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Vaginal cancer

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Diagnosing vaginal cancer

Diagnosis is the process of finding the cause of a health problem. The process of diagnosis may seem long and frustrating, but it is important for the doctor to rule out other reasons for a health problem before making a cancer diagnosis. Diagnostic tests for vaginal cancer are usually done when:

  • the symptoms of vaginal cancer are present
  • the doctor suspects vaginal cancer after talking with a woman about her health and completing a physical examination
  • pelvic examination or a Pap test suggests a problem with the vagina

Many of the same tests used to initially diagnose cancer are used to determine the stage (how far the cancer has progressed). Your doctor may also order other tests to check your general health and to help plan your treatment. Tests may include the following.

Medical history and physical examination

The medical history is a record of present symptoms, risk factors and all the medical events and problems a person has had in the past. The medical history of a woman’s family may also help the doctor to diagnose vaginal cancer.

In taking a medical history, the doctor will ask questions about:

  • a personal history of
    • smoking
    • exposure to diethylstilbestrol (DES) before birth
    • vaginal, vulvar or cervical precancerous conditions and treatment
    • cervical, vulvar or anal cancer
    • HIV
  • mother’s possible use of DES during pregnancy
  • sign and symptoms that may suggest vaginal cancer

A physical examination allows the doctor to look for any signs of vaginal cancer. During a physical examination, the doctor may:

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Colposcopy

Colposcopy is a type of endoscopy that is often recommended if vaginal cancer is suspected or when an abnormality is detected by physical examination or a Pap test. It allows a doctor to look inside the vagina using a flexible tube with a light and lens (colposcope). The doctor can see the surface of the vagina and cervix more clearly in order to look for abnormal cells.

A colposcopy is done much the same way as a Pap test.

  • A speculum is inserted into the vagina to hold it open so the cervix can be clearly seen and examined.
  • The doctor uses a special instrument called a colposcope. It has a light and magnifying lens (much like binoculars) on the end, which allows the surface of the cervix and the vagina to be seen under high magnification. The colposcope itself isn’t inserted – it is positioned outside the opening of the vagina.
  • The area may be swabbed with solutions that help the doctor see the tissues better.
  • Biopsies may be taken from any suspicious areas.

A colposcopy can usually be done even if a woman is pregnant. Avoid sexual intercourse, vaginal douches, vaginal medications and contraceptive (spermicidal) creams, foams and gels (except as directed by the doctor) for 48 hours before the test since these can interfere with the procedure and potentially affect the results.

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Biopsy

During a biopsy, small amounts of tissue are removed from the body so they can be tested in a laboratory. The pathology report from the laboratory will confirm whether or not cancer cells are present in the sample. The biopsies that could be used for vaginal cancer are:

  • punch biopsypunch biopsyA type of biopsy in which a disc-shaped sample of skin and underlying tissue is removed using a sharp, hollow instrument (called a punch) for examination under a microscope.
  • excisionexcisionA surgical procedure to remove tissue or an organ.

If an abnormal area is seen, a biopsy might be taken during colposcopy.

  • A local anesthetic may be used to numb the area of the biopsy.
  • Biopsy forceps are used to remove small amounts of tissue from suspicious-looking areas.
  • The procedure may cause mild cramping or discomfort (similar to menstrual cramps). There may be some light vaginal bleeding afterward.

Cervical and vulvar biopsies may be done to rule out primary cervical or vulvar cancers that have spread to the vagina.

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Complete blood count

A complete blood count (CBC) measures the number of white blood cells, red blood cells and platelets. A CBC is done to:

  • check for anemiaanemiaA reduction in the number of healthy red blood cells. from long-term vaginal bleeding
  • provide a baseline for comparison during and after treatment

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Blood chemistry tests

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can also be used to detect abnormalities.

  • Urea (blood urea nitrogen or BUN) and creatinine may be measured to check kidney function. Increased levels could indicate that cancer has spread to the ureters or kidneys.
  • Alanine aminotransferase (ALT), aspartate transaminase (AST) and alkaline phosphatase may be measured to check liver function. Increased levels could indicate that cancer has spread to the liver.

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X-ray

An x-ray uses small doses of radiation to make an image of the body’s structures on film.

  • A chest x-ray may be done to detect the spread of cancer to the lungs.
  • X-rays of the skeleton may be done to detect the spread of cancer to the bones.

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Endoscopy

Endoscopy procedures are done when women have signs or symptoms suggesting that vaginal cancer may have spread to the bladder or rectum. A biopsy can be performed at the same time if the doctor finds a suspicious area during examination.

  • A cystoscopycystoscopyA procedure that uses an endoscope (a thin, tube-like instrument with a light and lens) to examine or treat the bladder and urethra. is done to find out if the cancer has spread to the bladder and urethra.
  • A ureteroscopyureteroscopyA procedure that uses an endoscope (a thin, tube-like instrument with a light and lens) to examine or treat structures in the upper urinary tract, including the ureter and renal pelvis. is done to find out if the cancer has spread to the ureters.
  • A sigmoidoscopysigmoidoscopyA procedure that uses an endoscope (a thin, tube-like instrument with a light and lens) to examine or treat sigmoid colon (the last part of the colon) and rectum. or proctoscopyproctoscopyA procedure that uses an endoscope (a thin, tube-like instrument with a light and lens) to examine or treat the rectum. is done to find out if the cancer has spread to the rectum.

A thorough pelvic examination may be done at the same time as the endoscopy.

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Computed tomography (CT) scan

A CT scan uses special x-ray equipment to make 3-dimensional and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures. It is used to:

  • find out the local extent of the vaginal tumour
  • see if there is cancer in the liver or lungs
  • see if there is cancer in the surrounding lymph nodes

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Magnetic resonance imaging (MRI)

MRI uses powerful magnetic forces and radio-frequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3-dimensional pictures. It is used to:

  • find out the local extent of the vaginal tumour
  • see if there is cancer in the surrounding lymph nodes

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Positron emission tomography (PET) scan

A PET scan uses radioactive materials (radiopharmaceuticals) to detect changes in the metabolic activity of body tissues. A computer analyzes the metabolic patterns and makes 3-dimensional colour images of the area being scanned.

A PET scan is usually done in conjunction with a CT scan (PET/CT) to locate the abnormal area. It is sometimes used to see if the cancer has spread beyond the vagina.

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Intravenous pyelogram

An intravenous pyelogram (IVP) is a special x-ray of the urinary system. It may be used to see if cancer is blocking (obstructing) the ureters. IVP may not be needed if a CT scan using contrast mediumcontrast mediumA substance used in some diagnostic procedures to help parts of the body show up better on x-rays or other imaging tests. or an MRI has been done.

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Barium enema

A barium enema is an imaging test that uses a contrast medium (barium sulphate) and x-rays to produce pictures of the large intestine. It may be done to find out if cancer has spread to the rectum.

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See a list of questions to ask your doctor about diagnostic tests.

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