinoma	Surgery, Radiotherapy, Chemo	Multimodal, as per stage	5 12
Recurrent/Metastatic	Palliative Radiotherapy, Exenteration, Chemo	Individualized, symptom-focused	5 10 12 13

Table 4: Treatment Approaches

Early-Stage Disease (Stage I and II)

• Surgery: For small, localized tumors, surgical excision (wide local excision or partial vaginectomy) can be curative. Aggressive surgery may be needed for high-risk patients or tumors with unfavorable features 5 12.
• Radiotherapy: External beam radiotherapy (EBRT) and/or brachytherapy (internal radiation) are highly effective, especially for patients who are not surgical candidates. Survival rates for early-stage disease are favorable, with 5-year survival ranging from 58% to 84% 5 10 11 12.
• Combined Approaches: Surgery followed by radiotherapy may be used for tumors with high-risk features or positive margins 5 12.

Advanced-Stage Disease (Stage III and IV)

• Radiotherapy with Brachytherapy: The mainstay of treatment for advanced disease is combined EBRT and brachytherapy, often with concurrent chemotherapy (cisplatin). Brachytherapy delivers high-dose radiation directly to the tumor while sparing surrounding tissues, improving local control and survival rates 5 11 12 13.
• Chemoradiation: Adding concurrent chemotherapy (cisplatin) enhances the effectiveness of radiation, particularly in higher-stage disease 11 13.
• Surgery: Rarely, extensive surgery such as pelvic exenteration may be considered for selected patients with locally advanced or recurrent disease 12.

Special Considerations

• Image-Guided Adaptive Brachytherapy: Advanced imaging techniques (MRI, CT) are increasingly used to guide brachytherapy, allowing for more precise targeting of tumors and reduced side effects. This is now considered state-of-the-art 13.
• Treatment Toxicities: Side effects can include vaginal dryness, fibrosis, sexual dysfunction, and, less commonly, injury to surrounding organs. Supportive care and rehabilitation are vital for quality of life 1 11 13.
• Recurrence and Metastasis: Early-stage recurrences are usually local and may be managed with further surgery or radiation. Advanced disease may relapse distantly, requiring systemic therapies or palliative care 10 12.

Survivorship and Quality of Life

Pelvic floor disorders, sexual dysfunction, and chronic vaginal symptoms are common among survivors, often due to both the cancer itself and its treatment. Multidisciplinary support—including gynecology, oncology, pelvic floor therapy, and sexual health counseling—is crucial for long-term well-being 1.

Conclusion

Vaginal cancer, though rare, poses unique challenges in terms of diagnosis, treatment, and survivorship. Awareness and early intervention can make a significant difference. Here’s a summary of the main points:

• Symptoms: Most common are abnormal vaginal bleeding, discharge, pain, and the presence of a mass—especially in women over 60 3 6 12.
• Types: Squamous cell carcinoma is the most common; adenocarcinoma is linked to DES exposure; other rare types include melanoma and sarcoma 3 4 5 6.
• Causes: High-risk HPV infection is the leading cause, with other risk factors including DES exposure, smoking, prior gynecologic cancers, immunosuppression, and vaginal dysbiosis 2 4 7 9.
• Treatment: Depends on stage and type; options include surgery, external beam radiotherapy, brachytherapy, and chemotherapy—with advanced imaging and multidisciplinary care improving outcomes 5 11 12 13.
• Survivorship: Quality of life issues, especially sexual and pelvic floor health, need ongoing attention and support 1.

Early recognition and a team-based approach give women the best chance for effective treatment and a good quality of life after vaginal cancer. If you have symptoms or risk factors, talk to your healthcare provider about screening and prevention strategies.