Clear Cell Adenocarcinoma of the Vagina and Cervix, from the CureRays guide library.

Clear cell adenocarcinoma of the vagina or cervix is a rare gland-cell cancer historically linked to a medication (DES) given to some pregnant women decades ago, and it is treated with surgery and radiation, often combined, with very good results when caught early.

What it is.

Clear cell adenocarcinoma is a rare cancer that arises from gland-like cells in the vagina or cervix and gets its name from the clear appearance of its cells under the microscope. It became well known because of a historical link: daughters of women who took a synthetic estrogen called diethylstilbestrol (DES) during pregnancy between roughly the 1940s and early 1970s had a higher risk of developing it as teenagers and young adults. Because DES has not been used in pregnancy for many years, today the cancer is increasingly seen in older women with no DES exposure. It can cause abnormal vaginal bleeding or discharge and is often found during a pelvic exam or follow-up. Treatment combines surgery and radiation, and outcomes are generally good, especially when the cancer is found early.

How radiation treats it.

Radiation damages the DNA inside cancer cells so they can no longer divide and the tumor shrinks. For clear cell adenocarcinoma of the vagina or cervix, radiation is one of the main curative treatments. It is often delivered in two complementary ways: external beams that treat the whole area and any lymph nodes, and brachytherapy, in which a radiation source is placed right at the tumor to give a very high local dose while sparing nearby organs like the bladder and rectum. Modern image guidance and intensity-modulated techniques shape the dose precisely. Radiation is painless during delivery, given over a planned schedule, and external-beam treatment leaves no radioactivity in the body.

The ways we can treat it.

External-beam radiation (IMRT/IGRT). Shaped, image-guided beams treat the pelvis and the tumor while sparing the bladder, rectum, and bowel, lowering side effects.

Brachytherapy (internal radiation). A radiation source is placed inside the vagina or close to the tumor, delivering a high, precise dose to the cancer over a short distance while sparing surrounding tissue — a powerful tool for these cancers.

Concurrent chemoradiation. A radiation-sensitizing chemotherapy is given during radiation so that each treatment damages cancer cells more effectively together than either alone.

Questions we hear often.

I was exposed to DES before birth — should I be screened? Women exposed to DES in the womb are advised to have regular pelvic exams that specifically check the vagina and cervix, because their risk is higher than average even though the cancer remains rare. Tell your gynecologist about DES exposure so screening can be tailored. Most DES-exposed women never develop this cancer.

Is this cancer caused by HPV like most cervical cancers? No. Clear cell adenocarcinoma is generally not linked to HPV, which makes it different from the common types of cervical cancer. That is one reason it can occur in people who have had normal Pap and HPV tests, and why any unusual bleeding should be checked.

Will treatment affect fertility? It can, because surgery and pelvic radiation may affect the reproductive organs. For some young women with small, early tumors, fertility-sparing approaches may be possible at expert centers. Ask your care team about fertility preservation before treatment begins.

This guide is informational only. It is not medical advice — please confirm anything here with your care team.