Vaginal Cancer Diagnosis

Vaginal cancer is a rare gynecological malignancy that develops in the cells of the vagina, a muscular tube-like structure that connects a woman’s uterus to her external genitalia. The vagina plays a crucial role in the female reproductive system, serving as a passageway for menstrual blood, sexual intercourse and childbirth.

The most common type of vaginal cancer is squamous cell carcinoma, which forms in the flat, scale-like squamous cells that line the vaginal walls. Other less common types include adenocarcinoma, melanoma and sarcoma.

In many cases, vaginal cancer does not cause noticeable symptoms. Therefore, it is important for every woman to become familiar with her body and what is normal for her, and to promptly discuss any unusual changes, such as pelvic pain or abnormal vaginal bleeding, with a physician. Usually, the diagnostic process for vaginal cancer includes a medical history assessment, physical examination, imaging studies and a biopsy.

Is there a screening test for vaginal cancer?

Unlike other types of gynecological cancer, such as cervical cancer, there is currently no widely used screening test specifically for vaginal cancer. Because vaginal cancer develops differently than cervical cancer and also has different risk factors, the standardized screening tests for cervical cancer, such as the Pap smear and human papillomavirus (HPV) test, are not used to detect vaginal cancer.

With that said, many women receive a routine pelvic exam as part of each gynecological checkup. During this exam, a physician will visually inspect the vaginal walls and cervix for any abnormalities, including signs of vaginal cancer. Although this type of examination can detect vaginal cancer in some cases, it is not a specific screening test for vaginal cancer.

Given the relatively low incidence of vaginal cancer, routine screening of the general female population is not currently recommended. However, women with certain risk factors—such as smoking, a history of HPV infection or prior radiation therapy delivered to the pelvis—should discuss their screening options and frequency with their physician.

How is vaginal cancer diagnosed?

Vaginal cancer is often diagnosed based on the presence of symptoms, such as:

• Abnormal vaginal bleeding (between menstrual periods or after menopause)
• Unusual vaginal discharge
• Pain during sexual intercourse
• Pelvic pain

If a physician suspects vaginal cancer based on symptoms or the findings of a pelvic examination, they will typically order diagnostic testing, such as:

• Imaging scans
• A biopsy

Imaging tests used to diagnose vaginal cancer

Commonly used when diagnosing and staging vaginal cancer, imaging scans can help a physician assess the extent of a tumor and determine if it has spread to nearby structures or distant sites. Some imaging tests that may be used include:

• Computed tomography (CT) - A pelvic CT scan provides detailed cross-sectional images of the pelvis and can help a physician determine the size and extent of a tumor. To enhance the visibility of the pelvic structures in the resulting images, a contrast dye may be delivered intravenously before the test.
• Magnetic resonance imaging (MRI) - A pelvic MRI scan provides high-quality images of the soft tissues in the pelvis, including the vaginal walls and nearby structures. MRI is particularly useful for assessing the depth of tumor invasion and its relationship to the surrounding organs.
• Positron emission tomography (PET) - A PET scan can reveal areas of increased metabolic activity in the body. This type of imaging can help a physician determine whether a tumor has spread to lymph nodes or distant organs. PET scans are often used in combination with CT scans (PET-CT) for better localization of abnormalities.
• Ultrasound - Transvaginal ultrasound involves the use of a special probe, which is inserted into the vagina to create images of the vaginal walls and nearby structures. This type of ultrasound can help a physician assess the size and location of a tumor and may be used for guiding a biopsy.
• Cystoscopy - To examine the bladder for signs of cancer invasion or metastasis, a physician will insert a thin, flexible tube with a camera attached to the end (endoscope) into the urethra, then slowly guide the endoscope into the bladder.
• Proctoscopy - To examine the rectum for signs of cancer invasion or metastasis, a physician will insert an endoscope into the anus, then slowly guide the endoscope into the rectum.
• X-ray - X-ray images can help a physician assess the extent of vaginal cancer that has spread to the lungs or other distant sites.

The choice and timing of the imaging tests can vary based on several factors, including the stage of the vaginal cancer and the physician’s professional judgment. Typically, imaging is used in addition to other diagnostic tests, such as a biopsy.

Confirming a diagnosis of vaginal cancer

A biopsy is the only way to confirm or rule out a diagnosis of vaginal cancer. During this procedure, a physician will use a special lighted instrument (colposcope) to view the interior of the vagina under a high level of magnification and remove a small sample of vaginal tissue for further evaluation. The sample will be sent to a laboratory, where a pathologist will examine it under a high-powered microscope to check for cancerous cells. 

Follow-up tests used to diagnose vaginal cancer

After diagnosing vaginal cancer, the physician will perform follow-up testing to determine if the cancer has spread. Some common procedures include:

• Proctosigmoidoscopy - To examine the interior of the rectum and sigmoid colon, a physician will insert a thin, rigid, hollow tube (about 10 inches long) with a light and camera attached to the end (proctoscope) into the anus, then slowly guide the proctoscope into the rectum and sigmoid colon.
• Cystoscopy - To examine the interior of the bladder, a physician will insert a hollow tube equipped with a microscope-like lens (cystoscope) in the urethra, then slowly guide the cytoscope into the bladder.

Benefit from world-class care at Moffitt Cancer Center

As the only National Cancer Institute-designated Comprehensive Cancer Center based in Florida, Moffitt is nationally acclaimed for its research breakthroughs in the diagnosis and treatment of all forms of cancer, including vaginal cancer and other rare and complex malignancies. Through highly focused studies and promising clinical trials, we continue to make important strides toward our goal of one day finding a cure. Our patient outcomes and survival rates consistently outrank the national averages, and we provide our patients with the best possible quality of life.

If you would like to learn more about the diagnostic process for vaginal cancer, you are welcome to turn to the specialists in the gynecological clinic at Moffitt. To request an appointment, call 1-888-663-3488 or submit a new patient registration form online. You do not need a referral.