Vaginal cancer is a relatively uncommon type of gynecologic cancer, representing a small fraction of all cancers affecting the female reproductive tract. This malignancy develops in the tissues of the vagina, which is the muscular canal connecting the uterus to the external genitalia. Primary vaginal cancer, meaning cancer that starts in the vagina, is particularly rare, with most vaginal lesions being secondary, or metastatic, from other organs. Because of its rarity, there is no standardized screening for vaginal cancer, making the process of diagnosis highly dependent on physical signs and follow-up procedures.
Routine Screening and Initial Indicators
The initial steps in detecting potential vaginal abnormalities are often part of routine preventative care. While there is no dedicated screening test for vaginal cancer, the standard pelvic exam provides an opportunity for a doctor to inspect the vagina and cervix visually and manually. During this examination, the doctor uses a speculum to open the vaginal canal, allowing for a visual search for any abnormal growths, ulcers, or areas of thickening on the vaginal walls. The doctor also manually checks the internal reproductive organs for irregularities in size or shape.
The Pap test (cervical cytology) is a routine screening tool that can identify abnormal cells originating in the upper vagina, even though its primary focus is the cervix. Abnormal Pap test results suggest the presence of unusual cells, such as those indicating vaginal intraepithelial neoplasia (VAIN), a precancerous condition. These results, along with concerning findings during a pelvic exam, prompt further diagnostic testing.
Many investigations begin when a patient reports specific symptoms rather than through routine screening. The most frequent symptom is abnormal vaginal bleeding, including bleeding after intercourse, between periods, or post-menopausally. Other common indicators include unusual or watery vaginal discharge, pain during sexual intercourse, or pain in the pelvic area.
Confirmatory Diagnostic Procedures
Once an abnormality is noted or symptoms raise suspicion, the next step is to perform procedures designed to definitively confirm or rule out the presence of cancer. The colposcopy is often the first specialized procedure, where a physician uses a colposcope—a lighted, magnifying instrument—to closely examine the tissues of the vagina and cervix. This instrument remains outside the body, providing a highly magnified view of the vaginal surface to identify suspicious areas.
If the colposcopy reveals a suspicious lesion, the physician performs a biopsy, which is the only way to obtain a definitive cancer diagnosis. A biopsy involves removing a small tissue sample from the abnormal area, often using a small grasping tool or a punch biopsy instrument. This tissue is sent to a pathology lab where a specialist examines the cells under a microscope. The examination determines if the cells are cancerous and identifies the type, such as the most common form, squamous cell carcinoma.
These procedures are typically performed in an outpatient setting, sometimes during the initial pelvic or colposcopy exam. Patients may experience mild discomfort or cramping. The pathologist’s report provides the final histopathologic confirmation and classification of the cells, forming the basis for the formal diagnosis and guiding subsequent steps.
Staging Tests and Final Assessment
After vaginal cancer is confirmed, additional testing determines the extent of the disease, a process known as staging. Staging assesses whether the cancer is confined to the vagina or has spread to nearby lymph nodes or distant organs. The resulting cancer stage is a significant factor in guiding treatment planning.
A variety of imaging scans evaluate the spread of cancer within the pelvis and to other parts of the body. Computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) scans are commonly employed. MRI scans provide detailed images of the tumor’s size and local invasion within the pelvis. PET scans help detect abnormal lymph nodes or spread to distant organs like the lungs or liver.
Doctors may also use internal viewing procedures to assess if the cancer has invaded nearby hollow organs. A cystoscopy involves inserting a thin, lighted tube into the bladder to check for cancer spread to the urinary tract. Similarly, a proctoscopy or sigmoidoscopy may be performed to examine the rectum and lower colon for any signs of invasion. The information gathered from these diagnostic and imaging tests is synthesized to determine the final stage of the cancer before treatment begins.