Cancer of the Vagina - Diagnosis

Contents

Work-up for a suspected Vaginal Malignancy

Signs for Suspected Vaginal Malignancy:

Diagnosis 

A gynaecological examination and inspection of the vagina can perform the diagnosis. However, vaginal carcinoma is sometimes missed on gynaecological examination because the lesion is either small or it is situated in the lower parts of the vagina and the blades of the speculum cover the lesion during the examination. A vaginal biopsy must be performed to prove diagnosis. When indicated, an examination under anaesthetic and cystoscopy/proctoscopy should be performed to exclude bladder or rectal involvement. 

For patients with abnormal PAP smears and no gross abnormality, a Colposcopy/Vaginoscopy (staining with acidic acid &/or Lugol's iodine) with a careful examination of the vagina should be performed. 

Any suspicious vaginal lesion should be biopsied. 

Routine preoperative investigations 

For all patients a CT-scan of the abdomen and the pelvis might be warranted in order to determine status of the primary tumour, liver, kidneys and the retroperitoneal lymph nodes

Screening

The incidence of vaginal cancer is 0.6 out of 100,000. Because the disease is so rare, there is no accepted method for screening for vaginal cancer. 

Some authors recommend regular examinations for women showing the following conditions: 

1. Vaginal Intraepithelial Neoplasia (VAIN)
2. Women who had pre-invasive (CIN III) or invasive cervical carcinoma before. Thirty percent of patients with vaginal cancer have a history of either CIN III or cervical cancer. 

Dr Andreas Obermair, MD
Associate Professor of Gynecology and Obstetrics,
University of Vienna
Clinical Fellow, Gynaecologic Oncology,Queensland Centre for Gynaecological Cancer.

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