Primary vaginal cancer is a rare type of cancer that starts in the tissues of the vagina. The vagina is the muscular canal that connects the cervix (lower part of the uterus) to the outside of the body. Most vaginal cancers develop slowly over time, often beginning as precancerous changes in the lining of the vagina. This condition is uncommon and occurs more frequently in older women, although it can affect women of any age.
Early stages may cause few or no symptoms, while later stages can lead to abnormal vaginal bleeding, discharge, pain, or discomfort. Because it is rare, vaginal cancer is usually treated in specialised centres with experience in gynaecological cancers.
Anatomy of the vagina
The vagina is a flexible, muscular tube about 7–10 cm long. It lies between the bladder (in front) and the rectum (behind). Its inner lining is made up of moist, protective cells, while the outer layers contain muscle that allows the vagina to stretch and contract. The vagina plays an important role in menstruation, sexual intercourse, and childbirth.
Most common types of vaginal cancer (histology)
The most common type of vaginal cancer is squamous cell carcinoma, which develops from the thin, flat cells lining the vagina. Less common types include adenocarcinoma, arising from glandular cells, melanoma, which forms from pigment-producing cells, and sarcoma, which develops from muscle or connective tissue.
Common signs and symptoms and when to see a doctor
In its early stages, vaginal cancer may not cause any noticeable symptoms. As the disease progresses, some women may experience abnormal vaginal bleeding, especially after menopause, after sexual intercourse, or between periods.
Other possible symptoms include unusual vaginal discharge, a lump or mass in the vagina, pain during sex, or persistent pelvic or vaginal pain. Some women may also notice discomfort when passing urine or changes in bowel habits if the cancer presses on nearby organs.
Because these symptoms can be caused by many non-cancerous conditions, they do not always mean cancer is present. However, any persistent, unusual, or unexplained vaginal symptoms should be checked by a doctor.
Women should seek medical advice promptly if they experience abnormal bleeding, ongoing pain, or any new vaginal changes. Early assessment allows for timely diagnosis and treatment, which can significantly improve outcomes.
Squamous cell carcinoma is the most common type of vaginal cancer and is often linked to long-term changes in the vaginal lining.
Common risk factors include
Risk factors for adenocarcinoma of the vagina
Adenocarcinoma is less common and arises from gland-forming cells.
Common risk factors include
Diagnosis and staging of vaginal cancer
Vaginal cancer is usually diagnosed after a woman reports symptoms or when an abnormality is found during a pelvic examination. The doctor will examine the vagina using a speculum and may take a small tissue sample (biopsy) from any suspicious area. The biopsy is examined under a microscope to confirm whether cancer is present and to determine the type of cancer.
Once vaginal cancer is diagnosed, in addition to a thorough physical examination, further tests are done to find out how far the cancer has spread. This process is called staging. Imaging tests such as ultrasound, CT scans, MRI scans, or PET scans may be used to look at the vagina and nearby organs, including the bladder, rectum, and lymph nodes. In some cases, additional procedures may be performed to check the bladder or bowel if symptoms suggest involvement.
Staging helps doctors describe the size of the cancer and whether it has spread locally or to other parts of the body. This information is essential for planning the most appropriate treatment and discussing prognosis with the patient.
Treatment for vaginal cancer depends on the stage of the disease, the type of cancer, its location in the vagina, and the patient's overall health.
Early-stage vaginal cancer is often treated with radiotherapy, which may include external beam radiotherapy and/or internal radiotherapy (brachytherapy). In selected cases where the cancer is very small and localised, surgery may be considered to remove the tumour while preserving as much normal tissue as possible. The aim of treatment at this stage is cure, with good control of the disease and preservation of vaginal function.
Advanced-stage vaginal cancer usually requires a combination of treatments. Radiotherapy remains the mainstay and is often given together with chemotherapy, which helps make the cancer cells more sensitive to radiation. This combined approach is known as chemoradiotherapy. Surgery is less commonly used in advanced disease but may be considered in selected situations or to manage complications. Immunotherapy and targeted therapies are increasingly becoming more common demonstrating good clinical outcomes. You should consult your doctor about these treatments.
Supportive care, including pain control and symptom management, is an important part of treatment at all stages. Treatment is typically planned by a specialist gynaecological cancer team to ensure the best possible outcomes.
Chemoradiation, which combines chemotherapy and radiotherapy, can cause side effects because it affects both cancer cells and some healthy tissues. Common short-term side effects include tiredness, skin irritation in the treated area, and inflammation of the vagina, which may cause soreness, discharge, or pain during urination.
Some women may experience bowel changes such as diarrhoea, or bladder symptoms like increased frequency or burning when passing urine. Nausea and reduced appetite can also occur, especially from chemotherapy.
Longer-term side effects may include vaginal dryness or narrowing, changes in sexual function, and, less commonly, ongoing bowel or bladder problems.
Most side effects can be effectively managed. Fatigue often improves with rest and gentle activity. Skin and vaginal irritation are treated with soothing creams, medications, and careful hygiene advice. Medications can help control nausea, pain, diarrhoea, and urinary symptoms. Vaginal moisturisers and, in some cases, vaginal dilators may be recommended after treatment to reduce scarring and maintain vaginal flexibility.
Patients are encouraged to report symptoms early so their healthcare team can provide timely support and improve comfort during and after treatment.
