Diagnosing Vaginal Cancer

NYU Langone doctors specialize in diagnosing vaginal cancer, a rare condition.

The most common type of vaginal cancer is squamous cell carcinoma. Squamous cells are flat cells that help form the lining of the vagina.

Squamous cell carcinoma develops from precancerous cells in the vagina called vaginal intraepithelial neoplasia, or dysplasia. Dysplasia and squamous cell carcinoma tend to develop at the upper end of the vagina, near the cervix, which is the cylinder of tissue at the bottom of the uterus.

Squamous cell carcinoma tends to grow slowly, but it can spread to nearby organs. These include the bladder, which stores and empties urine, and the rectum, which is the last section of the digestive tract.

This type of cancer can also spread to nearby lymph nodes. Lymph nodes are small, bean-shaped organs that produce and store infection-fighting white blood cells called lymphocytes. Vaginal cancer can spread to the lymph nodes in the pelvis and groin.

Vaginal cancer can also spread to distant organs, such as the liver or lungs.

Adenocarcinoma is another type of vaginal cancer. It develops in the cells of glands in the vaginal lining that produce mucus or fluid. Adenocarcinoma grows more quickly than squamous cell carcinoma and is more likely to spread to the lymph nodes and distant sites, such as the lungs.

Although extremely rare, melanoma can also develop in the vagina. Melanoma occurs in melanocytes, the cells that create pigment, or color, in the skin.

Symptoms of vaginal cancer may include unusual vaginal bleeding, pain, a lump in the vagina, difficulty urinating, or pain during sex. Vaginal dysplasia usually does not cause symptoms.

Vaginal cancer typically occurs in older women. Infection with a common virus called human papillomavirus (HPV) can increase the risk of vaginal dysplasia and vaginal squamous cell carcinoma. Vaccination can help to prevent HPV infection and, in turn, the development of these conditions.

Women who have been diagnosed with cervical cancer or vulvar cancer also have an increased risk of vaginal cancer. Similarly, cervical dysplasia and vulvar dysplasia increase the risk of vaginal dysplasia.

Doctors may recommend routine testing of vaginal cells in women who have been diagnosed and treated for cervical dysplasia or cancer. Although typically used to screen women for cervical cancer, a Pap test can also be used to screen for vaginal dysplasia or cancer. During a Pap test, a doctor inserts an instrument called a speculum into the vagina and then uses a small swab or brush to collect vaginal cell samples for laboratory analysis.

Exposure to diethylstilbestrol, or DES, before birth also increases the risk of a type of vaginal adenocarcinoma called clear-cell adenocarcinoma. DES is a hormonal medication that was given to many women between 1940 and 1971 to help prevent miscarriage. Women who were exposed to diethylstilbestrol while in the womb also have a higher risk of vaginal dysplasia.

To diagnose vaginal cancer, NYU Langone gynecologic oncologists ask about your medical history, symptoms, and risk factors and conduct the following tests.

Pelvic Exam

During a pelvic exam, your doctor inserts one or two gloved and lubricated fingers into the vagina and places a hand on your abdomen to feel for masses. He or she also examines the vulva and cervix, and feels the uterus and ovaries—the two small reproductive organs that produce, store, and release eggs—and the fallopian tubes, which carry the eggs to the uterus. The rectum is also examined.

Colposcopy

To closely examine the vagina, your doctor can perform a colposcopy. After inserting a speculum, which separates the vaginal walls, he or she examines the vagina through a colposcope. This device magnifies and lights the vagina to provide a detailed view of the structure. If your doctor finds any abnormalities, he or she can perform a biopsy.

Biopsy

To diagnose vaginal cancer, your doctor performs a biopsy, which is the removal of a small amount of vaginal tissue. He or she uses an instrument with small surgical scissors at the end to remove or pinch off a small piece of the vaginal lining. Doctors usually perform this type of biopsy in their office and may use a colposcope to guide the procedure.

A pathologist, a doctor who studies diseases in a laboratory, examines the tissue under a microscope and determines whether cells are normal, cancerous, or precancerous.

CT Scans

If a biopsy shows the presence of vaginal cancer, doctors may use a CT scan to see if cancer has spread to other organs.

A CT scan is a form of X-ray that uses a computer to create cross-sectional, three-dimensional pictures. It offers detailed views of vaginal tumors and other areas of the pelvis or abdomen, such as the bladder, rectum, and nearby lymph nodes. The scan can also show if vaginal cancer has spread to distant sites, such as the liver or lungs.

Before the CT scan, your doctor may give you two different contrast agents, one by mouth as a liquid and one through an injection into a vein. These chemicals enhance the CT image.

MRI Scans

An MRI scan uses magnetic fields and radio waves to create computerized, three-dimensional images of the body’s structures. MRI scans often create better images of soft tissue than do CT scans. They may be especially useful for determining whether vaginal cancer has spread to the bladder or rectum. To enhance these images, your doctor may give you a contrast agent through an injection into a vein before the procedure.