Vaginal Cancer Screening and Diagnosis

Accurate diagnosis and staging for vaginal cancer.

Vaginal cancer is a rare disease that affects only about one in 1,100 women. Slow-growing precancerous cells in the vagina can turn into cancer and then grow uncontrollably, forming a tumor. Sometimes, cancerous cells move to other areas of the body. 

The disease can be treated easily in the early stages. Better yet, most vaginal cancers can be prevented when precancerous cells are diagnosed and treated. 

There are two main types of vaginal cancer: 

• Squamous cell carcinoma develops in the lining of the vagina. 
• Adenocarcinoma is a cancerous tumor that develops in the cells that produce fluids and mucus in the vagina. 

Signs and symptoms of vaginal cancer

For most women, symptoms do not appear in the early stages of vaginal cancer. But as vaginal cancer grows, symptoms may include:

• Pain in the pelvic area
• Pain during sexual intercourse
• Pain when urinating
• Discharge that is watery, bloody, or strong smelling
• Bleeding after intercourse or between periods
• Bleeding after menopause
• Constipation or changes in bowel function
• Frequent urination
• Lump in the vagina

Some symptoms may mimic other health problems. If you experience any of these symptoms, schedule a visit with your gynecologist. The doctor can rule out cancer or determine if any abnormal cells are in the precancerous stage. Vaginal cancer is most treatable when it’s caught early.

Risk factors for vaginal cancer

Several risk factors can increase the chance of developing vaginal cancer. However, not all women who have these risk factors will develop vaginal cancer.

• Being aged 60 or older
• Exposure in the 1950s to the drug diethylstilbestrol (DES), given to pregnant women to prevent miscarriage
• Unprotected sex
• Sexually transmitted infections such as HIV or HPV  
• Sexual activity with many partners
• Early sexual activity
• History of abnormal or cancerous cells in the cervix or uterus
• Hysterectomy (removal of the uterus) increases the risk of abnormal cells in the vagina
• Weak immune system
• Smoking

Human papillomavirus (HPV) is an important risk factor for vaginal cancer. About 75 percent of vaginal cancers are caused by HPV infections. They are very common in girls and women who are sexually active. In a small percentage of women, the virus can cause abnormal cells to become cancerous. 

To reduce the risk of vaginal cancer, girls and young women can receive a vaccine against HPV.

Diagnosing vaginal cancer

While there is no standardized vaginal cancer testing or screening for patients, your doctor might find a suspicious cells or evidence of cancer through one of the following ways: 

Medical history: You will be asked about your family, any pregnancies, and sexual history.

Physical exam: The doctor will press on your abdomen to feel for lumps in the vagina. Also, your breasts and glands may be checked for lumps.

Pelvic exam: Your doctor will examine the vulva and inside of your vagina to check for lumps or sores that may signal cancer. 

Pap test: Often vaginal cancer cells can be detected by a Pap test. During a pelvic exam, cells from the cervix and vagina will be swabbed and sent to a lab to be examined under a microscope to look for signs of cancer, high-risk types of HPV, and abnormal cells that could develop into cancer.

Biopsies

If the Pap test shows signs of precancerous or cancerous cells, more tests will be required, such as a colposcopy or a biopsy. 

Colposcopy: This test is similar to a pelvic exam. Your doctor will place a speculum in the vagina to see the cervix and vaginal walls. A weak solution similar to vinegar may be used to make any abnormal cells easier to see. Then the doctor will use a colposcope, an instrument with a light and magnifying lens, to visually examine the cervix and vagina

Biopsy: There are a few types of biopsies that diagnose vaginal cancer and pre-cancer. Sometimes a biopsy can completely remove all of the abnormal tissue, and it may be the only treatment required. 

• Colposcopic biopsy: If abnormal cells are found during the colposcopy, a small tissue sample will be removed. A local anesthetic can be used to numb the vagina before the biopsy.
• Punch biopsy: Your doctor will use a circular tool, similar to a paper-hole punch, to remove small samples of tissue from the wall of the vagina.

