What is the prognosis for vaginal cancer?

Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) depends on the following:

• The stage of the cancer (whether it is in the vagina only or has spread to other areas).
• The size of the tumor.
• The grade of tumor cells (how different they are from normal cells).
• Where the cancer is within the vagina.
• Whether there are symptoms.
• The patient's age and general health.
• Whether the cancer has just been diagnosed or has recurred (come back).

Treatment options depend on the following:

• The stage, size, and location of the cancer.
• Whether the tumor cells are squamous cell or adenocarcinoma.
• Whether the patient has a uterus or has had a hysterectomy.
• Whether the patient has had past radiation treatment to the pelvis.

What is the treatment for vaginal cancer?

There are different types of treatment for patients with vaginal cancer.
Different types of treatments are available for patients with vaginal cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.
Three types of standard treatment are used:
Surgery
Surgery is the most common treatment of vaginal cancer. The following surgical procedures may be used:

• Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.
• Wide local excision: A surgical procedure that takes out the cancer and some of the healthy tissue around it.
• Vaginectomy: Surgery to remove all or part of the vagina.
• Total hysterectomy: Surgery to remove the uterus, including the cervix. If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision in the abdomen using a laparoscope, the operation is called a total laparoscopic hysterectomy.
• Lymphadenectomy: A surgical procedure in which lymph nodes are removed and checked under a microscope for signs of cancer. This procedure is also called lymph node dissection. 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: Surgery to remove the lower colon, rectum, and bladder. In women, the cervix, vagina, ovaries, and nearby lymph nodes are also removed. Artificial openings (stoma) are made for urine and stool to flow from the body into a collection bag.

Skin grafting may follow surgery, to repair or reconstruct the vagina. Skin grafting is a surgical procedure in which skin is moved from one part of the body to another. A piece of healthy skin is taken from a part of the body that is usually hidden, such as the buttock or thigh, and used to repair or rebuild the area treated with surgery.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can affect cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Topical chemotherapy for squamous cell vaginal cancer may be applied to the vagina in a cream or lotion.
New types of treatment are being tested in clinical trials. These include the following:
Radiosensitizers
Radiosensitizers are drugs that make tumor cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more tumor cells.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

 

Treatment options by stage

Stage 0 Vaginal Cancer (carcinoma in situ)
Treatment of vaginal squamous cell carcinoma in situ may include the following:

• Wide local excision, with or without a skin graft.
• Partial or total vaginectomy, with or without a skin graft.
• Topical chemotherapy.
• Laser surgery.
• Internal radiation therapy.

Stage I Vaginal Cancer
Treatment of stage I squamous cell vaginal cancer may include the following:

• Internal radiation therapy, with or without external radiation therapy to lymph nodes or large tumors.
• Wide local excision or vaginectomy with vaginal reconstruction. Radiation therapy may be given after the surgery.
• Vaginectomy and lymphadenectomy, with or without vaginal reconstruction. Radiation therapy may be given after the surgery.

Treatment of stage I vaginal adenocarcinoma may include the following:

• Vaginectomy, hysterectomy, and lymphadenectomy. This may be followed by vaginal reconstruction and/or radiation therapy.
• Internal radiation therapy, with or without external radiation therapy to lymph nodes.
• A combination of therapies that may include wide local excision with or without lymphadenectomy and internal radiation therapy.

Stage II Vaginal Cancer
Treatment of stage II vaginal cancer is the same for squamous cell cancer and adenocarcinoma. Treatment may include the following:

• Both internal and external radiation therapy to the vagina, with or without external radiation therapy to lymph nodes.
• Vaginectomy or pelvic exenteration, with or without radiation therapy.

Stage III Vaginal Cancer
Treatment of stage III vaginal cancer is the same for squamous cell cancer and adenocarcinoma. Treatment may include both internal and external radiation therapy, with or without surgery.
Stage IVA Vaginal Cancer
Treatment of stage IVA vaginal cancer is the same for squamous cell cancer and adenocarcinoma. Treatment may include both internal and external radiation therapy, with or without surgery.
Stage IVB Vaginal Cancer
Treatment of stage IVB vaginal cancer is the same for squamous cell cancer and adenocarcinoma. Treatment may include the following:

• Radiation therapy as palliative therapy, to relieve symptoms and improve the quality of life. Chemotherapy may also be given.
• A clinical trial of chemotherapy and/or radiosensitizers.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.