Vaginal cancer: symptoms, causes, tests and treatment

The vagina is the tube between the vulva and the opening of the womb (cervix). Cancer Research UK describes it as an elastic, muscular passage about 7.5 to 10cm long. Vaginal cancer starts when abnormal cells in the vagina begin to divide and grow in an uncontrolled way.

Cancer Research UK says most vaginal cancers start in the squamous cells that line the vaginal wall and are called squamous cell carcinomas. A rarer type starts in the gland cells and is called adenocarcinoma. Cancers starting in the connective tissue are called sarcomas and are extremely rare, as are vaginal melanoma and lymphoma.

It also explains that cancer can start elsewhere and spread to the vagina, for example from the cervix, womb, bowel or vulva. That is a secondary cancer and is not the same as primary vaginal cancer.

The NHS lists the main symptoms as a lump in the vagina and ulcers or other skin changes in or around the vagina. Other symptoms are listed below. Cancer Research UK says it is rare to have symptoms with very early vaginal cancer or abnormal cell changes, which may instead be picked up at routine cervical screening.

Cancer Research UK says these symptoms are more likely with advanced vaginal cancer: constipation, feeling unable to completely empty your bowels, swelling in the legs, pain or pressure in the pelvic area that will not go away, and pain or blood when passing urine.

• Bleeding from the vagina after the menopause.

• Bleeding after sex, or pain during sex.

• Smelly or bloodstained vaginal discharge.

• Bleeding between periods.

• An itch in the vagina that will not go away.

• Pain when you pee, or needing to pee a lot.

The NHS stresses that these symptoms are very common and can be caused by many different conditions, so having them does not definitely mean you have vaginal cancer. It still says it is important to get them checked by a GP, because if they are caused by cancer, finding it early makes it more treatable.

Cancer Research UK makes the same point: many of the symptoms can be caused by other conditions such as infection, and most people with them do not have vaginal cancer. It also notes that it is possible to get vaginal cancer even after a hysterectomy, so symptoms should still be reported.

The NHS says vaginal cancer is nearly always caused by an infection with certain types of HPV, and that it is often found, and prevented, by attending cervical screening, which aims to find and treat abnormalities before they turn into cancer.

Cancer Research UK says the exact causes are not known and that one cause is long-lasting (persistent) infection with certain types of HPV, a common virus that the immune system clears without problems in most people. It lists older age and certain infections as factors that may increase risk.

The NHS describes what happens at a GP appointment: a GP or practice nurse may examine you, looking at the outside of the vagina and feeling inside with two gloved fingers while pressing on the tummy. It should not be painful but may be uncomfortable. You can ask for a female doctor or nurse, have a friend, family member or another member of staff in the room, and ask to stop at any time. If the GP thinks symptoms could be cancer you may get an urgent referral, which does not definitely mean you have cancer.

Cancer Research UK says the specialist, usually a gynaecologist, may carry out a colposcopy, take a sample of tissue (vaginal biopsy), perform a pelvic examination under general anaesthetic, and arrange MRI, CT or PET-CT scans to find out the extent of the cancer.

The NHS says the treatment depends on the size and type of the cancer, where it is in the vagina, whether it has spread and your general health. A specialist team explains the options, benefits and side effects and works with you on a plan.

The NHS says you will usually be seen every few months for the first few years after treatment, when a doctor or nurse checks for worries or problems, and that you do not need to wait for a check-up if you have symptoms or side effects that concern you. Support from family, friends or an organisation can help with anxiety between appointments.

The NHS names The Eve Appeal and Macmillan Cancer Support as organisations with free helplines for questions about vaginal cancer and cancer in general.

Vaginal cancer is investigated and treated through the NHS cancer pathway, starting with the GP and an urgent specialist referral, with treatment planned by a specialist team. Some people also choose a private gynaecology consultation for earlier assessment or a second opinion; the tests and treatments themselves are the same.