If the biopsy shows that vaginal cancer is present, more tests will be done to determine if the cancer cells have spread to other parts of the body. It is important to know where the cancer cells have moved to create a personalized treatment plan,

Diagnosing vulvar cancer 

Several different types of imaging tests may be used to determine if vaginal cancer has spread to other organs.

• Pelvic ultrasound: Images of the pelvic organs are obtained by using sound waves. A non-greasy gel is applied to the skin and a hand-held probe (transducer) is moved across the abdomen. In pregnant women, ultrasound is used to check the health of an unborn baby. In women suspected of vaginal cancer, ultrasound can help diagnosis pelvic masses, fibroids, and other problems. 
• Transvaginal ultrasound: This exam also uses high-energy sound waves to bounce off tissues and organs and make echoes. Then images called sonograms are obtained of the ovaries, uterus, and lining of the uterus. Either you or a sonographer will place a probe covered with a sheath and non-greasy gel in your vagina. The sonographer will move the probe to obtain the best images. You may feel some pressure. If you feel pain, tell the sonographer.
• Computed tomography (CT): Using a computer, detailed and cross-sectional images of the pelvic area are made quickly with x-rays taken at various angles. Dye may be injected into a vein or given orally to help tissues and organs show up in the image. The images may show enlarged nodes or signs that the cancer has spread to the abdomen or other areas.
• Positron emission tomography (PET) scan: During this painless procedure, glucose (sugar) is mixed with a very small amount of a radioactive substance and injected into a vein. As you rest on a table, the solution is absorbed by certain organs and tissues. Then you will be moved into a tunnel scanner. The PET scanner traces the flow of the solution inside your body to find cancer cells which use more glucose than normal cells and show up brighter in the images.
• Magnetic resonance imaging (MRI): Strong magnets, radio waves, and a computer are used to make detailed pictures of certain areas of your body. The test may be able to pinpoint if cancer cells have spread to the rectum, bladder, or other organs. Before the imaging begins, a contrast dye may be injected into a vein. This painless procedure involves resting on a table and sliding into a tunnel-shaped scanner for 30-60 minutes while pictures are taken. No radiation is used.
• Cystoscopy: This is a procedure to look inside the urethra and bladder to check for abnormal cells or signs of cancer. A thin instrument is inserted through the urethra into the bladder. Tissue samples may be removed by a tool on the cystoscope. 
• Ureteroscopy: At the same time that a cystoscopy is done, another procedure called a ureteroscopy may be performed if you have symptoms that the cancer has spread to your bladder. During this procedure, a ureteroscope with a light and lens for viewing will look inside the two ureters – the thin tubes that lead from the kidneys to the bladder. Tissue may be removed to be checked for signs of cancer.
• Colonoscopy: If you have symptoms that the cancer has moved into your colon, your doctor will want you to have a colonoscopy. You will be sedated for this procedure. A thin, flexible and lighted tube with a small video camera on the end is inserted through the anus. During the procedure, the doctor can remove any cancerous cells.
• Barium enema x-ray: For this x-ray, liquid is inserted into your rectum through a narrow tube and then images are taken of the colon. A specially trained doctor called a radiologist will be able to see if vaginal cancer has spread to the colon.
• Chest x-ray: In some cases, a chest x-ray may be required to determine if vaginal cancer has spread to the chest.

Staging vulvar cancer

Your doctor will want to find exactly where the cancer is located and how much of it is in your body. This process is called staging. The stage is determined by the physical exam, biopsies, imaging, and other tests. 

A specially trained physician called a pathologist will look at the cells taken during the biopsy and help identify the stage of cancer. Then your gynecologist and the tumor board will determine additional treatment options

These are the main stages of vulvar cancer. 

Stage 0: Precancerous cells are in the vulva only.
Stage 1: Cancer is only the vagina.
Stage 2: Cancer has grown through the vaginal wall. It has not spread to nearby lymph nodes.
Stage 3: Cancer is growing in the pelvic wall, or the lower third of the vagina, or has blocked the flow of urine. The cancer may be causing problems in the kidneys. The cancer may have spread to the nearby lymph nodes.
Stage 4: Cancer has spread into the bladder or rectum or is growing out of the pelvic area. It may have spread to lymph nodes. The cancer may have spread to the lungs, liver, bones, or other organs.