Vaginal cancer

Treating vaginal cancer

Treatment for vaginal cancer will depend on where the cancer is in your vagina and how far it has spread. Possible treatments include radiotherapy, surgery and chemotherapy .

When you are diagnosed with cancer, you will be cared for by a group of different healthcare professionals, known as a multidisciplinary team (MDT).

Your MDT will include a range of specialists, including surgeons, clinical oncologists (specialists in the non-surgical treatment of cancer), andspecialist cancer nurses.

Your MDT will recommend a treatment plan they feel is most suitable for you, 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

Radiotherapy is the main treatment for 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)

How it's carried out

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

external radiotherapy a machine beams high-energy rays at your vagina and pelvis
internal radiotherapy a small radioactive device, which looks like a tampon, is inserted into your vagina

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 for around four to six weeks in short daily sessions, from Monday to Friday. You return home between treatments and have a breakat the weekends.

Internal radiotherapy may involve either a long treatment session where you need to stay in hospital for 24 hours, or several short day-case treatments.

These occur because radiotherapy temporarily damages some healthy cells as well as destroying cancerous ones.

Possible side effects of radiotherapy for vaginal cancer include:

sore, red skin similar to sunburn
vaginal discharge
pain while passing urine
diarrhoea
tiredness
feeling sick
narrowing of the vagina (see below)
early menopause and infertility (see below)

Devices called dilators, which are inserted into the vagina, can also be used after treatment stops to helpstop your vagina getting narrower.

You may also experience somevaginal dryness or pain when having sex. If this happens, you can try using lubricants or asking yourcare team aboutpossible treatments.

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).

This means you will no longer be able to have children ( infertility ). This iscan bevery upsetting, particularly for younger women who wanted to have children. Before your treatment, yourcare team will explain whether this is a risk and discuss the options and supportavailable.

Surgery

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

partial vaginectomy removing the upper section of your vagina
radical vaginectomy removing all of your vagina and pelvic lymph nodes
radical vaginectomy and radical hysterectomy removing all of your vagina, womb, ovaries, fallopian tubes and pelvic 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 treatstage 1vaginal cancer, when 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 assome 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 sex after you have recovered from the operation.

Radical vaginectomy

A radical vaginectomymay beused 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.

You will still be able to have sex after a vaginal reconstruction, although you will need to use lubricant, becausethe lining of the new vagina cannot make the mucus it would naturally make.

Radical hysterectomy

A radical hysterectomy is oftenperformed 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.

Pelvic exenteration

Pelvic exenteration is used in a few cases to treat recurrent or advanced cases of vaginal cancer.

Ifyou 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 tummy. 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 youmay 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.

A vaginal reconstruction can be carried out aftera pelvic exenteration. Itmay also 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's 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 for vaginal cancer can include:

tiredness
feeling sick
increased risk of infections
diarrhoea
hair loss

It's not uncommon to feel a sense of loss and bereavement after treatment. In some women, this may lead to depression .

You may find it helpful to talk to other women who have had similar treatment. Your GP or hospital staff may be able to recommend a suitable local support group. Charities can also help:

Macmillan Cancer Support has informationon groups you can join and a support line that you can call for free on 0808 808 00 00 (Monday to Friday, 9am-8pm)
Cancer Research UK provides a free phone number that you can call on 0808 800 40 40 (Monday to Friday, 9am-5pm)
you can also find cancer support services in your area

The Hysterectomy Association provides hysterectomy support services , including a one-to-one telephone support line, counselling and "preparing for hysterectomy" workshops.

If feelings of depression persist,speak to yourGP about the treatment and support available.

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 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.