How does my doctor know I have vaginal cancer?

Even if you don’t have symptoms, your doctor or gynecologist may find vaginal cancer during a routine visit to have a pelvic exam and Pap test. If you’re having symptoms of vaginal cancer, your doctor will ask you about these things.

• Your health history, including whether you have had abnormal Pap tests or radiation to your pelvis and whether you smoke.
• Your other risk factors, such as a history of human papillomavirus (HPV) infection, vaginal adenosis, history of DES exposure, or previous cancer of the cervix or vulva.

The doctor may also perform certain tests to check if you have vaginal cancer. You may need more than one. Here are some of the tests doctors use to diagnose or rule out vaginal cancer.

• Pelvic Exam - This exam is recommended as a regular screening for cervical cancer in women. During this exam, your doctor may notice suspicious areas in the vagina or feel thickening or growths in the walls of the vagina. Your doctor does a pelvic exam in the office. You remove your clothes from the waist down and put on a hospital gown. You lie on your back on an exam table and bend your knees. You place your feet in supports called stirrups at the end of the table. This position allows the doctor to look at or feel your uterus, vagina, ovaries, fallopian tubes, bladder, and rectum. The doctor places a tool called a speculum inside your vagina to hold it open and widen it. This lets the doctor see the upper portion of your vagina and your cervix.  If the doctor or nurse notices something suspicious during the pelvic exam, additional tests can help the doctor determine whether you have vaginal cancer.  You may also have a Pap test and human papillomavirus (HPV) test during a pelvic exam.
• Pap Test - The Pap test is a way to check for cancer in the cervix. The cervix is the lower part of the uterus that connects to the vagina. Your doctor uses a speculum to widen the vagina during the test. Then he or she gently scrapes a few cells from the wall of your cervix. A special doctor called a pathologist examines these cells under a microscope. This test can’t confirm a diagnosis of vaginal cancer. But it can rule out other gynecologic problems, such as certain infections or cervical cancer. If the doctor notes something unusual in the vagina, he or she may also remove cells from the vagina.
• HPV Test - HPV is short for human papillomavirus. This virus usually goes away on its own. In rare cases, HPV can cause vaginal cells to change and become precancerous. Your doctor can do this test at the same time as a Pap test. The doctor uses a second swab to collect cells from your cervix and vagina. Your doctor may even be able to use the same sample for both tests.
• Vaginal Colposcopy - For this outpatient procedure, your doctor uses a tool called a colposcope. This is an instrument similar to a microscope. It has binocular lenses that magnify cells of the vagina or cervix.  If your vagina has thinned due to lack of estrogen, the doctor may prescribe topical estrogen for a few weeks before the test. This helps thicken the tissue, which makes you more comfortable and helps make the test more accurate.  You are usually awake for this procedure. During colposcopy, the doctor uses a speculum to widen your vagina. The doctor may “paint” the walls of your cervix and vagina with a mild acetic acid solution. This vinegar-like solution causes any suspicious areas to turn white. Your doctor views your cervix, and then views the walls of your vagina while removing the speculum. If your doctor notices any suspicious-looking spots, he or she can remove them for further study. This is called a biopsy. The doctor may inject local anesthetic in these areas to make them numb before removing the tissue. If the abnormal area is small, your doctor may completely remove it with the biopsy.  The doctor sends any tissue samples to a lab. There, a pathologist checks the samples for cancer.
• Biopsy - If the doctor finds something suspicious during your physical exam or tests, he or she will perform a biopsy. The doctor removes a small piece of tissue and sends the sample to a lab. Then a pathologist examines it under a microscope.

Tests that Help Evaluate Vaginal Cancer

Your doctor took a biopsy from your vagina to know that you have cancer. Your doctor may request other tests to learn more about your type of cancer and its specific location. This will help decide the treatment that is likely to be most effective for you. With these tests, doctors can tell the stage, which is the extent of the vaginal cancer. A cancer’s stage is one of the most important factors in deciding which treatment to use.

These tests use instruments or machines to allow your doctor to see inside your body and find the cancer. Many of these tests create detailed images for your doctor to view. They help show if the cancer has spread. Here are some of the tests you may have to learn the stage of vaginal cancer.

