Vaginal cancer is a rare cancer that occurs in your vagina — the muscular tube that connects your uterus with your outer genitals. Vaginal cancer most commonly occurs in the cells that line the surface of your vagina, which is sometimes called the birth canal.

While several cancers can spread to your vagina from other places in your body, cancer that begins in your vagina (primary vaginal cancer) is rare. Vaginal cancer comprises only 2 to 3 percent of gynecologic cancers. About 2,400 women are diagnosed with vaginal cancer each year in the United States, according to the American Cancer Society.

Women with early-stage vaginal cancer have the best chance for a cure. Vaginal cancer that spreads beyond the vagina is much more difficult to treat.

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Female reproductive system

Early vaginal cancer may not have any signs and symptoms. As it progresses, vaginal cancer may cause signs and symptoms such as:

• Unusual vaginal bleeding, such as after intercourse or after menopause
• Watery vaginal discharge that may be bloody and foul smelling
• Lump or mass in your vagina
• Painful urination
• Constipation
• Pelvic pain

When to see a doctor
See your doctor if you have any signs and symptoms related to vaginal cancer, such as abnormal vaginal bleeding. Since vaginal cancer doesn't always cause signs and symptoms, follow your doctor's recommendations about when you should have routine pelvic exams.

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Layers of vaginal tissue

In general, cancer begins when healthy cells acquire a genetic mutation that turns normal cells into abnormal cells. Healthy cells grow and multiply at a set rate, eventually dying at a set time. Cancer cells grow and multiply out of control, and they don't die. The accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby tissues and can break off from an initial tumor to spread elsewhere in the body (metastasize).

The majority — 85 to 90 percent — of vaginal cancers begin in the squamous cells. These thin, flat cells line the surface of your vagina. Other less common types of vaginal cancer include:

• Vaginal adenocarcinoma, which begins in the glandular cells on the surface of your vagina
• Vaginal melanoma, which develops in the pigment-producing cells (melanocytes) of your vagina
• Vaginal sarcoma, which develops in the connective tissue cells or smooth muscles cells in the walls of your vagina

As is the case with many types of cancer, it isn't clear what causes the genetic mutation that leads to vaginal cancer.

Certain factors may raise your risk of vaginal cancer, though women with no known risk factors can also develop vaginal cancer. Risk factors for vaginal cancer include:

• Age. Most women who are diagnosed with vaginal cancer are over 60 years old.
• Atypical cells in the vagina. Women with vaginal intraepithelial neoplasia (VAIN) have an increased risk of vaginal cancer. In women with VAIN, cells in the vagina appear different from normal cells, but not different enough to be considered cancer. A small number of women with VAIN will eventually develop vaginal cancer, though doctors aren't sure what causes some cases to develop into cancer and others to remain benign.
• Exposure to miscarriage prevention drug. Women whose mothers took a drug called diethylstilbestrol (DES) while pregnant have an increased risk of a certain type of vaginal cancer called clear cell adenocarcinoma. DES was used from the late 1940s until 1971 to prevent miscarriage in early pregnancy.
• Human papillomavirus (HPV). HPV is a sexually transmitted virus that can increase the risk of vaginal cancer and other cancers. HPV causes the majority of cervical cancers and precancerous changes in the cervix. A vaccine (Gardasil) that prevents some types of HPV is available.
• Previous gynecologic cancer. Women who've been treated for a different gynecologic cancer, especially cervical cancer, may have an increased risk of vaginal cancer.

Other risk factors that have been linked to an increased risk of vaginal cancer include:

• Multiple sexual partners
• Early age at first intercourse
• Smoking
• HIV infection

Vaginal cancer may spread (metastasize) to distant areas of your body, such as your lungs, liver and pelvic bones.

You're likely to start by first seeing your family doctor or a gynecologist. However, after your initial appointment, you may be referred immediately to a gynecologic oncologist.

Because appointments can be brief and there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what you can expect from your doctor.

