Vaginal Cancer Treatment – Surgery, Radiation, Chemotherapy

Once the diagnosis of vaginal cancer is established, the next step is deciding on the type of treatment to be undertaken. Surgery and radiation therapy are the standard treatment options. Chemotherapy may be done in selected cases where surgery and radiation does not give the desired response.

Treatment will depend upon several factors, such as the size, type, stage, and location of the cancer as well as the age and general health of the patient. Side effects of various treatments will also need to be taken into consideration and weighed out against the benefits.

Surgery

Surgery is usually the treatment of choice when the cancer is detected early and is limited to the vagina or surrounding structures. The various types of surgery for vaginal cancer may include :

Local Excision Surgery

A wide local excision surgery may be done in case of small tumors or lesions that are limited to surface of the vagina. The cancerous tissue, along with a small area of surrounding healthy tissue, is removed during the procedure so that no cancer cells remain.

Laser Surgery

Early stage vaginal cancer which is confined to the surface of the vagina may be treated by laser surgery. This procedure uses laser beam to surically ‘cut’ and remove the cancerous or pre-cancerous cells.

Vaginectomy

Removal of the vagina may be necessary, depending upon the spread of cancer in the vagina. Partial vaginectomy (removal of a part of the vagina) or radical vaginectomy (total removal of the vagina) may be done depending upon the extent of cancer. The vagina may be reconstructed after total vaginectomy to allow intercourse but sensation is often diminished.

In more advanced conditions, removal of the uterus, fallopian tubes and ovaries (total abdominal hysterectomy with salpingo-oophorectomy), and nearby lymph nodes (lymphadenectomy) may be recommended along with the vaginectomy. This is known as radical vaginectomy with radical hysterectomy.

Pelvic Exenteration

When there is extensive spread of the cancer throughout the pelvis, a pelvic extenteration may be undertaken. This type of surgery involves the removal of most of the pelvic organs. The vagina, uterus, ovaries, bladder, rectum, and the lower portion of the colon may be removed. Colostomy and urostomy bags may need to be used for the collection of feces and urine through openings in the abdomen. Pelvic exenteration may also be done in case of recurrent vaginal cancer.

Radiation Therapy

High energy beams, such as x-rays, are used in radiation therapy to destroy cancer cells. Radiation therapy may be given alone for treating vaginal cancer or it may be used after surgery to prevent the chance of recurrence.  It may also be combined with chemotherapy where radiation therapy alone or surgery is ineffective. Radiation therapy may be considered for symptomatic relief (palliative radiotherapy) where a cure is not possible.

Radiation therapy may be administered as :

External Beam Radiation

This type of radiation is given from an outside radiation source, the radiation machine, to the abdomen or pelvis.

Internal Radiation

Also known as brachytherapy, internal radiation is given by means of seeds, wires, or other radioactive devices which are placed within the vagina or the surrounding tissue for a stipulated number of days and then removed.

Internal radiation may be given alone to treat vaginal cancer detected in the early stages. In more advanced stages of the disease, internal radiation may be given after initial treatment with external beam radiation.

Chemotherapy

Chemotherapy is the use of drugs to target and destroy the cancer cells. It may be administered when surgery and radiation therapy fail to treat vaginal cancer effectively. Whether chemotherapy alone is of any use in treatment of vaginal cancer is debatable, but it may be used along with radiation therapy in advanced stages of the disease. Palliative chemotherapy may help to relieve symptoms where a cure is not possible.

Treatment of Vaginal Cancer According to Stage

Read more on stages of vaginal cancer.

Stage 0 (Carcinoma in Situ)

Treatment of stage 0 may include :

• Laser surgery.
• Wide local excision surgery.
• Partial or total vaginectomy.
• Topical chemotherapy.
• Internal radiation therapy.

Stage 1 Vaginal Cancer

Treatment of stage 1 squamous cell vaginal cancer may include :

• Internal radiation therapy alone, or with external radiation therapy to lymph nodes.
• Wide local excision or vaginectomy. Radiotherapy may be given after surgery.
• Vaginectomy and lymphadenectomy. This may be followed by radiotherapy after surgery.

Treatment of stage 1 vaginal adenocarcinoma may include :

• Vaginectomy, hysterectomy, and lymphadenectomy. Radiotherapy may be given after surgery.
• Internal radiation therapy alone, or with external radiation therapy to lymph nodes.
• Combination therapy, such as wide local excision surgery, with or without lymphadenectomy and internal radiation therapy.

Stages 2 Vaginal Cancer

Treatment of stage 2 vaginal cancer may include :

• Internal and external radiotherapy to the vagina, with or without external radiotherapy to lymph nodes.
• Vaginectomy or pelvic exenteration, with or without radiotherapy.

Stage 3 Vaginal Cancer

Treatment of stage 3 vaginal cancer may include :

• Internal and external radiation therapy, with or without surgery.
• Combining radiotherapy, chemotherapy, and surgery.

Stage 4A Vaginal Cancer

Treatment of stage 4A vaginal cancer may include :

• Internal and external radiation therapy, with or without surgery.
• A combination of radiation therapy, chemotherapy, and surgery.

Stage 4B Vaginal Cancer

Treatment of stage 4B vaginal cancer may include :

• Radiation therapy alone, or with chemotherapy, may help to alleviate symptoms and slow down the spread of cancer, although a cure may not be possible (palliative therapy).
• Clinical trial of chemotherapy and/or radiosensitizers.

Recurrent Vaginal Cancer

Treatment of recurrent vaginal cancer may include pelvic exenteration, and/or radiation therapy.

Sarcoma Botryoides

Sarcoma botryoides may be treated with a combination of chemotherapy, radiotherapy, and surgery.