Vaginal, Vulvar and Rare Gynecologic Cancers

Dr. Koen De Geest of the OHSU Knight Cancer Institute, speaking with a patient.

Dr. Koen De Geest is a nationally recognized researcher and gynecologic oncologist with particular expertise in vulvar, ovarian, cervical and uterine cancers.

Cancers of the vagina and vulva are rare and usually curable when found and treated early. Your care team at the OHSU Knight Cancer Institute will develop a treatment plan for your individual needs. We offer you:

  • The most advanced technology for detection and treatment.
  • Team-based care with gynecologic oncologists (doctors who treat women’s reproductive cancers), other doctors and nurses. They will work with you to plan the most effective treatment.
  • Minimally invasive robotic surgery, precise radiation therapy and rare expertise in reconstructive surgery.
  • Compassionate care in OHSU’s welcoming Center for Women’s Health.
  • A full menu of support services including complementary medicine and fertility services.
Go to our Gynecologic Cancers page to: 
  • See illustrations of women’s reproductive anatomy.
  • Learn more about our gynecologic cancer care.

Understanding vaginal and vulvar cancers

What are they?

Vaginal, vulvar and other rare gynecologic cancers occur when abnormal cells multiply out of control. Most cases start as abnormal skin cells that slowly become cancerous over many years.

  • Vaginal cancer begins in the cells that make up the lining, walls or glands of the vagina.
  • Vulvar cancer develops in the folds around the vaginal opening, most often on the inner edges of the labia and sometimes on the clitoris or in the glands.

Who gets vaginal and vulvar cancers?

New cases: These cancers are rare. An estimated 6,200 patients will be diagnosed with vulvar cancer and 5,200 with vaginal cancer in the United States in 2018. Combined, they make up 6 percent of gynecologic cancer cases in the U.S. These cancers can affect anyone who has a vagina and/or vulva, regardless of gender identity.

Risk factors include age. Women 60 and older are most likely to develop these cancers, and risk increases with age. Risk factors also include a history of:

  • HPV (human papillomavirus) infection (read more about HPV on our Cervical Cancer page)
  • Genital warts
  • Hysterectomy
  • Abnormal cells
  • Cervical or other gynecologic cancers
  • Smoking
  • HIV
  • For vaginal cancer, exposure to the medication diethylstilbestrol, or DES, before birth; some pregnant U.S. women took DES to prevent miscarriage from 1940 to 1971.

Survival rates

Just over 72 percent of vulvar cancer patients survive five years or more after diagnosis. The rate rises to 86 percent when treated before it spreads. For vaginal cancer, the rate is 84 percent when caught early. Survival rates are averages, though, and cannot predict the outcome for any individual.

Symptoms of vaginal and vulvar cancers

Vaginal and vulvar cancers often have no early signs or symptoms. They can be detected early with regular pelvic exams and Pap tests. See your doctor if you notice any of the following:

  • Unusual bleeding or discharge
  • Sores, lumps or growths
  • Persistent itching or burning
  • Tenderness or pain, especially during sex or urination
  • Changes in skin color
  • Constipation or other changes to bowel movements and urination
  • Swollen abdomen

Dr. Elizabeth Munro, of the OHSU Knight Cancer Institute listenting to a patient's heart beat.

Dr. Elizabeth Munro is a gynecologic oncologist with expertise in vulvar, vaginal and other women's reproductive cancers. She is skilled in minimally invasive and robot-assisted surgeries.

Diagnosing vaginal and vulvar cancers

Pelvic exam: The doctor looks at the inside of the vagina and cervix. The doctor also presses on the ovaries and uterus to check for abnormalities.

Pap test: During a pelvic exam, the doctor collects cells from the cervix to look at under a microscope.

Colposcopy: A magnifying device called a colposcope is used to spot suspicious tissue.The doctor may also take a tissue sample for testing (biopsy).

Biopsy: A small tissue sample is extracted for analysis under a microscope. The doctor will look for cancer cells and, if found, see if the cells show signs of growing slowly or quickly.

Imaging: MRI, CT scans and ultrasounds can locate tumors and indicate if the cancer has spread.

Types of gynecologic cancers

Squamous cell carcinoma: This is by far the most common form of vaginal and vulvar cancer. It makes up 85 to 90 percent of cases. It starts as a precancerous condition called intraepithelial neoplasia in which abnormal skin (squamous) cells develop in the lining of the vagina and the inside folds of the vulva. The cells can slowly develop into cancer on the surface and then spread to deeper tissues and the surrounding area.

