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Treatment Options for Precancerous Lesions in the Vagina

Vaginal cancer usually begins with precancerous changes that may take place over many years. Precancerous lesions in the vagina are often called vaginal intraepithelial neoplasia (VAIN). Intraepithelial means that the precancerous cells are only in the lining layer of the vagina. This is called the epithelium. These changes can eventually develop into invasive vaginal cancer in some women.

The most advanced grade of VAIN is also called carcinoma in situ or stage 0 vaginal cancer.

If your doctor makes a diagnosis of VAIN with colposcopy and biopsy, he or she may treat it right away. The type of treatment your doctor suggests depends, in part, on how far the lesion has progressed. Your doctor may suggest one of these types of treatments:

  • Laser therapy. This uses a narrow beam of light to destroy or remove abnormal cells. This procedure is usually done in a hospital under general anesthesia (drugs are used to put you into a deep sleep). You will likely not need an overnight stay. Cramping after the procedure is common. Bleeding may occur and then diminish over several weeks.

  • Topical chemotherapy. Your doctor applies a chemotherapy drug to the lining of the vagina. The drug kills cancer cells in the lining. The drug most often used is Efudex (fluorouracil, also called 5-FU). You usually receive treatments once a week for about 10 weeks or every night for 1 or 2 weeks. You may notice irritation to the vagina or vulva.

  • Other types of treatment. Your doctor may recommend other types of treatment based on your own needs. Partial vaginectomy is surgery to remove part of your vagina. Your doctor may recommend radiation therapy to kill any remaining cancer cells after other procedures. Your doctor may also suggest radiation if other treatments are not possible.

What to expect after your treatment depends on which treatments you receive. Your doctor will explain steps you can take to aid healing. Be sure to ask your doctor how often you’ll need follow-up exams or tests. For example, you may need more frequent Pap tests or colposcopy.