What you can do

• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Ask a family member or friend to come with you, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. List your questions from most important to least important in case time runs out. For vaginal cancer, some basic questions to ask your doctor include:

• What's the most likely cause of my symptoms?
• Are there any other possible causes for my symptoms?
• What kinds of tests do I need?
• What types of treatments are available? What kinds of side effects can I expect from each treatment? How will these treatments affect my sexuality?
• What do you feel is the best course of action for me?
• What are the alternatives to the primary approach that you're suggesting?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Has my cancer spread? What stage is it?
• What's my prognosis?
• Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor will likely have a number of questions for you. If you're ready to answer them, it may help reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous, or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Do you know if your mother took DES when she was pregnant with you?
• Do you have any personal history of cancer?
• Have you ever been told you have HPV?

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Pelvic examination

While there is no general screening test for vaginal cancer, it's sometimes found during a routine pelvic exam before signs and symptoms become evident. During a pelvic exam, your doctor carefully inspects the outer exposed part of your vagina, and then inserts two fingers of one hand into your vagina and simultaneously presses the other hand on your abdomen to feel your uterus and ovaries. He or she also inserts a device called a speculum into your vagina. The speculum widens your vagina so that your doctor can check your vagina and cervix for abnormalities.

Your doctor usually also conducts a Pap test to screen for cervical cancer, but sometimes vaginal cancer cells can be detected on a Pap test. Pap tests and pelvic exams are generally recommended every two to three years. How often you undergo these screenings depends on your risk factors for cancer and whether you've had abnormal Pap tests in the past. Talk to your doctor about how often you should have this health screening.

If you have any signs and symptoms, your doctor may conduct a pelvic exam and Pap test to check for abnormalities that may indicate vaginal cancer. Additionally, your doctor may conduct other procedures to determine whether you have vaginal cancer, such as:

• Colposcopy. Colposcopy is an examination of your vagina with a special lighted microscope called a colposcope. Colposcopy allows your doctor to magnify the surface of your vagina to see any areas of abnormal cells.
• Biopsy. Biopsy is a procedure to remove a sample of suspicious tissue to test for cancer cells. Your doctor may take a biopsy of tissue during a colposcopy exam. Your doctor sends the tissue sample to a laboratory for testing.

Staging
Once your doctor diagnoses vaginal cancer, he or she takes steps to determine the extent of the cancer — a process called staging. The stage of your cancer helps your doctor decide what treatments are appropriate for you. In order to determine the stage of your cancer, your doctor may use:

• Biopsy. Tissue samples from your cervix or vulva may show whether cancer has spread to those areas.
• Imaging tests. Your doctor may order imaging tests to determine whether cancer has spread. Imaging tests may include X-rays, computerized tomography (CT) scans or magnetic resonance imaging (MRI).
• Tiny cameras to see inside your body. Procedures that use tiny cameras to see inside your body may help your doctor determine if cancer has spread to certain areas. Cameras help your doctor see inside your bladder (cystoscopy) and your rectum (proctoscopy).
• Positron emission tomography (PET) scan. This test uses sugar (glucose) combined with a radioactive atom to detect areas where cancer has spread. Cancer cells use more glucose because they're more active than normal cells, and the PET scan highlights areas where it isn't always easy to noninvasively detect cancer, such as your lymph nodes.

Once your doctor determines the extent of your cancer, he or she assigns your cancer a stage. The stages of vaginal cancer are:

• Stage 0. Cancer hasn't spread past the first layer (epithelium) of the vaginal wall. Five-year survival rates at this stage are as high as 96 percent.
• Stage I. Cancer is limited to the vaginal wall.
• Stage II. Cancer has spread to tissue next to your vagina.
• Stage III. Cancer has spread to nearby lymph nodes, or to the pelvic wall or both.
• Stage IVA. Cancer has spread to nearby lymph nodes, and has also spread to your bladder, rectum or pelvis.
• Stage IVB. Cancer has spread to areas away from your vagina, such as your lungs.

Your treatment options for vaginal cancer depend on several factors, including the type of vaginal cancer you have and its stage. Because vaginal cancer is rare, no standard treatment guidelines have been developed. You and your doctor work together to determine what treatments are best for you based on your goals of treatment and the side effects you're willing to endure. Treatment for vaginal cancer typically includes surgery and radiation.

