Diagnosing vaginal cancer

Wednesday 30 November, 2011

On this page: Pap smear ι Colposcopy and biopsy ι Further tests ι Staging vaginal cancer ι Prognosis ι Which health professionals will I see? ι Information reviewed by

Women who have symptoms of vaginal cancer will have an examination by their doctor. This will include a physical examination of the groin and pelvic area to check for swollen glands. The doctor may also arrange some of the following tests:

Pap smear

You may have a Pap smear (Pap test) to check the cells inside the vagina and cervix. The doctor puts an instrument with smooth, curved sides (speculum) into your vagina. The speculum gently spreads the vaginal walls, and the doctor uses a tool such as a brush or spatula to scrape cells from the cervix. The tissue sample is sent to a lab, where it is checked for abnormalities. The results of the Pap smear may show that you have early cell changes in the lining of the vagina. This condition is called VAIN.

Colposcopy and biopsy

The doctor will do an internal examination to look at your vagina. This is called a colposcopy. In this procedure, you will lie on your back on an examination table with your buttocks near the end of the table and your feet on foot rests (stirrups). Your doctor may put some fluid inside your vagina, insert an instrument (speculum) and look though a microscope called a colposcope to examine the vaginal canal.

Colposcopy Your doctor may also take a tissue sample (biopsy) during the colposcopy. The tissue is sent to a laboratory where a specialist called a pathologist examines the cells under a microscope. The pathologist will be able to confirm that the cells are cancerous and tell you what type of cancer it is.

You may feel uncomfortable during the colposcopy. Some women take a pain-reliever, such as ibuprofen, about an hour beforehand to ease cramping and discomfort.

Further tests

If the above tests show that you have vaginal cancer, further tests may be necessary to find out whether cancer cells have spread:

  • Blood test - A blood sample is taken to check the number of cells in your blood, and see how well your kidneys and liver are working.
  • Cystoscopy - The doctor uses a slender tube with a lens and a light (cystoscope) to look into the urethra and bladder. This is done under general anaesthetic.
  • Chest x-ray - A painless x-ray scan of your lungs, heart or abdomen.
  • CT scan - A computerised tomography scan. This scan takes three-dimensional x-rays of the inside of your body.
  • MRI scan - A magnetic resonance imaging scan. You will lie on the treatment table inside a cylinder and a magnetic field will create pictures of your body. Some women feel claustrophobic during this scan. Tell your medical team if you feel claustrophobic - you may be able to have medication to reduce any anxiety.
Do not have sex or put anything into your vagina (e.g. tampons,
medicine)  for 24 hours before the colposcopy.


Staging vaginal cancer

Based on the results of the diagnostic tests, your doctor will tell you the stage of the cancer. Staging the cancer is a way to describe the size of the cancer and whether it has spread beyond its original site.

Before a CT or MRI scan, you may be given an injection or asked to drink a liquid
called a contrast. This makes the images on the computer appear clearer. Tell the
doctor if you are allergic to iodine, fish or dyes.
Stage 1 Cancer is found only in the vagina. 
Stage 2 Cancer has begun to spread through the wall of the vagina, but it has not spread into the walls of the pelvis. 
Stage 3 Cancer has spread to the pelvis. It may also be in the lymph nodes close to the vagina.
Stage 4 Cancer has spread beyond the vagina and surrounding area into the lining of the bladder or bowel. The cancer may also have spread to other parts of the body.  


Your doctor may also tell you the grade of the cancer cells. This gives you an idea of how quickly the cancer may develop.

A low-grade cancer means that the cells are slow growing and less likely to spread. High-grade cells look more abnormal and are more likely to grow and spread quickly.

Knowing the stage and grade of the cancer helps your medical team decide on the most appropriate treatment.

Prognosis

Prognosis means the expected outcome of a disease. You will need to discuss your prognosis and treatment options with your doctor, but it is not possible for any doctor to predict the exact course of your disease.

The earlier vaginal cancer is diagnosed, the better the chances of successful treatment and cure.

Test results, the type of vaginal cancer you have, the rate and depth of tumour growth, how well you respond to treatment, and other factors such as age, fitness and medical history are all important in assessing your prognosis.

"I was embarrassed to tell people I had a gynaecological cancer. If you have breast, bowel or lung cancer, people seem to know what to expect. When my body healed and I had time to process it, I felt less self-conscious." — Patient

Which health professionals will I see?

Your GP (general practitioner) will probably arrange the first tests to assess your symptoms. You will then be referred to a gynaecological oncologist.

You will be cared for by a range of health professionals who specialise in different aspects on your treatment. This is called a multidisciplinary team.

Health professional

Role
gynaecological oncologist  a surgeon who specialises in treating gynaecological cancers, such as cancer of the vagina
radiation oncologist  prescribes and coordinates the course of radiotherapy 
medical oncologist  prescribes and coordinates the course of chemotherapy 
nurses care for you after surgery and during treatment, and provide support and assistance through all stages of your treatment 
dietitian  recommends the best eating plan to follow while you are in treatment and recovery
social worker, physiotherapist, counsellor,
sex therapist, psychologist 		 advise you on support services and help you get back to normal activities
This information was reviewed by:

Dr Greg Robertson, Gynaecological Oncologist, Royal Hospital for Women and St George Hospital; Jonathan Carter, Prof of Gynaecological Oncology, The University of Sydney and Head of Sydney Gynaecological Oncology Group, Sydney Cancer Centre; Belinda Fern, Consumer; Alicia Hiron, Consumer; Jayne Maidens, Clinical Nurse Consultant, Gynaecological Oncology Department, Royal North Shore Hospital; Anne Mellon, Clinical Nurse Consultant, Hunter New England Centre for Gynaecological Cancer, John Hunter Hospital; Fiona Pearce, Cancer Council NSW Helpline; Ann Tocker, Cancer Voices.

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