To more thoroughly view your vagina and stage the cancer, your doctor may do a pelvic exam using general anesthesia. This means you will be asleep while it is happening. You may also have the following 2 procedures while you’re anesthetized.

• Cystoscopy - Your doctor may do this test if he or she suspects that the cancer may have spread to your bladder. You have this test in a hospital or outpatient surgery center. During a cystoscopy, the doctor looks at the inside of your bladder with a special instrument called a cystoscope, which is a thin, flexible tube with a tiny camera on the end. For this test, you lie on your back with your knees up and slightly apart. The doctor or nurse cleans your urethra and applies some numbing medication. Or you may be given general anesthesia so you fall to sleep and don’t feel anything. Then, the doctor or nurse passes the cystoscope through your urethra and up into your bladder. Water or saline solution flows through the scope into your bladder. This stretches your bladder wall, giving the doctor a better view. You may have some discomfort or feel an urge to urinate. If needed, the doctor can take a tissue sample called a biopsy to check for cancer. The whole test takes between 5 and 20 minutes. You will need a ride home after the test. You may feel a burning sensation when you urinate for a few days after the test.
• Proctoscopy - This test lets your doctor see if the cancer has spread to the rectum or the bottom part of the large intestine. For this test, the doctor uses a special instrument called a sigmoidoscope to see the inside of your rectum and lower colon. This is a thin, flexible or rigid tube with a tiny camera attached.  For this test, you undress from the waist down and put on a hospital gown. You lie on the exam table on your left side with your knees up toward your chest. The doctor gently inserts the sigmoidoscope through your rectum and into your large intestine. Air blows through the scope to allow for better viewing. The air may cause cramps. You may feel like you need to take a bowel movement. After the test, you will expel the air by passing gas.
• Chest X-Ray - Doctors use this test to find out if the cancer has spread to the lungs. It may also be done before surgery to be sure you have no heart or lung problems. You stand in front of an X-ray scanner and hold your breath as the picture is taken. The test does not hurt, but the X-ray plate may feel cold against your skin.
• Computed Tomography Scan (CT Scan) - Your doctor may order a CT scan to see if the cancer has spread to the lymph nodes or to other internal organs such as the liver or lungs. Unfortunately, CT scans have not been helpful in finding smaller amounts of cancer in the pelvic lymph nodes.  A CT scan uses X-rays to take pictures of the body from many angles. To have the test, you lie still on a table as it gradually slides through the center of the CT scanner. Then the scanner directs a continuous beam of X-rays at your pelvis. A computer uses the data from the X-rays to create many pictures of your pelvis, which can be used together to create a three-dimensional picture. A CT scan is painless and noninvasive. You may be asked to hold your breath one or more times during the scan. In some cases, you may be asked to drink a contrast dye 4 to 6 hours before the scan. And you may be asked not to eat anything in the time between drinking the contrast dye and the scan. The contrast dye will gradually pass through your system and exit through your bowel movements.
• Magnetic Resonance Imaging (MRI) - MRI may be done to find if cancer has spread. MRI uses radio waves and magnets to create detailed images of the inside of your body. For this test, you lie still on a table as it passes through a tube-like scanner. The scanner directs a continuous beam of radiofrequency radiation at the area being examined. A computer uses the data from the radio waves to create a three-dimensional picture of the inside of your body. You may need more than one set of images. Each one may take 2 to 15 minutes, so the whole scan may take an hour or more. This test is painless and noninvasive. Ask for earplugs if they aren’t offered since there is a loud thumping noise during the scan. If you’re claustrophobic, you may receive a sedative before this test.
• PET Scan (Positron-Emission Tomography) - A PET scan can show cancers that have spread but that do not show up with other imaging tests. Because PET scans your whole body, your doctor may order one instead of ordering multiple X-rays of different places on your body.  For this test, you first either swallow or are injected with a sugar solution that contains a mildly radioactive substance. Cancer cells absorb this sugar, and the radioactive material shows up during the image from the scan. It may take a few hours to more than a day for the sugar to reach the targeted organ. During this time, you’ll usually remain at the testing location. To have the scan, you’ll need to lie still on a table that is pushed into the PET scanner, a machine that rotates around you taking pictures that show where the glucose is in your body. The process takes about 45 minutes. A PET scan is painless and noninvasive. But if you’re sensitive to the sugar, you may have nausea, headache, or vomiting.