What are vaginal cancer medications?

Preventive vaccines against human papilloma virus (HPV) is a central pillar of preventing vaginal cancer. Treatments include surgery using various techniques, topical chemotherapy treatments and systemic chemotherapy if the cancer spreads.
Preventive vaccines against human papilloma virus (HPV) is a central pillar of preventing vaginal cancer. Treatments include surgery using various techniques, topical chemotherapy treatments and systemic chemotherapy if the cancer spreads.

Vaginal cancer medications are drugs used in the treatment of vaginal cancer. Medications for vaginal cancer include preventive vaccines, topical applications in precancerous stages, and chemotherapy, the primary treatment for cancer that has spread.

Vaccines are given to protect against human papillomavirus (HPV) infection, which is strongly associated with vaginal cancer. Topical applications for vaginal cancer in the precancerous stage include a chemotherapy drug known as fluorouracil and a cream called imiquimod that stimulates immune response to the tumor.

Chemotherapy is an integral part of vaginal cancer treatment, most often administered along with radiation, which is known as chemoradiation. FDA has not approved any medication specifically to treat vaginal cancer, but has approved HPV vaccines as a preventive measure.

Chemotherapy medications such as cisplatin and docetaxel are commonly used off-label to treat vaginal cancer.

What are the types of vaginal cancer medications?

Vaginal cancer medications are of three primary types:

  • Preventive vaccination against HPV infection
  • Topical applications of chemotherapy and/or immunotherapy
  • Systemic chemotherapy

How do vaginal cancer medications work?

Medications used to treat vaginal cancer work in the following ways:

  • Lower the risk of vaginal cancer from HPV infection
  • Directly kill cancer cells
  • Enhance the effect of radiation
  • Stimulate immune activity against cancer cells
  • Provide palliative care in advanced stages

Preventive vaccines

Vaccines may help prevent HPV infection, a known risk for vaginal cancer. The only medications FDA has specifically approved for prevention of vaginal cancer are the following HPV vaccines:

  • Recombinant HPV quadrivalent vaccine (Gardasil)
  • Recombinant HPV nonavalent vaccine (Gardasil 9)

Topical applications

Topical applications are creams and lotions applied directly in the vaginal canal, and may cause irritation. Topical applications may be used only for the second and third stages of vaginal intraepithelial neoplasia, often as an adjunct to radiation, and not for invasive vaginal cancer. Two types of ointments are used as vaginal applications:

  • Fluorouracil: A chemotherapy ointment which kills abnormal cells.
  • Imiquimod: An immunotherapy drug which stimulates immune activity against abnormal cells.

Systemic chemotherapy

Systemic chemotherapy drugs are used in all stages of vaginal cancer except in stage I, which is typically treated with radiation and/or surgery. Chemotherapy kills cancer cells, helps shrink the tumor and enhances radiation’s effects. Chemotherapy drugs commonly used off-label to treat vaginal cancer include:

  • Cisplatin
  • Carboplatin
  • Paclitaxel
  • Docetaxel
  • Irinotecan hydrochloride

Additional information

  • Please visit our medication section of each drug within its class for more detailed information.
  • If your prescription medication isn’t on this list, remember to look on MedicineNet.com drug information or discuss with your healthcare provider and pharmacist.
  • It is important to discuss all the drugs you take with your doctor and understand their effects, possible side effects and interaction with each other.
  • Never stop taking your medication and never change your dose or frequency without consulting with your doctor.

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What is vaginal cancer?

Vaginal cancer is a cancerous growth in the vagina, a part of the female reproductive system. Vagina, also known as the birth canal, is the passage between the uterus opening (cervix) and the external genitals (vulva). The vagina is a muscular tube lined with folds of tissue which allow expansion during sex or childbirth.

Cancers are uncontrolled growth of abnormal cells which may form lesions, warts or masses of tissue known as tumors. Tumors are termed benign when they grow but do not spread. When tumors turn malignant, they can invade nearby tissue and also spread (metastasize) to distant parts of the body.

Vaginal cancer is a rare form of cancer, and cancer originating in the vagina is even rarer. Approximately 80% of vaginal cancers are metastatic, originating in the cervix or the uterus lining (endometrium). Cancers originating in the vulva, ovaries or the bladder may also spread to the vagina, though these are less common. Consequently, the cancer type (cervix or other types) should be determined so the metastatic cancer type can be treated.

