The first 60 days: Vaginal cancer
Primary vaginal cancer is rare and mostly caused by HPV, the virus behind cervical cancer. It is treated like cervical cancer, with weekly cisplatin alongside external and internal radiotherapy, which controls most tumours while preserving the organ; HPV vaccination and cervical screening, which also detects vaginal precursors, are steadily reducing it. Below, week by week, is what OnCo's record of Vaginal cancer says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- PathologistNamed in the standard of care for: VAIN 2 to 3.
- SurgeonNamed in the standard of care for: VAIN 2 to 3, Stage I, small upper-vaginal lesion, Recurrent or metastatic.
- Medical oncologistNamed in the standard of care for: Stage I, small upper-vaginal lesion, Stage I to IVA, most patients, Recurrent or metastatic.
- Clinical oncologist (radiotherapy)Named in the standard of care for: Stage I, small upper-vaginal lesion, Stage I to IVA, most patients, Recurrent or metastatic.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
- 1.Stage I, small upper-vaginal lesionNCCN category Category 2A, NCCN Guidelines: Vulvar Cancer (vaginal cancer principles) / Cervical Cancer
Wide excision or brachytherapy alone in selected cases.
- 2.Stage I to IVA, most patientsESGO / ESTRO / ESP recommendations; extrapolation from cervical cancer chemoradiation trials
External beam radiotherapy with concurrent weekly cisplatin followed by image-guided brachytherapy, extrapolated from cervical cancer.
Laser ablation, topical imiquimod or fluorouracil, or excision; surveillance after treatment of CIN 3 or hysterectomy for CIN.
Platinum-based chemotherapy; pembrolizumab for PD-L1-positive disease by extension from cervical cancer; salvage exenterative surgery for isolated central recurrence after radiotherapy.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example HPV DNA / p16 IHC, FIGO stage, PD-L1 CPS, Prior cervical neoplasia or hysterectomy history, DES exposure history), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Squamous cell carcinoma, Adenocarcinoma, Vaginal melanoma.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
VAIN 2 to 3
- For my situation (vain 2 to 3), which of the standard options do you recommend and why?Guideline options include: Laser ablation, topical imiquimod or fluorouracil, or excision; surveillance after treatment of CIN 3 or hysterectomy for CIN.
Stage I, small upper-vaginal lesion
- For my situation (stage i, small upper-vaginal lesion), which of the standard options do you recommend and why?Guideline options include: Wide excision or brachytherapy alone in selected cases.
Stage I to IVA, most patients
- For my situation (stage i to iva, most patients), which of the standard options do you recommend and why?Guideline options include: External beam radiotherapy with concurrent weekly cisplatin followed by image-guided brachytherapy, extrapolated from cervical cancer.
- Am I a candidate for Cisplatin, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Recurrent or metastatic
- For my situation (recurrent or metastatic), which of the standard options do you recommend and why?Guideline options include: Platinum-based chemotherapy; pembrolizumab for PD-L1-positive disease by extension from cervical cancer; salvage exenterative surgery for isolated central recurrence after radiotherapy.
- Am I a candidate for Cisplatin, Paclitaxel / nab-paclitaxel, Pembrolizumab, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of KEYNOTE-826 apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Any stage
- Are there clinical trials I could join, for example of Pembrolizumab, KEYNOTE-A18 / ENGOT-cx11 / GOG-3047, HPV & HBV vaccination?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
- I read that “No dedicated randomised trials; HPV-basket immunotherapy trials and international rare-tumour registries are filling the gap”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “Optimal brachytherapy technique and dose for vaginal primaries; MRI-guided adaptive brachytherapy series are maturing”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.
- Evaluate the Efficacy, Immunogenicity and Safety of 9-valent HPV Recombinant Vaccine in Chinese Healthy FemalesPhase 3 · recruiting · NCT04422366A Multicenter,Randomized,Blind and Positive-Controlled Phase Ⅲ Study to Evaluate the Efficacy, Immunogenicity and Safety of the 9-valent Human Papillomavirus (Types 6, 11, 16, 18,31,33,45,52 and 58) Recombinant Vaccine (Hansenula Polymorpha) in Chinese Female Subjects Aged 20-45 Years
- Immunogenicity and Safety of Quadrivalent HPV Vaccine in Healthy Chinese Female Subjects Aged 9 to 19 YearsPhase 3 · recruiting · NCT05027776Evaluating the Immunogenicity and Safety of Quadrivalent Human Papillomavirus Recombinant Vaccine (Type 6, 11, 16, 18) in Healthy Chinese Female Subjects Aged 9 to 26 Years: A Phase 3, Open-label, Non-randomized Clinical Trial
- Artesunate Vaginal Inserts for the Treatment of Cervical Intraepithelial Neoplasia (CIN2/3)Phase 2 · recruiting · NCT04098744A Phase II Double Blind, Placebo-controlled, Randomized Trial of Artesunate Vaginal Inserts for the Treatment of Patients With Cervical Intraepithelial Neoplasia (CIN2/3)
- Phase II Study of Dysplasix™ Intravaginal Suppositories in Patients Patients With High-Risk HPV and Mild Cervical Cytologic AbnormalitiesPhase 2 · recruiting · NCT07572396A Phase II, Randomized, Double-blind, Placebo-Controlled, Proof of Concept Study to Assess the Safety and Efficacy of Dysplasix™ Intravaginally-Administered Suppositories in Patients With High-Risk Human Papillomavirus (Hr-HPV) as Determined by HPV Testing, and Accompanied by Either (1) Atypical Squamous Cells of Undetermined Significance (ASC-US) or (2) Low-Grade Squamous Intraepithelial Lesions (LSIL), as Determined by Cytology
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Vaginal cancer: the full pagePrimary vaginal cancer is rare and mostly caused by HPV, the virus behind cervical cancer. It is treated like cervical cancer, with weekly cisplatin alongside external and internal radiotherapy, which controls most tumours while preserving the organ; HPV vaccination and cervical screening, which also detects vaginal precursors, are steadily reducing it.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Cervical precancer (CIN, HSIL/LSIL): Abnormal cervical cells caused by HPV that can turn into cancer over 10-20 years.
- HPV status (HPV-positive / HPV-negative): Whether a cancer is caused by human papillomavirus.
- HPV-positive (p16) head and neck cancer: Throat cancers caused by the human papillomavirus, identified by a p16 stain.
- Chemoradiation (chemoradiotherapy, CRT): Radiotherapy given at the same time as chemotherapy, which sensitises the cancer to radiation.
Every term links to the glossary.