Why Vaginal Cancer Treatment Is Complex
Vaginal cancer sits between the bladder and rectum, making surgery technically challenging without compromising urinary or bowel function. For this reason, radiotherapy — either alone or as concurrent chemoradiation — is the treatment of choice for most cases of invasive vaginal cancer.
Radiation Therapy: External Beam and Brachytherapy
- External beam radiation therapy (EBRT) — treats the vagina, parametrium, and pelvic lymph nodes with precisely focused radiation beams over 5–6 weeks. Modern IMRT or VMAT reduces the radiation dose to adjacent bowel and bladder, limiting toxicity.
- Brachytherapy (internal radiation) — a radiation source is placed inside the vagina or directly into the tumour, delivering a high localised dose to residual disease. This boost significantly improves local control rates.
For locally advanced disease (Stages II–IVA), concurrent cisplatin-based chemotherapy is added to sensitise the tumour to radiation — a strategy derived from cervical cancer data.
Surgery for Vaginal Cancer
- Stage I (superficial) tumours of the upper vagina — radical vaginectomy may offer equivalent results to radiotherapy while preserving ovaries in young women
- Vaginal intraepithelial neoplasia (VAIN) — localised excision, laser ablation, or topical 5-fluorouracil cream may be appropriate
- Recurrence after radiotherapy — pelvic exenteration may be considered for selected recurrent cases
Survivorship and Quality of Life
Radiotherapy to the vagina and pelvis carries risks of long-term effects including vaginal stenosis, sexual dysfunction, bladder and bowel changes, and lymphoedema of the lower limbs. Patients should be counselled on the use of vaginal dilators after treatment, pelvic floor physiotherapy, and ongoing follow-up.
Survivorship planning — discussing these side effects, their management, and psychosexual support — is an integral part of comprehensive gynaecological oncology care.
Contact Dr. Nishtha Tripathi Patel at +91 76988 00333 for specialist consultation on vaginal cancer treatment in Ahmedabad.