Surgery
Surgery to remove the cancer from your body is primarily used for early-stage vaginal cancer that's limited to the vagina or, in selected cases, nearby tissue. Because many important organs are located in your pelvis, surgery to remove larger tumors would require removal of these organs. For this reason, your doctor may attempt to control your cancer through other treatment methods first. Types of surgery that may be used in women with vaginal cancer include:

• Removal of small tumors or lesions. Cancer limited to the surface of your vagina may be cut away using a scalpel or a laser. Your surgeon may also remove a small amount of healthy tissue to ensure that all of the cancer cells have been removed.
• Removal of the vagina (vaginectomy). Removing part of your vagina (partial vaginectomy) or your entire vagina (radical vaginectomy) may be necessary to remove all of the cancer. Depending on the extent of your cancer, your surgeon may recommend surgery to remove your uterus and ovaries (hysterectomy) and nearby lymph nodes (lymphadenectomy) at the same time as your vaginectomy.
• Removal of the majority of the pelvic organs (pelvic exenteration). This extensive surgery may be an option if cancer has spread throughout your pelvic area or if your vaginal cancer has recurred. During pelvic exenteration, the surgeon removes many of the organs in your pelvic area, including your bladder, ovaries, uterus, vagina, rectum and the lower portion of your colon. Openings are created in your abdomen to allow urine (urostomy) and waste (colostomy) to exit your body and collect in ostomy bags.

If your vagina is completely removed, you may choose to undergo surgery to construct a new vagina. Surgeons use pieces of skin, sections of intestine or flaps of muscle from other areas of your body to form a new vagina. With some adjustments, a reconstructed vagina allows you to have vaginal intercourse. However, a reconstructed vagina isn't the same as your own vagina. For instance, a reconstructed vagina lacks natural lubrication and creates a different sensation when touched due to changes in surrounding nerves.

Radiation therapy
Radiation therapy is a common treatment for vaginal cancers. Radiation therapy uses high-powered energy beams to kill cancer cells. Radiation can be delivered two ways:

• External radiation. External beam radiation is directed at your entire abdomen or just your pelvis, depending on the extent of your cancer. During external beam radiation, you're positioned on a table and a large radiation machine is maneuvered around you in order to target the treatment area. Most women with vaginal cancer receive external beam radiation.
• Internal radiation. During internal radiation (brachytherapy), devices containing radiation — radioactive seeds, wires, cylinders or other materials — are placed in your vagina or the surrounding tissue. After a set number of days, the devices are removed. Women with very early-stage vaginal cancer may receive internal radiation only. Other women may receive internal radiation after undergoing external radiation.

Radiation therapy kills quickly growing cancer cells, but it may also damage nearby healthy cells, causing side effects. Side effects of radiation depend on the radiation's intensity and where it's aimed. Complications include bladder irritation, inflammation of the lining of the rectum, narrowing of the vagina, thinning of the lining of the vagina, premature menopause and infertility.

Other options
If surgery and radiation can't control your cancer, you may be offered other treatments, including:

• Chemotherapy. Chemotherapy uses chemicals to kill cancer cells. It isn't clear whether chemotherapy is useful in women with vaginal cancer. Small studies of different chemotherapy combinations have had mixed results. Chemotherapy may be used during radiation therapy to enhance the effectiveness of radiation.
• Clinical trials. Clinical trials are experiments to test new treatment methods. While a clinical trial gives you a chance to try the latest treatment advances, a cure isn't guaranteed. Discuss available clinical trials with your doctor to better understand your options, or contact the National Cancer Institute or the American Cancer Society to find out what clinical trials might be available to you.

It's important to work on your overall health while you're undergoing cancer treatments and beyond. Eating well, managing stress and getting adequate exercise can all help promote good health.

Eating well
Good nutrition is especially important for people undergoing cancer treatment. But eating well can be difficult for a time if your treatment includes chemotherapy or radiation therapy. You may feel nauseated or lose your appetite, and foods may taste bland or unpleasant. You may find that the last thing you want to do is plan meals.

