Treatment for vaginal cancer depends on a number of factors, including your age and general health; the stage, grade and type of cancer; and what you want.
Radiotherapy, surgery and chemotherapy may be used to treat cancer of the vagina. You may have one, or a combination, of these treatments.
Treatment given after the main treatment to increase the chances of a cure is called adjuvant therapy. Treatment given before the main treatment is called neoadjuvant treatment.
If you want to try complementary therapies, which are generally used in conjunction with conventional cancer treatment, it is important that you discuss this with your doctors and health professionals.
All these treatments are explained in more detail in the following sections.
Sometimes, vaginal cancer needs to be removed in an operation. The type of surgery you will have depends on the size and position of the cancer.
It may be possible to just remove the cancer, together with some of the surrounding normal tissue. Depending on the amount removed, the remaining vaginal tissue may be stretched so that you may still be able to have sexual intercourse.
Some women may need to have a larger operation that removes all of the vagina (vaginectomy). Sometimes it is possible to make a new vagina (vaginal reconstruction) using tissue from other parts of the body.
It may also be necessary to remove the uterus (womb), cervix, ovaries and fallopian tubes. This operation is called a radical hysterectomy. During this operation, some of the lymph nodes in the pelvis may also be removed. You may have to spend about a week in hospital.
When you wake up from a hysterectomy, you will have several tubes in place. An intravenous drip will administer fluid as well as medication. There may also be 1 or 2 tubes in your abdomen to drain away fluid from the operation site and a small plastic tube (catheter) in your bladder to drain away urine. These tubes will usually be removed about 3–5 days after the operation.
Your doctors, nurses and physiotherapists will advise you on how to move your legs to prevent blood clots forming and help lymph fluid to drain. As soon as you are able, you should get out of bed and walk around.
After any stitches or clips are taken out, you will be able to go home. It may take several weeks before you feel fully recovered from the surgery.
Lymph node dissection (lymphadenectomy)
Lymph node dissection is a surgical procedure in which lymph nodes are removed and checked under a microscope for signs of cancer. 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 is 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.
Side effects of surgery
- Effects on your sex life. If you have a vaginal reconstruction, you may still be able to have intercourse, but it may not be possible to have an orgasm through penile penetration of the vagina. However, as surgery to the vagina does not affect the clitoris, it is still possible to have an orgasm through oral sex and masturbation.
- Pain during intercourse. Sometimes the scar tissue from the surgery may cause pain during intercourse. If this occurs, using a lubricant and trying different positions can help. If vaginal dryness is an ongoing problem, water-based and nonperfumed lubricants are best. Using a vaginal moisturiser several times a week will also help to keep tissue more flexible. Using a dilator may also be beneficial.
- Not able to become pregnant. If you have a hysterectomy, you will no longer be able to become pregnant. If fertility is an important issue for you, talk to your doctor before your surgery to discuss any options available to you.
- Pain. After surgery, you will have some pain or discomfort. It is best to let your doctor or nurse know when you are feeling uncomfortable – don’t wait until the pain becomes severe. You will be administered pain relief medication through an intravenous drip. You may be able to use a patient-controlled analgesia (PCA) system, which allows you to choose when you receive a dose of medication. Some people receive an epidural to relieve pain. An epidural is a form of regional anaesthesia involving injection of drugs into the spine.
- Adhesions. Adhesions – internal scar tissue that glues together tissues in the body – may form. Sometimes this can be painful. Adhesions to the bowel or bladder may need to be treated with further surgery.
- Lymph fluid build-up. If you have had your lymph glands removed (lymphadenectomy), parts of your body may swell because your lymphatic system is not working properly. This is called lymphoedema. Lymphoedema symptoms may not appear for more than 2 years after surgery. Swelling in your limbs may be reduced with gentle massage towards your heart, special compression garments and gentle exercise.
- Bladder and bowel problems. If you’ve had a radical hysterectomy, you may have difficulty emptying your bladder for a few weeks. You may also have constipation. These problems will go away with time, and your doctor or nurse can help you deal with them.
- Menopause. If you had both ovaries removed and were not menopausal before the surgery, the removal of your ovaries will cause menopause. Hot flushes and other symptoms of menopause caused by surgery may be more severe than those caused by natural menopause. Some drugs have been shown to help with these symptoms, and they may be more effective if started before surgery.
Radiotherapy is a commonly used treatment for women with cancer of the vagina. In some younger women, radiotherapy may be combined with chemotherapy.
In women with vaginal cancer, chemotherapy is mainly used if the cancer is advanced, or if the cancer returns after treatment. In some younger women, chemotherapy may also be combined with radiotherapy.
Recurrent vaginal cancer
Recurrent vaginal cancer is cancer that has recurred (come back) after it has been treated.
Metastatic cancer, also known as advanced or secondary cancer, is when the cancer spreads to another part of the body.
Vaginal cancer may come back in the vagina, the pelvis or elsewhere in the body.
Treatment of recurrent vaginal cancer may include the following:
- pelvic exenteration – this is surgery to remove the lower colon, rectum, bladder, cervix, vagina, ovaries and nearby lymph nodes, and create stomata (openings) through which urine and stool are passed out of the body
- a clinical trial of a new treatment.