context: Vaginal cancer happens when malignant (cancerous) cells form in the vagina. It's a very uncommon disease. The vagina -- also known as the birth canal -- is a hollow channel that goes from the opening of your uterus to the outside of your body. There are two main types of vaginal cancer: Squamous cell carcinoma : This is by far the more common of the two. It happens when cancer forms in the flat, thin cells that line the vagina. This type spreads slowly and tends to stay close to where it starts. But it can move into other organs including the liver, lungs, or bones. Older women are most likely to get this form of the disease. Nearly half of all cases occur in those age 60 and up. Adenocarcinoma: This type starts in the glandular cells in the lining of the vagina. These cells make mucus and other fluids. Of the two main types, it's the more likely to spread to other areas. These include the lymph nodes (organs that filter harmful substances in the body) in the groin area and the lungs. Clear cell carcinoma: This is an even rarer form of adenocarcinoma. It's been linked with women whose mothers took a hormone called diethylstilbestrol ( DES) in the early months of pregnancy. Between 1938 and 1971, doctors often prescribed this medication to pregnant women to prevent miscarriage and other problems. Doctors stopped using it in 1971. But just how long do you remain at risk if your mother was given DES? That remains unknown. Women who haven't been exposed to it can still get vaginal cancer, but the chances are very small. If DES isn't a factor, clear cell carcinoma is most likely to happen after menopause. About nine out of every 10 vaginal cancer cases are linked to human papilloma virus, or HPV, infection. This is the most common STI, or sexually transmitted infection. An HPV infection most often goes away on its own, but if the infection lingers, it can lead to cervical and vaginal cancers. The following things can also increase your chances of developing vaginal cancer: Drinking alcohol Having cervical cancer or pre-cancer Having HIV Smoking Many cases of vaginal cancer aren't linked to any specific causes. These can include pain or abnormal vaginal bleeding. But the disease often doesn't come with any warning signs. Your doctor might find it during a routine exam or Pap test. Other symptoms can include feeling a lump in your vagina, pain in your pelvis, and painful sex. If you notice any of these things, it doesn't mean you have vaginal cancer. You could just have an infection. But it's important to get it checked out. If a pelvic exam or a Pap test shows there might be cancer, your doctor may want to take a closer look with a procedure called colposcopy. She'll use a lighted magnifying instrument -- a colposcope -- to check your vagina and cervix for anything abnormal. She might take tissue samples at the same time. A specialist will study the samples under a microscope. This is called a biopsy. If she finds cancer, your doctor will choose a treatment based on many factors. These include how close the cancer is to other organs, which type of cancer is present, how advanced it is, whether you've had a hysterectomy, and if you've had radiation treatment in your pelvic area. Most likely, your doctor will recommend one of the following courses of action: Surgery. This is the most common treatment. Your doctor may use a laser to cut out affected tissue or growths. In some cases, she may need to remove all or part of the vagina. Or she'll perform a hysterectomy. This is when the uterus is taken out. Sometimes the cervix or other organs need to be removed, too. Many women can have a normal sex life after surgery. Your doctor will need to tell you what's safe and when. Sex can increase the chance of infection, and it can cause bleeding or strain the surgical site. How you're healing and what kind of surgery you've had will make a difference in the effect on your sex life, too. Radiation therapy. This treatment uses high-powered X-rays or other forms of radiation to kill the cancer. It might be performed using a machine that sends X-rays into your body from outside. Your doctor might also place a protected radioactive substance inside your body on or near the cancer. Radiation treatments in the pelvic area can damage the ovaries. This cuts off estrogen production, which leads to menopause symptoms like hot flashes and vaginal dryness. If you've already been through menopause, these symptoms likely won't happen. This type of therapy also can irritate healthy tissue. Your vagina might get swollen and tender. Sex may be painful. Chemotherapy (â Chemoâ). This kills or stops the growth of cancer cells using medications. You might take them by mouth or get them through an IV. If you have squamous cell vaginal cancer, your doctor might prescribe a chemo treatment in lotion or cream form. Many patients lose their sex drive when they get chemo. Plus, the physical side effects, like nausea, hair loss, and changes in body weight can cause feelings of insecurity. Knowing that the physical side effects will improve when treatment stops can help a lot. The best way to guard against it is to avoid being exposed to HPV. The FDA has approved the Gardasil 9 vaccine to prevent HPV-related diseases, including the four most common types of HPV. If you don't want the vaccine, you might try the following lifestyle changes. Studies show they may help to reduce your risk of vaginal cancer: Wait to have sex until your late teen years or beyond. Don't have sex with more than one partner. Don't have sex with someone who has more than one partner. Use condoms during sex. Get regular Pap exams. If you smoke, stop. If you don't smoke, don't start. Vaginal cancer often can be cured if it's detected and treated early.