Adenocarcinoma: This cancer forms in the mucus cells and glands of the vagina and vulva. Rarely, women who were exposed to DES before they were born are at higher risk for a type called clear cell adenocarcinoma.

Other rare gynecological cancers:

  • Melanoma in skin pigment cells
  • Sarcoma in deep tissues
  • Ovarian germ (egg) cell tumors
  • Trophoblastic tumors in cells that develop into the placenta during pregnancy
Tumor Sizes Illustration - full size

Staging vaginal and vulvar cancers

Staging helps guide treatment decisions by determining the cancer's size and spread.

Vaginal cancer

Stage I: Cancer is confined to the vagina. In Stage IA, the tumor is 2 centimeters or smaller. In Stage IB, it’s bigger than 2 centimeters.

Stage II: Cancer has invaded tissue next to the vagina but has not reached the pelvic wall. In Stage IIA, the tumor is 2 centimeters or smaller. In Stage IIB, it’s bigger than 2 centimeters.

Stage III:

  • The tumor is any size and has spread to nearby lymph nodes. It may be confined to the vagina, or it may have spread to the pelvic sidewall next to the vagina and/or it may block a kidney from draining urine.
  • The cancer has not spread to lymph nodes, but the tumor has spread to the pelvic sidewall next to the vagina and/or blocks a kidney from draining urine.

Stage IV: In Stage IVA, the tumor has spread to tissues of the bladder or rectum and/or extends beyond the pelvis. In Stage IVB, cancer has spread to distant parts of the body.

Vulvar cancer

Stage I: The tumor is confined to the vulva or the perineum (the tissue between the vulva and anus).

  • Stage IA: Cancer lesions are 2 centimeters or smaller and have not invaded tissue deeper than 1 centimeter.
  • Stage IB: Lesions are larger than 2 centimeters. Or they’re any size, and cancer has invaded tissue deeper than 1 centimeter.

Stage II: The tumor is any size, and cancer has spread to perineal tissues such as the lower third of the urethra (the tube that drains urine from the bladder), the vagina or the anus.

Stage III: Cancer has spread to nearby lymph nodes. The tumor may be confined to the vulva or perineum, or it may have spread to perineal tissues. The cancer is Stage IIIA, IIIB or IIIC depending on the number and size of lymph node cancer and whether any cancer has broken through a lymph node’s outer shell.

Stage IV: In Stage IVA, the cancer has spread to the upper two-thirds of the urethra or vagina, to bladder or rectal tissue, or to a pelvic bone. In Stage IVB, cancer has spread to a distant part of the body.

Treatments

Our cancer specialists draw on the latest research, technology and techniques to develop your treatment plan. A combination of therapies may be recommended, depending on the type and stage of your cancer.

Surgery

Your doctor takes out as much of the cancer as possible using precise, minimally invasive, robotic surgery. These advanced techniques allow for smaller incisions, less pain and faster recovery. A laser may be used to remove precancerous abnormal tissue.

Chemotherapy

Chemotherapy uses medications given intravenously, by mouth or applied to the skin to kill cancer cells. Sometimes chemotherapy is combined with radiation therapy. It can be used to:

  • Shrink a tumor before surgery.
  • Kill cancer cells circulating in your body after surgery.
  • To slow growth and control symptoms of advanced cancer.

Radiation therapy

Radiation therapy uses beams of energy to target cancer cells. It can be used to:

  • Shrink a tumor before surgery.
  • Kill cancer cells left after surgery.
  • Slow growth and control symptoms of advanced cancer.

Vulvar cancer: Radiation therapy is given using a machine outside your body (external beam radiation) or inside your body during surgery (intraoperative radiation therapy, or IORT). OHSU is only cancer center in Oregon and southwest Washington to offer IORT with a Mobetron device. This delivers a dose of high-energy beams directly to the tumor area. This therapy is faster and precise, sparing healthy tissue.

Vaginal cancer: A tube containing radioactive material may be placed in your vagina. This is called brachytherapy.

Reconstruction

If you need reconstructive services after cancer treatment, our expert plastic surgeons can provide consultation and care. Our team offers rare skill in delicate gynecologic surgery.

Additional services

Learn more