Diagnosis of vaginal cancer

Usually, diagnosing vaginal cancer begins when a routine pelvic examination or Pap test suggests a problem with the vagina. Your doctor will ask you about any symptoms you have and do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for vaginal cancer or other health problems.

The process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as vaginal cancer. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of vaginal cancer.

The following tests are usually used to rule out or diagnose vaginal cancer. Many of the same tests used to diagnose cancer are used to find out the stage (how far the cancer has progressed). Your doctor may also order other tests to check your general health and to help plan your treatment.

Your health history is a record of your symptoms, risk factors and all the medical events and problems you have had in the past. Your doctor will ask questions about your history of:

• symptoms that suggest vaginal cancer
• smoking
• exposure to diethylstilbestrol (DES) before birth
• vaginal, vulvar or cervical precancerous conditions and treatment
• cervical, vulvar or anal cancer
• HIV

A physical exam allows your doctor to look for any signs of vaginal cancer. During a physical exam, your doctor may:

• do a pelvic exam
• do a digital rectal exam (DRE) to feel for a lump or thickened area
• feel the lymph nodes in the groin and above the collarbone to see if they are swollen

Find out more about physical exam, pelvic exam and digital rectal exam (DRE).

A colposcopy is a procedure that uses a colposcope (a lighted magnifying instrument) to examine the vulva, the vagina and the cervix.

A colposcopy is done after an abnormal Pap test or a positive HPV test suggests you may have a precancerous condition of the vagina or vaginal cancer. A colposcopy may also be done if you have symptoms of vaginal cancer.

A colposcopy is done in much the same way as a Pap test. The doctor places a speculum in the vagina. The speculum is a plastic or metal device that separates the walls of the vagina so the doctor can clearly see the cervix and vagina. The doctor may swab the area with a solution that makes it easier to see abnormal areas. The doctor then uses a colposcope to carefully examine the inside surface of the cervix and the vagina. The colposcope is positioned outside the opening of the vagina, rather than inserted into the vagina. If there is an abnormal area on the vagina, the doctor may do a biopsy during the colposcopy.

It is better to have a colposcopy when you aren’t menstruating. Avoid sexual intercourse, vaginal douches, vaginal medicines and contraceptive (spermicidal) creams, foams and gels (except as directed by your doctor) for 48 hours before the test. These should be avoided because they can interfere with the procedure and may affect the test results.

A pregnant woman can have a colposcopy if her doctor recommends it.

During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a pathology lab. A report from the pathologist will confirm whether or not cancer cells are found in the sample.

The following biopsies may be used to test cells and tissue from the vagina.

This biopsy is done during a colposcopy. A local anesthetic (freezing) may be used to numb the cervix. The doctor uses biopsy forceps to remove small amounts of tissue from areas that look abnormal in the cervix or vagina.

The procedure may cause mild cramping or pain. You may have some light bleeding from the vagina after a colposcopic biopsy.

A biopsy may be taken from lymph nodes that look abnormal in the groin or above the collarbone. A CT scan is used to guide the biopsy needle to the lymph nodes to collect samples from them.

The sentinel node is the first lymph node in a chain or cluster of lymph nodes that receives fluid from the area around a tumour. Cancer cells will most likely spread to these lymph nodes first. A sentinel lymph node biopsy removes the sentinel lymph node so it can be examined to see if it contains cancer cells. A sentinel lymph node biopsy may be done for vaginal melanoma.

Find out more about a biopsy and a sentinel lymph node biopsy.

A CBC measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to check for anemia from long-term, or chronic, vaginal bleeding. A CBC also gives doctors a baseline to compare future blood tests to during and after treatment.

Find out more about a complete blood count (CBC)..

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can help find abnormalities. Blood chemistry tests used to diagnose and stage vaginal cancer include the following:

• Blood urea nitrogen (BUN) and creatinine may be measured to check kidney function. Increased levels could mean that cancer has spread to the ureters or kidneys.
• Alanine aminotransferase (ALT), aspartate transaminase (AST) and alkaline phosphatase may be measured to check liver function. Increased levels could mean that cancer has spread to the liver.

Find out more about blood chemistry tests.

An x-ray uses small doses of radiation to make an image of the inside of the body on film. A chest x-ray is used to see if cancer has spread to the lungs. An x-ray of the skeleton may be used to see if cancer has spread to the bones.

Find out more about an x-ray.

A barium enema is an x-ray procedure that uses a contrast medium called barium sulphate. A contrast medium is a substance used in some diagnostic procedures to help parts of the body show up better on x-rays or other imaging tests. A barium enema is used to check if cancer has spread to the rectum.

Find out more about a barium enema.

An endoscopy allows a doctor to look inside body cavities using a flexible tube with a light and lens on the end. If a woman has a large vaginal tumour, an endoscopy is done to see if the cancer may have spread to the bladder or rectum. It may also be done to help stage more advanced vaginal cancers.

Cystoscopy is a procedure that uses a cystocope, which is a type of endoscope, to examine the bladder and urethra. It is done to find out if the cancer has spread to these organs. Doctors can do a biopsy at the same time as a cystoscopy if they find an abnormal area during the exam.

Sigmoidoscopy is a procedure that uses a type of endoscope (called a sigmoidoscope) to examine the sigmoid colon (the last part of the colon) and the rectum. It is done to find out if the cancer has spread to the rectum. Doctors can do a biopsy at the same time as a sigmoidoscopy if they find an abnormal area during the exam.

The doctor may do a pelvic exam and digital rectal exam (DRE) at the same time as a cystoscopy or sigmoidoscopy. These exams allow the doctor to check if the cancer has spread to surrounding structures.

Find out more about a cystoscopy and a sigmoidoscopy.

A computed tomography (CT) scan uses special x-ray equipment to make 3-D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.

A CT scan is used to:

• check the size of the tumour
• find out if cancer has spread to nearby organs and tissues in the pelvis
• find out if cancer has spread to the liver and lungs
• find out if cancer has spread to lymph nodes
• guide a needle for a biopsy

A CT scan may also be used to help doctors determine prognosis, measure response to treatment and check if cancer has come back, or recurred.

A dye (contrast medium) may be injected into a vein (given intravenously) before the CT scan. The dye can help the doctor see structures of the body better than without contrast. Tell your doctor or the radiology staff if you have had an allergic reaction to a contrast medium in the past.

Find out more about a CT scan.

Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3-D pictures.

An MRI is used to find out if cancer has spread to:

• nearby organs and tissues in the pelvis
• the brain or spinal cord
• lymph nodes

An MRI may also be used to help doctors determine prognosis, measure response to treatment and check if cancer has come back, or recurred.

Find out more about a MRI.

An intravenous pyelogram (IVP) is a special x-ray of the urinary system. It may be used to see if cancer is blocking, or obstructing, the ureters (tubes that connect the kidneys to the bladder). An IVP may not be needed if a CT scan using a contrast medium or an MRI has been done.

Find out more about an intravenous pyelogram (IVP).

A positron emission tomography (PET) scan uses radioactive materials called radiopharmaceuticals to look for changes in the metabolic activity of body tissues. A computer analyzes the radioactive patterns and makes 3-D colour images of the area being scanned.

A PET scan is usually done in combination with a CT scan (called a PET/CT) to show the abnormal area. It is sometimes used to see if the cancer has spread beyond the vagina.

Find out more about a PET scan.

To make the decisions that are right for you, ask your healthcare team questions about a diagnosis.