Even so, eating well during cancer treatment can help you maintain your stamina and your ability to cope with the side effects of treatments. Good nutrition may also help you prevent infections and remain more active.

Remember these strategies for eating well when you don't feel well:

• Eat protein-rich foods. Foods high in protein can help build and repair body tissues. Choices include eggs, yogurt, cottage cheese, peanut butter, lean meat, poultry, fish, beans and lentils.
• Keep an open mind about the foods you might eat. Something that is unappealing today might taste better to you next week.
• When you do feel well, make the most of it. Eat as many healthy foods as you can. Prepare meals that you can easily freeze and reheat. Also look for low-fat frozen dinners and other prepared foods.
• Pack calories into the foods you eat. For example, spread butter, jam or honey on bread. Sprinkle foods with chopped nuts.
• Eat smaller amounts of food more frequently. If you can't face the thought of a large meal, try eating small amounts of food more often. Keep fruits and vegetables handy for snacking.

Staying active
Even if you don't feel well, try to stay physically active. A regular, short walk or climbing the stairs can keep your muscles from deteriorating due to lack of use. Exercise can also help prevent fatigue, reduce anxiety and help prevent depression.

In addition, activities that require repetitive movement, such as swimming, can produce a mental state similar to that achieved with meditation. The same is true of yoga and other stretching exercises.

Each woman with cancer deals with her diagnosis in her own way. You might want to surround yourself with friends and family, or you may ask for time alone to sort through your thoughts. The shock and confusion of your diagnosis may leave you feeling lost and unsure of yourself. To help you cope, try to:

• Learn everything you want to about your cancer. Write down the questions you have and ask them at the next appointment with your doctor. Get a friend or family member to come to appointments with you to take notes. Ask your health care team for further sources of information. The more you know about your condition, the better prepared you'll be to make decisions about your treatment. Contact the National Cancer Institute for information online or by telephone at 800-4-CANCER (800-422-6237). The American Cancer Society also offers support and information on its Web site and by telephone at 800-ACS-2345 (800-227-2345).
• Maintain intimacy with your partner. Vaginal cancer treatments are likely to cause side effects that make sexual intimacy more difficult for you and your partner. If treatment makes sex painful or temporarily impossible, try to find new ways of maintaining intimacy. Spending quality time together and having meaningful conversations are ways to build your emotional intimacy. When you're ready for physical intimacy, take it slowly. If sexual side effects of your cancer treatment are hurting your relationship with your partner, talk to your doctor. He or she may offer ways to cope with sexual side effects and may refer you to a specialist.
• Create a support network. Having friends and family around you and supporting you can be valuable. You may find it helps to have someone to talk to about your emotions. Other sources of support include social workers and psychologists — ask your doctor for a referral if you feel like you need someone to talk to. Talk with your pastor, rabbi or other spiritual leader. Other people with cancer can offer a unique perspective, and may better understand what you're going through, so consider joining a support group — whether it's in your community or online. Contact the American Cancer Society for more information on support groups.
• Take time for yourself when you need it. Let people know when you want to be alone. Quiet time to think or write in a journal can help you sort out emotions.

No sure way to prevent vaginal cancer exists. However, you can increase the chance that vaginal cancer is discovered early by having routine pelvic exams and Pap tests. When discovered in its earliest stages, vaginal cancer is more likely to be cured. Doctors recommend women get pelvic exams and Pap tests soon after they've begun having sexual intercourse or by age 21. Ask your doctor how often you need to have pelvic exams and Pap tests and if you should have an HPV DNA test to see if you've been infected with HPV.

Preventing an HPV infection may also help prevent vaginal cancer. A vaccine called Gardasil to protect against some forms of HPV is available, and it's recommended for use in girls before they become sexually active. In September 2008, the Food and Drug Administration expanded the approved uses for Gardasil to include prevention of vaginal cancers caused by HPV types 16 and 18.

Because early first intercourse is associated with vaginal cancer, delaying your first sexual experience and may also help prevent vaginal cancer. In addition, avoiding having sex with multiple partners may also reduce your risk of vaginal cancer. Quitting smoking or never starting to smoke also may decrease your risk of vaginal cancer.