If a woman has any of the signs or symptoms of vaginal cancer, she should see a doctor. If the Pap test detects abnormal cells, or if the pelvic exam results are not normal, more tests will be needed. This may mean referral to a gynecologist (specialist in problems of the female genital system).
Signs and symptoms of vaginal cancer
More than 8 out of 10 women with invasive vaginal cancer have one or more symptoms, such as:
- Abnormal vaginal bleeding (often after intercourse)
- Abnormal vaginal discharge
- A mass that can be felt
- Pain during intercourse
Symptoms of advanced vaginal cancer may be painful urination, constipation, and continuous pain in the pelvis.
Having these symptoms does not always mean that you have cancer. In fact, these symptoms are more likely to be caused by a benign condition, like an infection. The only way to know for sure what is causing these problems is to see your health care professional. If you have any of these symptoms, discuss them with your doctor right away. Remember, the sooner the problem is correctly diagnosed, the sooner you can start treatment, and the more effective your treatment will be.
Medical history and physical exam
The first step is for the doctor to take a complete medical history to check for risk factors and symptoms. Then your doctor will physically examine you, including a pelvic exam with a Pap test and possible biopsy.
Colposcopy
If certain symptoms suggest cancer or if the Pap test shows abnormal cells, you will need to have a test called colposcopy. In this procedure you will lie on the exam table as you do for a pelvic exam. A speculum is placed in the vagina. The doctor will use the colposcope to examine the cervix and vagina. The colposcope stays outside of the body and has magnifying lenses (like binoculars). When the doctor looks through the colposcope, he or she can see the vaginal walls and the surface of the cervix closely and clearly. Sometimes a weak solution of acetic acid (similar to vinegar) or iodine is applied to make any abnormal areas easier to see. Using a colposcope to look at the vagina is called vaginoscopy.
Colposcopy itself is no more painful than a speculum exam and can be done safely even if you are pregnant. If an abnormal area is seen on the cervix or vagina, a biopsy will be done. The biopsy can be slightly painful and may some cause pelvic cramping.
Biopsy
Certain signs and symptoms may strongly suggest vaginal cancer, but many of them can be caused by conditions that aren't cancer. The only way to be certain that cancer is present is to do a biopsy. In this procedure, a small piece of tissue from the suspicious area is removed and examined under the microscope. A pathologist (a doctor specializing in diagnosing diseases by laboratory tests) will look at the tissue sample under a microscope to see if cancer or a pre-cancerous condition is present and, if so, what type it is.
Imaging tests
Chest x-ray
If vaginal cancer is diagnosed, a plain x-ray of your chest may be done to see if your cancer has spread to your lungs. This is very unlikely unless your cancer is far advanced. This x-ray can be done in any outpatient setting.
Computed tomography (CT)
The CT scan is an x-ray procedure that produces detailed cross-sectional images of your body. Instead of taking one picture, as does a conventional x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these pictures into an image of a slice of your body (think of a loaf of sliced bread). The machine will take pictures of multiple slices of the part of your body that is being studied.
Before any pictures are taken, you may be asked to drink 1 to 2 pints of a liquid called oral contrast. This helps outline the intestine so that certain areas are not mistaken for tumors. You may also receive an IV (intravenous) line through which a different kind of contrast dye (IV contrast) is injected. This helps better outline structures in your body.
The injection can cause some flushing (redness and warm feeling that may last hours to days). A few people are allergic to the dye and get hives. Rarely, more serious reactions like trouble breathing and low blood pressure can occur. Medicine can be given to prevent and treat allergic reactions. Be sure to tell the doctor if you have ever had a reaction to any contrast material used for x-rays.
CT scans take longer than regular x-rays and you will need to lie still on a table while they are being done. Also, you might feel a bit confined by the ring-like equipment you’re in when the pictures are being taken.
A CT scan can provide information about the size, shape, and position of a tumor, and can be helpful to see if the cancer has spread to other organs. It can also help find enlarged lymph nodes that might have cancer cells.
CT scans can also be used to precisely guide a biopsy needle into a suspected area of cancer spread. For this procedure, called a CT-guided needle biopsy, you remain on the CT scanning table while a doctor moves a biopsy needle toward the mass. CT scans are repeated until the doctor is sure that the needle is inside the mass. A fine needle biopsy sample (tiny fragment of tissue) or a core needle biopsy sample (a thin cylinder of tissue about ½ inch long and less than 1/8 inch in diameter) is removed and looked at under a microscope.
Magnetic resonance imaging (MRI)
MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of the body. Not only does this produce cross sectional slices of the body like a CT scanner, it can also produce slices that are parallel with the length of your body.
Sometimes a contrast material is injected into a vein to help better see some structures in the body. The contrast used for MRI is different than the one used for CT, so being allergic to one does not mean that you are allergic to the other. MRI scans are a little more uncomfortable than CT scans. First, they take longer -- often up to an hour. Also, you have to be placed inside a tube, which is confining and can upset people with claustrophobia (a fear of close spaces). Newer, “open MRI” machines can help people with this fear. The machine also makes a thumping noise that many people find annoying. Some places will provide headphones with music to block this out.
MRI images are particularly useful in examining pelvic tumors. They may often detect enlarged lymph nodes in the groin. They are also helpful in detecting cancer that has spread to the brain or spinal cord. This rarely occurs in vaginal cancer.
Positron emission tomography
Positron emission tomography (PET) uses glucose (a form of sugar) that contains a radioactive atom. Because cancers use glucose at a higher rate than normal tissues, the radioactivity tends to concentrate in the cancer. A special camera is used to detect the radioactivity. This test can be helpful for spotting collections of cancer cells, and can be useful to see if the cancer has spread to lymph nodes. PET scans are also useful when your doctor thinks the cancer has spread, but doesn’t know where. PET scans can be used instead of several different x-rays because they scan your whole body. Special machines that combine a CT scan and a PET scan can even better pinpoint the tumor. PET scans are not often used in vaginal cancer, but they may be helpful in finding areas of cancer spread.
Endoscopic tests
These tests are not often used to evaluate women with vaginal cancer.
Proctosigmoidoscopy
Proctosigmoidoscopy is a procedure that looks at the rectum and part of the colon. It is done to check for spread of vaginal cancer to the rectum or colon. In this procedure a slender, flexible, hollow, lighted tube is placed into the rectum. Any areas that look suspicious will be biopsied. This test may be somewhat uncomfortable, but it should not be painful. Proctosigmoidoscopy may be recommended for patients whose vaginal cancers are large and/or located in the part of the vagina next to the rectum and colon.
Cystoscopy
Cystoscopy is a procedure that looks at the inside of the bladder. It is done to check for spread of vaginal cancer to the bladder. This procedure can be done in the doctor's office or clinic. You may be given an intravenous medication to make you drowsy. A thin tube with a lens and light is inserted into the bladder through the opening called the urethra. If suspicious areas or growths are seen, a biopsy will be done. Cystoscopy may be recommended if a vaginal cancer is large and/or located in the front wall of the vagina, near the bladder.
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