Vaginal cancer - Treating vaginal cancer

Treatment for vaginal cancer will depend on how advanced the cancer is. Possible treatments include radiotherapy, chemotherapy and surgery.

If your GP gives you an urgent referral because they think you have cancer, you have the right to be seen by a specialist within two weeks.

Read more about NHS waiting times for treatment.

Cancer treatment team

You will have multidisciplinary teams (MDTs) involved in treating your vaginal cancer.

If you have vaginal cancer, you may see several or all of these professionals as part of your treatment.

Deciding which treatment is best for you can be difficult. Your cancer team will make recommendations, but the final decision will be yours.

Before going to hospital to discuss your treatment options, you may find it useful to write a list of questions to ask the specialist. For example, you may want to find out the advantages and disadvantages of particular treatments.

Radiotherapy

There are several ways radiotherapy can be used to treat vaginal cancer. It can be used:

• as an initial treatment to cure the cancer
• in combination with chemotherapy (chemoradiation)
• after surgery to prevent the cancer from returning
• to control symptoms when a cure is not possible (palliative radiotherapy)

There are two ways radiotherapy for vaginal cancer can be given:

• a machine beams high-energy rays at your vagina and pelvis (external radiotherapy or brachytherapy)
• a small radioactive device, which looks like a tampon and is known as a source, is inserted into your vagina (internal radiotherapy)

The type of radiotherapy you receive depends on where the cancer is in your body. For example, internal radiotherapy may be used if the cancer is in the lining of your vagina, and external radiotherapy may be used if the cancer is deeper in the tissues of the vagina. Many women receive a combination of internal and external radiotherapy.

External radiotherapy is usually given in short daily sessions from Monday to Friday, with a break at the weekend. High dose rate brachytherapy involves a series of brief internal treatments, and low dose rate takes 24 hours for one treatment. 

While it kills cancerous cells, radiotherapy can also affect healthy tissue and has a number of side effects, including:

• sore, red skin similar to sunburn
• vaginal discharge
• pain while passing urine
• loss of taste
• loss of appetite
• tiredness
• feeling sick (nausea) 

Read more about radiotherapy, including how it is performed and other side effects. 

Effects on sex

Having radiotherapy may cause you to lose interest in sex, particularly if you have other side effects such as tiredness or nausea, or if you are anxious about your condition or treatment.

Radiotherapy to the vaginal area can cause scar tissue to form in your vagina. Scar tissue is less stretchy than normal tissue and can lead to your vagina becoming narrower.

It may be possible to treat this using a vaginal dilator, which is a device that is inserted into your vagina to help prevent it narrowing.

A recent study into vaginal dilators found there was little research into the benefits of using them after radiotherapy. It is possible that using vaginal dilators while you are still healing may cause more damage to your vagina. You should discuss the risks and benefits of vaginal dilators with your treatment team.

Having sex regularly after your treatment can also help prevent your vagina narrowing.

If you experience vaginal dryness or pain when having sex, you can use lubricants or ask your treatment team to prescribe appropriate medication.

Menopause and fertility

If you have external radiotherapy to your pelvis, you may experience an early menopause (if you have not had the menopause already).

If you have an early menopause, you will no longer be able to have children (infertility). This is often very upsetting, particularly for younger women who want to have a family. Before your treatment, your treatment team will discuss all the options and available support with you.

Surgery

There are four different types of surgery used to treat vaginal cancer:

• partial vaginectomy – removing the upper section of your vagina
• radical vaginectomy – removing all of your vagina 
• radical vaginectomy and radical hysterectomy – removing all of your vagina, womb, ovaries, fallopian tubes and nearby lymph nodes 
• pelvic exenteration – removing all of your vagina and surrounding tissue, including the bladder and/or rectum (back passage)

Partial vaginectomy

A partial vaginectomy can be used to treat stage 1 vaginal cancer, where radiotherapy has failed to remove the cancer or where a woman prefers to have surgery rather than radiotherapy because she still wants to have children.

Your surgeon will remove the cancerous section of the vagina as well as some surrounding healthy tissue, just in case a small number of cancerous cells have spread.

Your surgeon will repair the defect in the vaginal wall, which means you will be able to have normal sexual intercourse after you have recovered from the operation.

Radical vaginectomy

A radical vaginectomy is used to treat cases of advanced stage 1 and stage 2 vaginal cancer. The surgeon will remove most, or all, of your vagina.

A plastic surgeon may be able to make a new vagina using skin, muscle and tissue taken from another part of your body, usually one of your thighs or buttocks.

There are a number of different vaginal reconstruction techniques, although it is not always possible to create a fully functioning vagina.

Radical hysterectomy

A radical hysterectomy is often performed at the same time as a radical vaginectomy.

During a radical hysterectomy, all of the reproductive system is removed, including the womb, fallopian tubes, ovaries and nearby lymph nodes.

Read more about hysterectomies, including how to prepare for the operation and your recovery.

Pelvic exenteration

Pelvic exenteration is used to treat recurrent or advanced cases of vaginal cancer. It is major surgery, so you will need to be in good health before the procedure can be performed.

If you no longer have a bladder, you will need another way to pass urine. One solution is for your surgeon to make a hole (stoma) in your abdomen. A bag is then attached to the stoma so that urine can be passed into it. The bag is known as a urostomy bag.

Similarly, as you may no longer have a rectum, you will need a way to pass stools (faeces) out of your digestive system. Another stoma can be made and attached to a collection bag, known as a colostomy bag. Read more about colostomies.

It may be possible to reconstruct your rectum and attach it to the remaining section of your bowel once this has healed. In this case, you will only need a temporary colostomy.

As pelvic exenteration is major surgery, it may take you several months to fully recover from the operation.

Chemotherapy

Chemotherapy is usually used in combination with radiotherapy or to control symptoms when a cure is not possible (palliative chemotherapy). It is usually given by injection (intravenous chemotherapy).

Like radiotherapy, the powerful cancer-killing medicines used in chemotherapy can also damage healthy tissue and cause a range of side effects. Side effects of chemotherapy include:

• nausea
• vomiting
• hair loss 
• fatigue

During chemotherapy, hair loss may or may not occur depending on the type of medications used.

Chemotherapy can also weaken your immune system, making you more vulnerable to infection. However, the side effects should stop once treatment has finished.

Read more about chemotherapy, including how it is performed and more about the possible side effects.

Clinical trials

As vaginal cancer is rare, you may be asked to take part in a clinical trial. Clinical trials are an important way for healthcare professionals to learn more about the best way to treat specific conditions.

Most clinical trials involve comparing a new treatment with an existing treatment to determine whether the new treatment is more or less effective.

If you do receive a new treatment, there is no guarantee that it will be more effective than an existing one.

You can find out whether there are currently any clinical trials for vaginal cancer, or ask your care team if there are clinical trials in your area. Your care team can explain the advantages and disadvantages of taking part.

Read more about clinical trials and medical research, including how they are regulated and how to take part. 

Common questions about cancer answered

How can I deal with hair loss caused by cancer treatments?

Can chemotherapy and radiotherapy affect my fertility?

Can you tell me about complementary therapies for cancer?

What are cancer treatment trials and how do I find out more about these?

Want to know more?

• Cancer Research UK – treating vaginal cancer
• Macmillan – treatment for vaginal cancer