Your physician will consider your the best treatment option based on the stage of the disease and the tumor grade. The doctor also considers other factors, including your age and general health. We encourage our patients to review treatment options carefully and ask questions of your care team until you feel confident in your decision.
The goal of surgery is to remove all the cancer with the least amount of impact on a woman's sexual function. One of the following types of surgery may be done:
- Wide local excision: A surgical procedure to remove the cancer and some of the normal tissue around the cancer.
- Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.
- Vaginectomy: Surgery to remove all or part of the vagina.
- Total hysterectomy: The surgical removal of the uterus through the vagina, through a large incision in the abdomen or through a small opening in the abdomen. To determine if cancer has spread, the lymph nodes near the tumor may be removed.
- Pelvic exenteration: A surgical procedure to remove the lower colon, rectum and bladder. The cervix, vagina and 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.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may have chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
In radiation therapy, high-energy rays are used to kill cancer cells. Like surgery, radiation therapy is a local therapy. It affects cancer cells only in the treated area. Doctors use two types of radiation therapy to treat vaginal cancer:
- External radiation: In external radiation therapy, a large machine outside the body is used to aim radiation at the tumor area. The woman is usually an outpatient in a hospital or clinic and receives external radiation five days a week for several weeks. This schedule helps protect healthy cells and tissue by spreading out the total dose of radiation. No radioactive materials are put into the body for external radiation therapy.
- Internal radiation: In internal radiation therapy, tiny tubes containing a radioactive substance are inserted through the vagina and left in place for a few days. The woman stays in the hospital during this treatment. To protect others from radiation exposure, the patient may not be able to have visitors or may have visitors only for a short period of time while the implant is in place. Once the implant is removed, the woman has no radioactivity in her body.
Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. It may be used after surgery to treat vaginal cancer that has an increased risk of returning after treatment.
When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, a body cavity such as the abdomen or onto the skin, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Topical chemotherapy for squamous cell vaginal cancer may be applied to the skin in a cream or lotion.
Making an Informed Decision
You may find that your options for treatment here are greater than anywhere else, which can be reassuring but also overwhelming. We are committed to providing you with the information you need to make an informed decision about your treatment. Here are some points to consider as you evaluate your options:
- Fertility and sexuality: Because treatment for vaginal cancer often involves the removal of reproductive organs, it is important to understand how this will impact your ability to have children as well as your sexual function. If you are concerned about these issues, talk to your care team about what to expect after treatment and steps you might take prior to treatment that may preserve your ability to conceive.
- Side effects: Cancer treatments often damage healthy cells and tissues along with the cancer cells, so side effects are common. These side effects vary depending on the type and extent of treatment, and from one patient to the next. Knowing what to expect prior to treatment will allow you to be proactive in managing side effects or, taking quality of life into consideration, may also help you rule out particular treatment options.
- Second opinion: Before starting treatment, you might want a second opinion about the diagnosis, the stage of cancer, and the treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if you request it. Gathering medical records and arranging to see another doctor may take a little time. In most cases, a brief delay does not make treatment less effective.