Vaginal Cancer - Diagnosis and Treatment

Diagnosis

Diagnosing vaginal cancer involves several careful steps and specialized tools. Each method helps doctors gather information about the health of the vaginal tissue and nearby organs.

Below is a look at the common ways doctors check for this type of cancer.

Pelvic Exam: During a pelvic exam, a doctor inspects the female reproductive organs. The doctor may use a speculum to open the vaginal canal. This device gives a clear view of the vaginal walls and cervix, making it easier to spot unusual features.
Magnification with a Colposcope: Sometimes, a doctor uses a colposcope, which works like a strong magnifying glass and provides extra detail. This tool helps the doctor find areas that might have abnormal cells or early cancer changes.
Tissue Sample Testing (Biopsy): If the doctor sees any changes, they usually take a biopsy. The doctor removes a small piece of tissue from the suspicious area and sends it to a laboratory, where experts check for cancer cells.
Pap Test: In a Pap test, the doctor collects a sample of cells from inside the vagina or cervix. This test helps find abnormal cells before cancer develops and can also detect cancer at an early stage.
Testing for HPV: Doctors may suggest human papillomavirus (HPV) testing because some types of this virus are linked to vaginal cancer.
Looking at the Lymph Nodes: If the doctor suspects the cancer could spread, they may check the lymph nodes. Swollen lymph nodes can signal that cancer is moving to other parts of the body.
Endoscopic Tests: Doctors sometimes use procedures with tiny cameras, such as cystoscopy (to view inside the bladder) and proctosigmoidoscopy (to check the rectum), for a better look inside.
Imaging Scans: Doctors use imaging such as chest x-rays, CT scans, or MRI scans to see if the cancer has spread beyond the vagina.

Summary Table of Key Diagnostic Methods

Diagnostic Tool	Purpose
Pelvic Exam	Check for physical changes in the vagina/cervix.
Colposcopy	Magnify vaginal surface for detailed view.
Biopsy	Remove tissue for lab testing.
Pap Test	Detect abnormal and cancer cells.
HPV Testing	Screen for viral infection linked to cancer.
Lymph Node Check	Look for signs of cancer spread.
Endoscopic Procedures	View inside bladder or rectum.
Imaging (CT, MRI, X-ray)	Find cancer beyond vaginal area.

Determining the Extent of the Disease

After confirming a diagnosis, doctors determine how far the cancer has reached. This step, sometimes called cancer mapping, involves several detailed tests:

Imaging Studies: Technologies like CT scans, MRIs, and chest x-rays give close-up and whole-body views. They show the size of the growth and whether it has reached other tissues.
Camera Procedures: Cystoscopy uses a small camera to look inside the bladder, and proctosigmoidoscopy checks inside the rectum. These help see if cancer has reached neighboring organs.

Doctors assign the cancer to a stage, usually from 1 to 4. Stage 1 means the cancer is only in the vagina. Higher numbers mean larger growth or spread to other parts. The stage helps guide treatment decisions.

Treatment

Use of High-Energy Beams

Radiation therapy is often the main treatment for vaginal cancer. It uses strong beams of energy to destroy cancer cells. There are two main types:

External Beam Treatment: A special machine aims energy beams at the tumor from outside the body.
Internal Radiation (Brachytherapy): Doctors place radioactive materials directly in or near the vagina. These may be small seeds, wires, or tubes, delivering high doses of radiation close to the cancer.

Doctors often give chemotherapy—using low doses—along with radiation therapy to make the radiation work better. Chemotherapy uses medicines that kill cancer cells or stop them from growing.

Doctors may use radiation after operations to remove any leftover cancer cells. The type of radiation and how it is given depends on the stage and location of the cancer.

Table: Types of Radiation Approaches

Method	How It Works	When Used
External beam	Targets from outside the body.	Early, locally advanced, or with surgery.
Internal (brachytherapy)	Places radiation inside or close to the vagina.	Often used after external radiation.
Radiation + Chemotherapy	Combine low-dose chemo with radiation.	Increases effectiveness in many cases.

Doctors choose the type of radiation, with or without other medicines, based on the kind of cancer and its spread.

Surgical Procedures

Some people need an operation to remove the cancer. There are different surgeries for vaginal cancer:

Partial or Full Removal of the Vagina (Vaginectomy): For small growths limited to the vagina, doctors may remove part or all of the organ. This method is usually best when the tumor is not close to important body parts, like the urethra.
Removal of Several Organs (Pelvic Exenteration): Sometimes more than the vagina must be removed. The bladder, uterus, ovaries, or rectum may also be taken out, especially if cancer returns or does not go away with other treatments. After this, the body may need new pathways for urine (urostomy) or waste (colostomy) using a surgical opening in the belly.

If the whole vagina is taken out, doctors might build a new vagina with tissue from other places on the body. This can let the person continue to have intercourse, but the sensation and natural moisture may be different.

