How is vaginal cancer diagnosed?
You might have some or all the following tests to confirm a diagnosis of vaginal cancer.
Once vaginal cancer is suspected, you should be referred to a gynaecologic oncologist. This is a doctor who has specialist training in cancer of the female reproductive system.
Physical examination and medical history
At the hospital, the gynaecologic oncologist will do a full pelvic examination. This will include examining the inside of your vagina to check for any lumps or swellings. The doctor will also feel your groin and pelvic area to check for any swollen glands, and may also check your rectum.
You will also have a test to check for cell changes in the vagina or cervix. Your doctor or nurse will use an instrument called a speculum to open the vagina and see your cervix. Your doctor or nurse will then collect some cells from the cervix using a small brush or spatula. This may feel slightly uncomfortable, but does not take very long. The cells are then sent to a laboratory where they are examined under a microscope for abnormalities. The results are usually available within 2 weeks.
The doctor will also ask you about your medical history.
[accordion collapsed]
Colposcopy
If the cells taken in the smear test are abnormal, your doctor may ask you to have a colposcopy.
This is a closer examination of the vagina using a colposcope, which is a small low-powered microscope that allows the doctor or specialist nurse to see the vagina in more detail.
A colposcope looks like a pair of binoculars sitting on a large stand. It does not enter the body – the doctor inserts an instrument called a speculum into your vagina and then views a magnified picture of the vagina, cervix and vulva through the colposcope.
Some colposcopes are fitted with a camera that is connected to a TV screen. This may allow you to watch what the doctor is doing. You should feel free to ask the doctor or nurse to explain what is happening.
[accordion collapsed]Biopsy
A small sample of tissue will be taken from any abnormal areas and sent to a pathologist to be examined under a microscope.
Further tests
If the above tests show that you have vaginal cancer, further tests may be necessary to find out whether any cancer cells have spread (metastasised) to other parts of the body (see Staging and grading). The results will help you and your doctor decide on the best treatment for you.
You may have 1 or more of the following tests.
Chest X-ray and blood tests
These are necessary to assess your general health and to check if the cancer has spread to the lungs.
CT, MRI or PET scans
Computerised tomography (CT) or magnetic resonance imaging (MRI) scans allow doctors to see pictures of the organs and other structures (including tumours) in your body. They are usually done at a hospital or radiology clinic.
Your doctor may also ask for a positron emission tomography (PET) scan (a type of nuclear imaging test).
Lymphangiogram
Lymphangiogram is a procedure used to X-ray the lymph system. A dye is injected into the lymph vessels in the feet. The dye travels upwards through the lymph nodes and lymph vessels, and X-rays are taken to see if there are any blockages. This test helps find out whether cancer has spread to the lymph nodes.
Endoscopy
Endoscopy refers to any procedure where the doctor inserts a thin tube in the body to look inside. There are different types of endoscopies, depending on the area of the body your doctor wants to examine. These tests are usually only done if the doctor thinks the cancer may have spread to different areas.
Cystoscopy
Cystoscopy is a test that allows the doctor to look at the interior lining of the bladder and the urethra, to see if the cancer has spread to this region. The cystoscope is a slender tube with a lens and a light that is inserted into the urethra and moved into the bladder.
Ureteroscopy
Ureteroscopy is a procedure to look inside the ureters to check for abnormal areas. Ureters are long, thin tubes that carry urine from the kidneys to the bladder.
A ureteroscope is inserted through the bladder and into the ureters, to see if cancer has spread to this region. A ureteroscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.
Ureteroscopy and cystoscopy may be done during the same procedure.
Proctosigmoidoscopy
Proctosigmoidoscopy is a procedure to look inside the rectum and part of the colon to check for abnormal areas. A thin, tube-like instrument with a light and a lens for viewing is inserted into the rectum. The instrument is called a proctoscope or a sigmoidoscope, and may also have a tool to remove tissue to be checked under a microscope for signs of disease.
Staging and grading
The stage of a cancer is a term used to describe its size and whether it has spread beyond its original area of the body.
The grade of a cancer describes how quickly the tumour is likely to grow.
Knowing the grade and stage of the cancer helps doctors decide on the most appropriate treatment.
Staging
If tests find vaginal cancer, 1 of the following stages will be used to describe your cancer:
- Stage 1: The cancer is only in the vagina and has not spread.
- Stage 2: The cancer has begun to spread through the wall of the vagina, but has not spread further into the walls of the pelvis.
- Stage 3: The cancer has spread to the pelvis and may also be in the lymph nodes close to the vagina.
- Stage 4: The cancer has spread to the bladder or the bowel, or to other parts of the body such as the lungs.
Grading
Grading refers to the appearance of the cancer cells under the microscope and gives an idea of how quickly the cancer may develop.
Low grade means the cancer cells look like normal cells. They are usually slow growing and are less likely to spread.
High grade means the cells look very abnormal. They are likely to grow more quickly and to spread.
Diagnosing vaginal intraepithelial neoplasia (VAIN)
During a physical examination, it is usually hard for the doctor to see any abnormalities on the lining of the vagina. This is made harder by the fact that VAIN is often high up in the vagina and in multiple places (multifocal).
If your doctor thinks you may have VAIN, you will be recommended to have a colposcopy and a biopsy to assess how likely the VAIN will develop into cancer, and if it should be treated.
Pathologists assess the seriousness of VAIN from the biopsy. Among other things, they look at how superficial or deep the abnormal cells have spread, and grade the risk of cancer developing. There are 3 grades of VAIN: VAIN1, VAIN2 and VAIN3. VAIN1 often goes away on its own, but VAIN2 and VAIN3 are often treated before they develop into vaginal cancer.
