Tests for Vaginal Cancer

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).

Medical history and physical exam

The first step is for the doctor to ask about your complete medical history and discuss your risk factors and symptoms with you. Then your doctor will physically examine you, which typically means a pelvic exam (also called a bimanual exam) and a speculum exam.

• For a pelvic exam, the doctor places two gloved, lubricated fingers of one hand inside the vagina, while the other hand presses on the abdomen to check for any abnormalities of the pelvic organs, such as the uterus and ovaries. The physician may also examine your groin area for enlarged lymph nodes at this time.
• For a speculum exam, the doctor gently inserts a device, called a speculum, inside the vagina to look inside for abnormal areas.

Any abnormal findings, such as a mass or ulcer may then be biopsied.

Pap test

During a Pap test, the doctor gently scrapes the outside of the cervix and vagina and takes a sample of cells for testing. During the test, you will usually feel some pressure as the doctor takes the sample of the cells, but there is usually no pain. Human papillomavirus (HPV) testing is usually part of the Pap test after age 29, based on guidelines from the American College of Obstetricians and Gynecologists (ACOG).

Vaginal colposcopy (vaginoscopy)

Your doctor might suggest you have a test called a colposcopy:

• If your pelvic exam reveals a concerning finding, or
• If your Pap test (a swab of cells from your cervix) shows abnormal cells, or
• If you test positive for HPV (human papillomavirus)

A colposcopy is typically done in a clinic and takes less than 20 minutes. You can go home the same day. During a colposcopy, 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 solution called acetic acid (much like vinegar) or iodine is used to make any abnormal areas easier to see. This may cause a mild discomfort, like a brief sting.

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 with a microscope to see if cancer or a pre-cancerous condition is present and, if so, what type it is. If the biopsy indicates vaginal cancer, the doctor may refer the patient to a gynecologic oncologist, a doctor who specializes in treating gynecologic cancers. The specialist may suggest imaging tests to see if the cancer has spread beyond the vagina.

Imaging tests

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.

Chest x-ray

A plain x-ray of your chest may be done to see if the cancer has spread to your lungs.

Computed tomography (CT) scan

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. Sometimes, a special dye called a contrast medium is given before the scan to show better details in the image. This dye can be injected into a patient’s vein or swallowed as a pill or liquid.

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) scan

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. To get the most detailed images of a vaginal tumor, you may be asked to insert a vaginal gel before the pelvic MRI. MRI images may show exact location and size of the vaginal tumor, as well as any enlarged lymph nodes in the groin. Sometimes a contrast medium is given before the scan to create a clearer picture. This contrast medium is different from the contrast given during a CT scan.

Positron emission tomography (PET) scan

A positron emission tomography or PET scan uses a mildly radioactive sugar that's put into your blood. The amount of radiation in the substance is too low to be harmful. 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.  A PET scan combined with a CT scan is called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan.

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.

Endoscopic tests

These endoscopy procedures are not used often for women with vaginal cancer, but they may be needed in certain cases.

Proctosigmoidoscopy

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 at the inside of the rectum and the last part of the colon for cancer spread. Any areas that look suspicious will be biopsied. This test may be somewhat uncomfortable, but it should not be painful.

Cystoscopy

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.