Vaginal cancer

Vaginal cancer that starts in the vagina itself (called primary vaginal cancer) is rare. Around 250 women are diagnosed with it in the UK each year.

It's far more common for a cancer to begin somewhere close by, like the cervix or womb, and then grow into the vagina.

What follows is only about cancers that start in the vagina.

The vagina is a muscular tube that runs from the opening of the womb (the cervix) to the folds of skin between your legs (the vulva). Blood from your periods (menstruation) drains out of the body through it. It is also the passage a baby comes through when it is born, which is why it's called the birth canal.

People who have a vagina include women, transgender men and people assigned female at birth.

Vaginal cancer comes in different types. What follows is only about squamous cell cancer and adenocarcinoma of the vagina, and both are treated in a similar way.

Squamous cell cancer (SCC) is the most common type of vaginal cancer. It starts in the squamous cells, which line the vagina, and it usually begins in the upper part of the vagina.

SCC is more common in people over the age of 60.

Adenocarcinoma of the vagina is rare. It starts in the glandular cells of the vagina, the cells that normally make the liquid that keeps the vagina lubricated. This type of cancer is most common in women under the age of 30.

The most common symptoms of vaginal cancer are:

• bleeding after the menopause, between periods or after sex
• blood-stained vaginal discharge
• pain when peeing (passing urine), needing to pee often, or blood in your pee
• pain in the pelvic (lower tummy) area
• constipation
• feeling you need to poo, even though you have just been (tenesmus)
• swelling in your legs

Many other conditions can cause these symptoms. But if you notice any of them, see your doctor.

If you have symptoms of vaginal cancer, you'll usually start by seeing your doctor. The doctor will then refer you to a specialist (a gynaecologist) at the hospital, who may arrange some of the following tests.

In an internal vaginal examination, the doctor gently checks inside the vagina for any lumps or swellings.

Taking a sample of cells from the cervix is the same test used for cervical screening. The test checks for any abnormal cells in the cervix.

In a colposcopy, the doctor uses a microscope called a colposcope to look closely at your vagina. If any area looks abnormal, they'll take a small sample of tissue from it (this is called a biopsy).

An examination under anaesthetic, or EUA, is a check of your vagina and cervix while you're under a general anaesthetic. Because you're asleep, the doctor can examine you thoroughly and you won't feel any discomfort.

If tests show that you have vaginal cancer, you'll need some further tests. Most of them are done to find out whether the cancer has spread to the pelvis or to other parts of the body. This helps your doctors plan the best treatment for you. They'll explain more about the tests you need. These may include the following.

If you have vaginal cancer, you'll have blood tests to check your general health.

Your doctor may ask you to have a chest X-ray, just to check that your lungs are healthy.

A CT scan takes a series of X-rays and puts them together to build a detailed picture of the inside of your body.

An MRI scan uses magnetism to build up a detailed picture of areas inside your body.

Radiotherapy uses high-energy rays to treat cancer, and it's the most common treatment for vaginal cancer.

Chemotherapy for vaginal cancer uses anti-cancer drugs to destroy cancer cells. Doctors often give it together with radiotherapy. It may also be used when vaginal cancer has spread to other parts of the body. Sometimes it's given before surgery, but that isn't common.

Doctors often give radiotherapy together with chemotherapy to treat vaginal cancer. This combined treatment is called chemoradiation.

Putting the two together can work better than radiotherapy alone.

The chemotherapy drug used most often is cisplatin, which is given as a drip (IV infusion). You'll usually have it once a week for as long as your radiotherapy lasts.

Doctors usually keep surgery for small stage 1 vaginal cancers, and for cancers that radiotherapy has not cured.

After your treatment, you'll have regular follow-up appointments with your cancer doctor or specialist nurse. If you have any problems or notice new symptoms between these appointments, tell them as soon as you can.

You may feel anxious between appointments. That's natural, and support from family, friends or a support organisation may help.

Macmillan Cancer Support also has further information to support you. You can:

• phone the Macmillan Support Line on 0808 808 00 00
• chat to Macmillan specialists online
• use the Macmillan vaginal cancer forum, where you can talk to others affected by vaginal cancer, ask questions and share your experience

Radiotherapy for vaginal cancer can sometimes cause side effects that don't go away, or that show up months or even years later. If this happens to you, there are lots of ways to manage or treat them.

Macmillan Cancer Support, a charity in the UK, has more information about late effects of pelvic radiotherapy.

You may not feel like having sex for a while after treatment for vaginal cancer. If you have a partner, you may both need time to get used to any changes. You can still share your feelings for each other through cuddling, massage, kissing and stroking.

After treatment, you may find that your sex life slowly improves. Changes may get better over time, but sometimes they're permanent. If you have any problems or are worried about this, talk to your doctor or nurse. They can explain what to expect. There are often things that can help and support you too.

It's common to have many different emotions when you're told you have vaginal cancer. These include:

• anger
• shock
• guilt
• anxiety
• fear

These are all normal feelings. People react to cancer in many different ways, and there's no right or wrong way to feel. You'll cope in your own way.

Talking to family, friends or other people affected by cancer may help. Or you may prefer to get help from people who don't know you well. Sometimes you may not want to talk about how you're feeling at all. There's no right or wrong way to cope, but help is available if you need it.

Macmillan Cancer Support's cancer support specialists can give you information about counselling in your area. You can phone them on 0808 808 0000 for advice.

Macmillan's Online Community is also a good place to meet people who may be in a similar situation.

Even if you already live a healthy life, you may still choose to make some positive changes after your treatment for vaginal cancer. Small changes, like eating well and staying active, can improve your health and wellbeing and help your body recover.