Treatment Options for Vaginal Cancer, by Stage and Type

The type of treatment your cancer care team recommends depends on the type of vaginal cancer you have, how far the cancer has spread, your overall health, and your preferences.

Because vaginal cancer is rare, it's been hard to study it well. There are no "standard" treatments that experts agree on. Most experts agree that treatment in a clinical trial should be considered for any type or stage of vaginal cancer. This way, women can get the best treatments available now and may also get the treatments that are thought to be even better.

Vaginal intraepithelial neoplasia (VAIN)

VAIN is a pre-cancerous change in cells of the vagina. Many cases of low-grade VAIN (VAIN 1) will go away on their own, so some doctors will choose to watch them closely without starting treatment. This means you will be getting Pap tests, often with colposcopy, every few months. If the area of VAIN doesn’t go away or gets worse, treatment will be started.

VAIN 2 is less likely to go away on its own, so treatment may be started right away. Still, some doctors may just watch it closely and then start treatment later, if needed.

VAIN is often treated using topical therapy (like 5-FU or imiquimod) or laser treatment. When there are many areas of VAIN, intracavitary radiation (brachytherapy) may be used. Sometimes, surgery is used to remove the lesion (the area of abnormal cells). Surgery might also be used if other treatments don't work or if the doctor wants to be sure that the area isn’t invasive cancer. Surgery may involve a wide local excision, removing the abnormal area and a rim or edge of surrounding normal tissue. A partial vaginectomy (removing part of the vagina) is rarely needed to treat VAIN.

Stage 0 (also called VAIN 3 or carcinoma in situ [CIS])

The usual treatment options are laser vaporization, local excision, or intracavitary radiation (brachytherapy).

Topical therapy with 5-FU cream or imiquimod is also an option, but this often means treatment at least weekly for about 10 weeks.

If the cancer comes back after these treatments, surgery (partial vaginectomy) might be needed.

Stage I

Squamous cell cancers: Radiation therapy is used for most stage I vaginal cancers. If the cancer is less than 5 mm thick (about 3/16 inch) and the diameter of the cancer is less than 2 cm, intracavitary radiation may be used alone. Interstitial radiation is an option for some tumors, but it’s not often used. For tumors that have grown more deeply or larger in diameter, intracavitary radiation may be combined with external beam radiation.

Removing part or all of the vagina (partial or radical vaginectomy) might be needed depending on the size of the cancer and where it is in the vagina. Reconstructive surgery to create a new vagina after treatment of the cancer is an option if a large part of the vagina has been removed.

If the cancer is in the upper part of the vagina, it may be treated with surgery, such as radical hysterectomy, bilateral radical pelvic lymph node removal, and/or radical or partial vaginectomy.

After radical partial or complete vaginectomy, radiation (external beam) may be used if not all of the cancer cells were removed or if cancer cells were found in the lymph nodes of the groin and/or pelvis.

Adenocarcinomas: For cancers in the upper part of the vagina, the treatment is surgery -- a radical hysterectomy, partial or radical vaginectomy, and removal of pelvic lymph nodes. This can be followed by reconstructive surgery if needed or desired. Both internal and external radiation therapy may be given as well.

For cancers lower down in the vagina, external beam radiation therapy may be used, along with either interstitial or intracavitary radiation therapy. The lymph nodes in the groin and/or pelvis are often treated with external beam radiation therapy.

Stage II through Stage IVA

The usual treatment is external beam radiation given with chemo, and with or without brachytherapy.

Some people may be too frail or have other medical conditions which would not let them tolerate chemo. In those cases, they may be treated with external beam radiation (without concurrent chemo) followed by brachytherapy.

Stage IVB

Since the cancer has spread (metastasized) to distant sites, it can’t be cured. Because vaginal cancer is relatively uncommon, much of the treatment methods for vaginal cancer are based on studies from patients with cervical cancer.

If the tumor cells have certain mutations or biomarkers, a patient with metastatic vaginal cancer may be treated with chemo with immunotherapy, chemo alone, immunotherapy alone, or targeted therapy. 

Radiation therapy to the vagina and pelvis might be used to ease symptoms and reduce bleeding.

Because there’s no standard treatment for this stage, the best option is to enroll in a clinical trial.

Recurrent squamous cell cancer or adenocarcinoma of the vagina

If a cancer comes back after treatment it's called recurrent cancer.

• If it comes back in the same place it was the first time, it's called a local recurrence.
• If it comes back in a location near where it was the first time, it is called a regional recurrence.
• If it comes back in another part of the body, like the liver or lungs, it's called a distant recurrence.

A local recurrence of a stage I or stage II vaginal cancer may be treated with radical surgery (such as pelvic exenteration). If the cancer was treated with surgery before, radiation therapy is an option.

Surgery is the usual choice when the cancer comes back after radiation therapy.

Higher-stage cancers are hard to treat when they recur. They usually can’t be cured. Care focuses mostly on relieving symptoms, although taking part in a clinical trial of new treatments may be helpful.

For a distant recurrence, the goal of treatment is to help the patient feel better.