How is vaginal cancer diagnosed?
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 and possibly a Pap test and a vaginal biopsy.
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.
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. 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.
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 computed tomography (CT) scan is an x-ray test that produces detailed cross-sectional images of your body. Instead of taking one picture, like a standard 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. 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.
A CT scanner has been described as a large donut, with a narrow table in the middle opening. You will need to lie still on the table while the scan is being done. CT scans take longer than regular x-rays, and you might feel a bit confined by the ring while the pictures are being taken.
Before the test, 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 line through which a different kind of contrast dye (IV contrast) is injected. This helps better outline structures such as blood vessels in your body.
The injection can cause some flushing (redness and warm feeling). A few people are allergic to the dye and get hives, or rarely, have more serious reactions like trouble breathing and low blood pressure. Be sure to tell the doctor if you have ever had a reaction to any contrast material used for x-rays.
CT-guided needle biopsy:
CT scans can also be used to guide a biopsy needle precisely into a suspected tumor. For this procedure, the patient remains on the CT scanning table, while a doctor moves a biopsy needle through the skin and toward the tumor. CT scans are repeated until the needle is within the mass. A fine-needle biopsy sample or a core needle biopsy sample is removed and looked at under a microscope. Although this is not used to biopsy vaginal tumors, it may be used to biopsy possible metastasis.
Magnetic resonance imaging (MRI)
Magnetic resonance imaging (MRI) scans use radio waves and strong magnets instead of x-rays to make images of the body. The energy from the radio waves is absorbed by the body and then released in a specific pattern formed by the type of tissue and by certain diseases. A computer translates the pattern into a detailed image of parts of the body. Like a CT scanner, this produce cross-sectional slices of the body. An MRI can also produce slices that are parallel with the length of your body. As with a CT scan, a contrast material might be used, but it is not needed as often.
MRI scans are more uncomfortable than CT scans. They take longer -- often up to an hour. You have to be placed inside tube-like equipment. This is confining and can upset people with claustrophobia (a fear of close spaces). If you have trouble with close spaces, let your doctor know before the MRI scan. Sometimes medication can be given just before the scan to reduce anxiety. Another option is to use a special "open" MRI machine that is less confining and more comfortable for such people, the drawback being that the images from these machines are not as good.. The machine also makes a buzzing or clanging noise that some people find disturbing. Some places will provide headphones with music to block this sound.
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 low-level 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.
These tests are not often used to evaluate women with vaginal cancer.
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 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.
Last Medical Review: 01/30/2013
Last Revised: 02/13/2014