|How Is It Diagnosed?
Usually cancer of the vagina is first discovered during a routine Pap test. The symptoms of vaginal cancer are not usually obvious in the early stages of the disease. During a Pap smear test the doctor collects a sample of cells from cervix and vagina. The cells are then sent to a lab for testing under a microscope. If the results are abnormal, the patient will be recalled to the doctor’s office for an extensive physical examination and pelvic exam. The doctor will examine the woman's body looking lumps or other signs of disease. Past illnesses will be taken into account. During the pelvic exam the physician will insert gloved fingers into the vagina feeling for abnormalities in the area including around the uterus and ovaries. They are also likely to insert a finger into the rectum to check for lumps. A diagnosis is usually possible at this stage. If the prognosis is cancer the woman will be referred to a specialist (usually a gynecologist) for further testing. These tests are important for determining both prognosis (vaginal cancer survival rates) and vaginal cancer treatment options.
Prognosis or outlook will depend on:
• The stage of the cancer, see: vaginal cancer stages.
• The size of the tumor.
• The cell grade of the tumor, how different the cells appear to normal cells.
• If there are symptoms such as pain or vaginal bleeding.
• Where exactly in the vagina the cancer is located.
• The woman's general health and age.
• Whether it is a new diagnosis or a recurrence.
Treatment will depend on:
• The size, location and stage of the cancer.
• Type of cancer: squamous cell or adenocarcinoma.
• If the woman has had a hysterectomy.
• If radiation therapy to the pelvis has already been applied.
Why Was I Recommended A Colposcopy?
If the results from a Pap smear test are abnormal a gynecologist will want to perform a colposcopy. During this exam the woman lies on the table in the same way she would for a pelvic examination. A speculum will be inserted; this is an instrument which stretches the vaginal opening so that the doctor can look more easily inside. A special lighted magnifying instrument called a colposcope is placed a few inches away from the vaginal opening to make the task easier. Sometimes a solution of acetic acid (similar to vinegar) is swabbed on the cervix and vagina to clear away any mucus. This may cause a burning feeling but it helps to highlight any area of suspicious cells. When a colposcope is used specifically to investigate the vagina it is known as a vaginoscopy. It may cause mild cramping but is a safe procedure, even in pregnancy. If the doctor finds suspicious cells a biopsy will be carried out.
This means removing a sample of cells from an area of suspicion and sending them to a pathologist for testing. The pathologist will be able to identify which type of cancer of the vagina is present. There are different types of biopsies, but most commonly a punch biopsy is performed (see biopsy). This snips a tiny slice of vaginal lining and it may be performed at the same time as a vaginoscopy. Occasionally a cone biopsy will be performed. Alternatively, if the area of concern is difficult to reach an excision biopsy may need to be done. This is carried out as an outpatient under local anesthetic, but sometimes under general. In other instances, a CT scan is used for a guided needle biopsy.
Tests For Staging The Disease
The next part of diagnostic process is to determine vaginal cancer staging. That is, how far it has spread. This is important in order to decide the best type of treatment plan. The following tests may be used in the staging process:
This will be carried out to check if cancer has spread (metastasis) to the lungs and bones. This is very unlikely unless the cancer is in an advanced stage.
Computed Tomography (CT) Scan
The CT scan provides a more detailed internal picture of the body than an X-ray. It provides a cross-section picture of the body, taking multiple pictures as it rotates around the patient. The resulting images can be stored digitally and printed as needed. Although the dose of radiation is higher than an X-ray, the diagnostic information it provides greatly outweighs the increased risk. Before the scan you may be asked to drink a few pints of a liquid called oral contrast. This helps to outline parts of the intestine so they are not confused as tumors. You may also have an IV line inserted into the arm, through which contrast dyes are injected. This helps to outline all the structures of the body. Some people are allergic to the contrast dye materials, so the doctor may issue a medication to prevent this. See also Cancer diagnosis.
Magnetic Resonance Imaging (MRI) Scan
An MRI scan uses magnets and radio waves to gain images rather than X-rays. A computer translates those waves into detailed images of the internal body. Like the CT scan it produces cross sectional images of the body, but it also produces vertical images. It tends to be a less popular with patients than a CT scan because it takes longer (up to an hour) and it involves being placed inside a tube which some people find claustrophobic. However, newer open machines are finding their way into some hospitals. Some people may find the thumping noise the machine makes a little distressing. Do ask your doctor if they provide headphones to block the noise out. MRI's are particularly useful for examining pelvic tumors, although they generally cost more than CT scans which may be a factor for women who are uninsured.
Positron Emission Tomography (PET) Scan
PET scans are not commonly used for vaginal cancer, however they may be useful if doctors suspect the cancer has spread to other parts of the body but are not sure where exactly. It involves the use of glucose which contains a radioactive atom. The glucose will be taken up by malignant cells which need more energy (glucose converts to energy) than healthy cells. The PET scan will identify those areas of uptake much more effectively than other scanning methods. However doctors are aware that sites of infection can also produce similar results. New machines which combine a PET with a CT scan are more effective.
Interesting: Check the Causes of Vaginal Cancer.
Less Frequent Tests
The following tests are performed less frequently for vaginal cancer:
This uses a thin, hollow, flexible lighted tube which is inserted into the rectum and part of the colon. It is done to check for the spread of cancer. It may also be used to take a biopsy sample for analysis.
A thin lighted tube called a cystoscope is inserted into the urethra and bladder to check for signs of cancer. It may also be used to take a biopsy sample. It is sometimes recommended if there is a large tumor near the front of the vagina next to the bladder.
Intravenous Pyelogram (IVP)
This is an X-ray of the bladder, kidneys and ureters taken after a contrast material is injected into the veins. The contrasting material turns the organs bright white so that the radiologist can assess them more easily.
The pelvic lymph is injected with a dye and then X-rayed. As the dye travels through the system it is checked for any blockages. This will help determine if cancer has spread to the lymph nodes. This test is increasingly being replaced by MRI.
Interesting: Vaginal Cancer Prevention
Questions To Ask Your Doctor
Once you have been diagnosed with vaginal cancer (or the precancerous stage, VAIN), you may want to discuss the following issues with your healthcare team:
• What type of vaginal cancer do I have?
• What stage is it at?
• Based on my age and general health, what are my chances of survival?
• What treatment options do I have?
• What are the side effects and risks of each treatment?
• How long will the recovery period be and will I be able to take care of myself?
• What are the long term effects of surgery?
• Will I need reconstruction surgery?
• Will I be able to have a normal sex life after treatment?
• Should I use vaginal dilators?
• What are my chances of developing lymphedema? (Blockage of the lymph vessels).
• What can the surgeon do to lessen my chances of lymphedema?
• Will I need radiation therapy? Is it likely to be external or internal?
• Should I consider joining a cancer clinical trial for a new treatment?
• What is the plan for my follow-up care?
• What are the chances of it coming back? (Recurrent vaginal cancer)
• Should I get a second opinion?