If a woman has any of the signs or symptoms discussed in the section “Can Vaginal Cancer Be Found Early?” she should see a doctor. If the Pap test detects abnormal cells, or if the doctor sees or feels anything unusual during a pelvic examination, more medical procedures will be needed. If the doctor is not a gynecologist (specialist in problems of the female genital system), a referral to one may be made.
Signs and Symptoms of Vaginal Cancer
Between 80% and 90% of women with invasive vaginal cancer have one or more symptoms. About half the women with invasive vaginal cancer have abnormal vaginal bleeding (often after intercourse). Other signs and symptoms include an abnormal vaginal discharge, a mass that can be felt, or pain during intercourse. Painful urination, constipation, and continuous pain in the pelvis may occur with advanced vaginal cancer.
A number of benign conditions, such as infections of reproductive organs, can produce similar symptoms, and examinations and tests by your health care professional are the only way to tell if the symptoms are due to a cancer. If you have any of these symptoms, discuss them with your doctor without delay. Remember, the sooner you receive a correct diagnosis, the sooner you can start treatment, and the more effective your treatment will be.
Medical History and Physical Examination
The first step is to take a complete medical history to check for risk factors and symptoms. Then your doctor will perform a complete physical examination, including a pelvic examination. He or she will feel your uterus, ovaries, cervix, and vagina to check for anything irregular. Your doctor will also look into the vagina and cervix using a speculum and will perform a Pap smear.
Colposcopy
Your doctor also may ask you to have a colposcopy. In this procedure, an instrument with binocular magnifying lenses is used to view the walls of the vagina, as well as the cervix.
Biopsy
If a suspicious area is found, the doctor will do a biopsy. In this procedure, a local anesthetic is used to numb the area, and a small piece of the tissue is cut out and sent to a laboratory. There, a pathologist (a doctor specializing in laboratory diagnosis of diseases) looks at the tissue under a microscope to determine if cancer is present.
Imaging Tests
Chest x-ray: A plain x-ray of your chest will be done to see if your cancer has spread to your lungs. This is very unlikely unless your cancer is far advanced. This x-ray can be done in any outpatient setting. If the results are normal, you probably don’t have cancer in your lungs.
Computed tomography (CT): The CT scan is an x-ray procedure that produces detailed cross-sectional images of your body. Instead of taking one picture, as does a conventional 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 (think of a loaf of sliced bread). The machine will take pictures of multiple slices of the part of your body that is being studied. Often after the first set of pictures is taken you will likely receive an intravenous injection of a “dye” or radiocontrast agent that helps better outline structures in your body. A second set of pictures is then taken.
CT scans take longer than regular x-rays and you will need to lie still on a table while they are being done. But just like other computerized devices, they are getting faster and your stay might be pleasantly short. The newest CT scanners take only seconds to complete the study. Also, you might feel a bit confined by the ring-like equipment you’re in when the pictures are being taken.
The contrast “dye” is injected through an IV line. Some people are allergic to the dye and get hives, a flushed feeling, or rarely more serious reactions like trouble breathing and low blood pressure. Be sure to tell your doctor if you have ever had a reaction to any contrast material used for x-rays. If you have, you may need medicine before you can have such an injection during your test.
You may also be asked to drink a contrast solution. This helps outline your intestine if your doctor is looking at organs in your abdomen. The CT scan will provide precise information about the size, shape, and position of a tumor, and can help find enlarged lymph nodes that might contain cancer.
Magnetic resonance imaging (MRI): MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of the body. Not only does this produce cross sectional slices of the body like a CT scanner, it can also produce slices that are parallel with the length of your body.
A contrast material might be injected just as with CT scans, but is used less often. MRI scans take longer – often up to an hour. Also, you have to be placed inside a tube-like piece of equipment, which is confining and can upset people with claustrophobia. The machine makes a thumping noise that you may find annoying. Some places will provide headphones with music to block this out. MRI images are particularly useful in examining pelvic tumors. They may often detect enlarged lymph nodes in the groin. They are also helpful in detecting cancer that has spread to the brain or spinal cord.
Positron emission tomography: Positron emission tomography (PET) uses glucose (a form of sugar) that contains a radioactive atom. Cancer cells in the body absorb large amounts of the radioactive sugar and a special camera can detect the radioactivity. This test is useful to see if the cancer has spread to lymph nodes. PET scans are also useful when your doctor thinks the cancer has spread, but doesn’t know where. PET scans can be used instead of several different x-rays because they scan your whole body. Newer devices combine a CT scan and a PET scan to even better pinpoint the tumor.
Endoscopic Tests
Proctosigmoidoscopy: Proctosigmoidoscopy is a procedure to view the rectum and part of the colon. It is done to check for spread of vaginal cancer to the rectum or colon. Proctosigmoidoscopy is recommended for patients whose vaginal cancers are large and/or located in the part of the vagina next to the rectum and colon. In this procedure a slender, flexible, hollow, lighted tube is placed into the rectum. Any areas that look suspicious will be biopsied. This test may be somewhat uncomfortable, but it should not be painful.
Cystoscopy: Cystoscopy is a procedure to view the inside of the bladder. It is done to check for spread of vaginal cancer to the bladder. This procedure is usually done in the doctor’s office or clinic. An intravenous medication to make you drowsy may be given. A thin tube with a lens and light is inserted into the bladder through the opening called the urethra. If suspicious areas or growths are seen, a biopsy will be done. Cystoscopy is recommended if a vaginal cancer is large and/or located in the front wall of the vagina, near the bladder.

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