Treatment options
Treatment and care of people with cancer is usually provided by a team of health professionals, both medical and allied health, called a multidisciplinary team.
Treatment for vaginal cancer depends on:
- the type of vaginal cancer
- where it is in the body
- whether the cancer has spread, and where it has spread to
- your general health
- your personal preferences.
Treatment options include surgery, chemotherapy and radiation therapy.
Surgery
Stage 1 or 2 vaginal cancer is often removed during surgery. The type of surgery you will have depends on the size and position of the cancer.
It may be possible to just remove the cancer and some of the surrounding normal tissue. Depending on the amount of vaginal tissue removed, the remaining vaginal tissue may be stretched so that you may still be able to have sexual intercourse.
Surgery for vaginal cancer can affect many aspects of your life. See Living with vaginal cancer for more information.
Vaginectomy
Some women may need to have a larger operation that removes all the vagina (vaginectomy). Sometimes it is possible to make a new vagina (vaginal reconstruction) using tissue from other parts of the body.
Radical hysterectomy
It may also be necessary to remove the uterus (womb), cervix, ovaries and fallopian tubes. This operation is called a radical hysterectomy. During this operation, some of the lymph nodes in the pelvis may also be removed. You may have to spend about a week in hospital.
Lymphadenectomy (lymph node dissection)
Lymph node dissection is a surgical procedure in which lymph nodes are removed and checked under a microscope for signs of cancer. If the cancer is in the upper vagina, the pelvic lymph nodes may be removed. If the cancer is in the lower vagina, lymph nodes in the groin may be removed.
Pelvic exenteration
Pelvic exenteration is usually only used for recurrent vaginal cancer that has come back even after radiation therapy.
Pelvic exenteration is surgery to remove the lower colon, rectum and bladder. In women, the cervix, vagina, ovaries and nearby lymph nodes are also removed. Openings called stoma are made to bring the small or large intestine out onto the abdomen. This allows urine and faeces to flow from inside the body to a collection bag.
Common stoma include:
- an ileostomy (formed from the lower half of the small bowel, called the ileum, which joins up with the colon)
- a colostomy (formed from the colon)
- an ideal conduit (formed by isolating a small piece of ileum and implanting the tubes from the kidney – the ureters – into it).
For more information about adapting to life with a stoma, ask your treatment team or contact your local stoma association.
Plastic surgery to reconstruct the vagina may also be needed after pelvic exenteration.
Radiation therapy
Radiation therapy is a commonly used treatment for vaginal cancer. In some women, radiation therapy may be combined with chemotherapy.
You might have external radiation therapy to your pelvic area to treat vaginal cancer. Radiation therapy may also be recommended if the cancer has come back or spread (recurrent cancer).
You may also have a type of radiation therapy called vaginal brachytherapy. This is when a source of radiation is placed in your vagina, like a tampon. This allows the radiation treatment to target the area more precisely.
Chemotherapy
In women with vaginal cancer, chemotherapy is mainly used if the cancer is advanced, or if the cancer returns after treatment. It may also be used with radiation therapy before surgery to help shrink the tumour.
Recurrent or advanced disease
Recurrent vaginal cancer is cancer that has recurred (come back) after it has been treated.
Metastatic cancer, also known as advanced or secondary cancer, is when the cancer spreads to another part of the body.
Vaginal cancer may come back in the vagina, the pelvis or elsewhere in the body.
Treatment of recurrent vaginal cancer may include the following:
- pelvic exenteration
- radiation therapy
- a clinical trial of a new treatment.
Treating vaginal intraepithelial neoplasia (VAIN)
Not all VAIN needs to be treated. The decision to treat will depend on several factors, including if a woman is considered to be at high risk of vaginal cancer.
VAIN that has not spread far may not require any treatment. To recommend no treatment, a gynaecologist needs to be sure that there isn’t an underlying malignancy in the VAIN tissue.
Surgically removing the abnormal tissue is an option, but involves some risk of complications and can affect sexual function.
Destroying the VAIN with laser treatment or heat treatment (loop diathermy) has fewer side effects. However, if the VAIN is at high risk of developing into cancer, surgery may be safer and give greater peace of mind.
Anti-cancer chemotherapy topical creams are also sometimes prescribed. Although these are effective, they can cause discomfort and inflammation.
Occasionally, VAIN is so widespread or hard to treat that more extensive surgery or radiotherapy is recommended.