Other surgical options include laser surgery to destroy small tumors and lymphadenectomy for the removal of lymph nodes if cancer has spread. The exact surgery depends on where the cancer is and whether it has moved to other tissues.

Additional Treatment Choices

When cancer is hard to treat or returns after standard care, doctors may consider other options:

Stronger Chemotherapy: Doctors sometimes use larger doses of drugs if the cancer comes back or spreads.
Immunotherapy: Doctors use medicines that help the body’s natural defense system attack cancer. This is sometimes an option for advanced cases, especially for certain rare types like vaginal melanoma.
Targeted Therapy: These treatments focus on specific parts of cancer cells. Doctors may use them in special cases or as part of a research study.
Topical Therapy: Some early cancers can be treated with medication applied directly to the vagina. This is usually only for very small and early-stage disease.

Comfort Care and Symptom Control

Supportive care—also called palliative care—focuses on feeling better and improving quality of life. It is not just for those at the end of life; it can be started at any time during cancer treatment.

A palliative care team includes doctors, nurses, and other specialists. They help control pain, manage symptoms, and provide extra help. This includes help with side effects from treatments like nausea, tiredness, and emotional stress.

People receiving palliative care often continue regular cancer treatments at the same time.

Supportive care can include medicines, physical therapy, and counseling. Social workers and other experts may help solve practical problems. The aim is always to support the person’s everyday life as much as possible while managing cancer and treatments.

Ways to Manage and Receive Support

Each person’s experience with vaginal cancer is different, and what is helpful for one may not work for another.

Some may choose to be surrounded by loved ones, while others may prefer quiet time alone. Testing a few options can help someone discover what supports their well-being.

Getting enough information is important for making decisions about care. Writing down questions before doctor visits helps keep track of concerns. Bringing a trusted person to appointments allows for note-taking and support.

Health care teams can suggest more resources for learning about vaginal cancer and treatment options. Side effects from treatment can affect intimacy. It may take time and patience to find new ways to connect with a partner.

Emotional closeness can grow through honest conversations and by spending time together. If sexual difficulties affect the relationship, discussing these with a medical provider can lead to solutions or referrals.

Building a strong support network is helpful. Friends, family members, social workers, and psychologists each offer unique kinds of support.

Professional counselors or members of a faith community can provide space for difficult emotions. Support groups, whether in person or online, connect people who share similar experiences.

A simple table below shows basic supportive care aspects:

Support Type	Description
Friends/Family	Emotional support and help with daily tasks
Health Professionals	Medical advice and treatment planning
Support Groups	Shared experiences and advice from others
Mental Health Specialists	Help with stress, anxiety, or emotional needs
Spiritual Leaders	Spiritual or religious guidance and comfort

Fertility and quality of life concerns are common. Open discussions with healthcare providers can help address these, ensuring treatment plans align with the individual’s personal and family goals.

Accepting help and support can make the process more manageable and improve well-being along the way.

Getting Ready for Your Visit

How to Prepare Yourself

Being prepared can help make the appointment smoother and more productive. Before seeing the doctor or a gynecologic cancer specialist, you can:

Keep track of your symptoms. Note any new or ongoing changes, like unusual bleeding, pain, or changes in discharge. Even if the symptom seems minor or unrelated, write it down.
Record important personal events. List recent big life events or sources of stress, as these can impact your health.
Write down your medications and supplements. Create a list, including the dose and frequency of everything you take — from prescription drugs to vitamins and herbal supplements.
Bring someone with you. Ask a friend or family member to come along so they can provide support, help remember details, and ask questions you may not think of.
Prepare your own questions. Use a simple list. You might want to ask about possible reasons for your symptoms, test options, treatment choices, and how any plan could affect your daily life, sexuality, or other health conditions. Here’s a table of sample questions:

Topic	Sample Question
Symptoms	What might be causing the problems I notice?
Diagnosis	What kinds of tests do I need?
Treatment options	What treatments are available?
Side effects/sexuality	How do these treatments affect sexuality or fertility?
Prognosis	Has my cancer spread? What stage is it?
Follow-up care	What are my next steps after treatment?
Costs/insurance	Will my insurance pay for these tests or specialists?

It’s also helpful to bring previous health records, reports on past Pap tests, and any test results related to gynecology. Remember to include information about past HPV infections, as HPV is linked to many vaginal cancers.

Questions You Might Get from Your Specialist

Doctors want detailed and honest answers to better understand the situation and provide the right care. Expect questions like:

When did you first notice symptoms?
Are these symptoms steady or do they come and go?
How noticeable or severe are the symptoms?
Is there anything that makes symptoms better or worse?

They may also ask about your personal and family medical history, especially things like:

If your mother took DES (diethylstilbestrol) during pregnancy, as this affects risk factors.
Any previous diagnoses of HPV or abnormal Pap smear results.
If you have a history of other cancers or gynecologic issues.

Gynecologic oncologists, radiation oncologists, and gynecologists work together to evaluate your case and recommend the best next steps.

Vaginal Cancer – Diagnosis and Treatment