Types of vaginal cancer

  • Squamous cell carcinoma: Squamous cell carcinoma is the most common, accounting for approximately 85% of vaginal cancers. Squamous cells are a type of flat cells found on the skin and lining of the body’s organs. Squamous cell cancer usually develops in the upper third portions of the vagina and typically in older women.
    • Verrucous carcinoma: Verrucous carcinoma grows into a large cauliflower-like wart, and is a rare form of squamous cell carcinoma.
  • Adenocarcinoma: Adenocarcinoma is a cancer that develops in glandular cells in the vagina’s lining, which produce lubricating fluids. Adenocarcinoma accounts for approximately 9% of vaginal cancers and is more likely than squamous cell carcinoma to spread to other parts of the body.
    • Clear cell adenocarcinoma: Clear cell adenocarcinoma is a cancer that occurs in late teens in women whose mothers took diethylstilbestrol (DES) in early pregnancy. DES was a hormone initially prescribed to prevent miscarriage, but was banned by the FDA in 1971, for use in pregnancy.
  • Melanoma: Melanoma affects the pigment-producing skin cells, and is a rare primary vaginal cancer.
  • Embryonal rhabdomyosarcoma: Also known as sarcoma botryoides, embryonal rhabdomyosarcoma is a rare vaginal cancer that occurs in young children. It is an aggressive and malignant form of cancer characterized by grapelike growth in the vaginal walls.
  • Yolk sac tumor: Also known as endodermal sinus tumor, yolk sac tumor is an extremely rare vaginal cancer that occurs in children. Yolk sac tumor more commonly affects the ovaries, a cancer of germ cells which grow into eggs in the ovaries.
  • Vaginal leiomyosarcoma: Vaginal leiomyosarcoma is an extremely rare cancer that originates in the vagina’s muscle walls.

Stages of vaginal cancer

The stages of vaginal cancer include the following:

  • Vaginal intraepithelial neoplasia (VaIN): VaIN is a precancerous stage with abnormal cells in the vaginal tissue. VaIN is classified into three stages, VaIN1, VaIN2 and VaIN3, depending on the extent and depth of the vaginal tissue in which VaIN is present. VaIN1 may go away on its own, but VaIN2 and VaIN3 must be treated immediately.
  • Stage I: Cancer is limited to the vaginal wall.
  • Stage II: Cancer has invaded deep vaginal tissue.
  • Stage III: Cancer has spread to the pelvic wall and nearby lymph nodes.
  • Stage IVa: Cancer has grown beyond the pelvis and spread to the nearby organs such as the bladder and rectum.
  • Stage IVb: Cancer has spread to distant parts in the body, such as lungs, liver or bones.

What are the symptoms of vaginal cancer?

The symptoms of vaginal cancer include the following:

What are the risk factors for vaginal cancer?

The exact cause of vaginal cancer is not known, but the following are major risk factors for developing vaginal cancer:

  • Advanced age, particularly in the case of squamous cell cancer
  • Use of diethylstilbestrol by the woman’s mother in early pregnancy
  • Infections such as:
  • Cervical or vulvar cancer
  • Prior radiation to the pelvis, chemotherapy or immunosuppressive therapy
  • Irritation to the vagina from long-term pessary use for cervical prolapse
  • Smoking 

What is the treatment for vaginal cancer?

Treatment for vaginal cancer depends on its type and stage. Being a rare type of cancer, there are no specific treatment protocols for vaginal cancer. Treatments are typically similar to more common cancers such as cervical cancers. Patients also have the option of enrolling for clinical trials for new treatments. There are three standard treatments for vaginal cancer:

Radiation therapy

Radiation therapy is the use of high-energy X-rays to destroy the cancer cells. Radiation therapy is an integral part of vaginal cancer treatment, used in all stages. Radiation in early stages of cancer destroys cancer cells, and in advanced stages radiation is used as palliative therapy to reduce symptoms and bleeding.

Radiation therapy for vaginal cancer are of two types:

  • External beam radiation: X-rays are directed at the vagina from a device that is placed outside the body.
  • Internal radiation: Also known as brachytherapy, in internal radiation therapy the X-ray device is placed inside the vagina.

Surgery

Surgery for vaginal cancer depends on the size and extent of tumor and mostly used in the first two stages of vaginal cancer.

  • Laser surgery: Use of laser beams to destroy abnormal cells and remove surface lesions on the vagina, useful mainly for vaginal intraepithelial neoplasia.
  • Wide local excision: Removal of the cancerous lesions in the vagina with a margin of healthy tissue, useful mainly in early stages.
  • Vaginectomy: Vaginectomy is the surgical removal of a part of, or the entire vagina. Vaginectomy may require reconstruction of the vagina with skin grafts from other parts of the body.
  • Trachelectomy: Removal of the upper vagina, cervix and the tissue around it, because vaginal cancer most often starts in the upper part of the vagina, close to the cervix.
  • Hysterectomy: Removal of the uterus and cervix, known as total hysterectomy. Depending on the stage and spread of cancer, the procedure may include removal of one or both ovaries (salpingo-oophorectomy) or a radical hysterectomy in which some of the surrounding tissue is also removed.
  • Lymphadenectomy: Removal of the nearby lymph nodes in the pelvis and/or the groin.
  • Pelvic exenteration: Removal of nearby organs such as cervix, ovaries, rectum, lower colon or bladder, depending on the extent of cancer spread in the pelvic region.

Medications

Medications are used in almost all stages of vaginal cancer, including precancerous stages. Medications may be topical applications, oral formulations or injections.

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Medically Reviewed on 4/5/2021
References
https://emedicine.medscape.com/article/269188-overview#a1

https://www.webmd.com/cancer/what-is-vaginal-cancer

https://www.cancer.org/cancer/vaginal-cancer/treating/chemotherapy.html

https://www.cancer.gov/types/vaginal/patient/vaginal-treatment-pdq#link/_55

https://www.cancer.gov/about-cancer/treatment/drugs/vaginal