If you have any of the signs or symptoms of vaginal cancer, you should see a doctor. A Pap test might be done for certain signs and symptoms. If it shows abnormal cells, or if a pelvic exam results are not normal, more tests will be needed. This may mean referral to a gynecologist (a doctor who specializes in problems of the female genital system).
The first step is for the doctor to take a complete medical history. Risk factors and symptoms will be discussed. Then your doctor will physically examine you, including a pelvic exam and possibly a Pap test and/or a vaginal biopsy.
If certain symptoms suggest cancer or if a Pap test is done and shows abnormal cells, you will need a test called colposcopy. In this procedure you lie on the exam table and a speculum is placed in your vagina to keep it open -- just like a pelvic exam. The doctor will use a colposcope to examine the cervix and vagina. The colposcope stays outside the body and has magnifying lenses (like binoculars). When the doctor looks through the colposcope, they can see the vaginal walls and the surface of the cervix closely and clearly. Sometimes a weak solution of acetic acid (much like vinegar) or iodine is used 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 regular pelvic exam and can be done safely even if you're 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 other problems. The only way to be certain that it's cancer is to do a biopsy. In this procedure, a small piece of tissue from the suspicious area is removed. A doctor specializing in diagnosing diseases with lab tests (a pathologist) will then 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 use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. Imaging tests may be done after a diagnosis of vaginal cancer to learn more about the cancer and see if it has spread.
A plain x-ray of your chest may be done to see if the cancer has spread to your lungs.
The computed tomography scan, most often called a CT or CAT scan, is an x-ray test that makes detailed cross-sectional images of your insides. 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.
CT-guided needle biopsy: CT scans can also be used to guide a biopsy needle into a suspected tumor. To do this, the patient lies 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 tip of the needle is inside the tumor. A small piece of the tumor is removed and looked at under a microscope. This isn't done to biopsy vaginal tumors, but it may be used to biopsy possible sites of cancer spread (metastases).
Magnetic resonance imaging (MRI) scans use radio waves and strong magnets instead of x-rays to make images of the inside of your body. The energy from the radio waves is absorbed by your 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 your body. An MRI can also produce slices that are parallel with the length of your body.
MRI images are particularly useful in examining pelvic tumors. They may show enlarged lymph nodes in the groin. They are also helpful in finding cancer that has spread to the brain or spinal cord. (This rarely happens with vaginal cancer.)
A positron emission tomography or PET scan uses a mildly radioactive sugar that's put into your blood. Because cancer cells use sugar at a higher rate than normal cells, they absorb more of the radioactive sugar. The areas of radioactivity can be seen with a special camera.
The picture is not finely detailed like a CT or MRI scan, but it provides helpful information about your whole body. PET scans are not often used in women with early vaginal cancer, but they may be helpful in finding areas of cancer spread in more advanced cancers.
These endoscopy procedures are not used often for women with vaginal cancer, but they may be needed in certain cases.
This test may be done if the vaginal cancer is large and/or in the part of the vagina next to the rectum and colon. Proctosigmoidoscopy looks at the rectum and part of the colon. It’s done to check for spread of vaginal cancer to these organs. In this procedure a thin, flexible, lighted tube is put into the rectum. The doctor can look closely and the inside of the rectum and the last part of the colon to look for cancer spread. Any areas that look suspicious will be biopsied. This test may be somewhat uncomfortable, but it should not be painful.
Cystoscopy may be recommended if a vaginal cancer is large and/or is in the front wall of the vagina, near the bladder. This procedure allows the doctor to look at the inside of the bladder. It’s done to check for spread of vaginal cancer to the bladder. It can be done in the doctor’s office or clinic. You might be given an intravenous (IV) drug to make you drowsy. A thin tube with a lens and light is put into the bladder through the urethra. If suspicious areas or growths are seen, a biopsy will be done.
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American Society of Clinical Oncology. Vaginal Cancer: Diagnosis. 08/2017. Accessed at www.cancer.net/cancer-types/vaginal-cancer/diagnosis on March 8, 2018.
National Cancer Institute. Vaginal Cancer Treatment (PDQ®)–Patient Version. October 13, 2017. Accessed at www.cancer.gov/types/vaginal/patient/vaginal-treatment-pdq on March 8, 2018.
Society of Gynecologic Oncology. Vaginal Cancer. What tests might your gynecologic oncologist perform to determine treatment? Accessed at www.sgo.org/patients-caregivers-survivors/patients/vaginal-cancer-what-tests-might-your-gynecologic-oncologist-perform/ on March 8, 2018.
Last Revised: July 21, 2020