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How is vaginal cancer diagnosed?
The main tests used to diagnose vaginal cancer are a physical examination, a cervical screening test, a procedure called a colposcopy, and the removal of a tissue sample (biopsy).
Your doctor will ask to do a physical examination of your vagina, groin and pelvic area. You will remove your clothing from the waist down and lie on a table with your knees bent and legs apart. The doctor may arrange for you to have the examination under a general anaesthetic if the area is very painful.
If you feel embarrassed or scared about this examination, let your doctor know. A nurse may be present during the examination, but you can also ask for a family member or friend to be in the room.
During the physical examination, you may have a cervical screening test (this test has replaced the Pap test) to check the cells inside the vagina and cervix.
The cervical screening test detects cancer-causing types of HPV in a sample of cells taken from the cervix or vagina. While the speculum is in place for the internal examination, the doctor will use a small brush or swab to remove some cells from the surface of the cervix. This can feel slightly uncomfortable, but it usually takes only a minute or two.
The sample is sent to a laboratory to check for the presence of HPV. If HPV is found, the pathologist will do an additional test on the sample to check for cell abnormalities.
The results may show early cell changes in the lining of the vagina. This condition is called vaginal intraepithelial neoplasia or VAIN.
During the physical examination, the doctor may use a magnifying instrument called a colposcope to look at your vagina, cervix and vulva. This procedure is known as a colposcopy, or sometimes a vaginoscopy. The doctor may take a tissue sample (biopsy) during the colposcopy.
The colposcope is placed near your vulva but does not enter your body.
You will lie on your back on an examination table with your knees up and apart. The doctor will use a speculum to spread the walls of the vagina apart, and then apply a vinegar-like liquid or iodine to your vulva and vagina. This makes it easier to see abnormal cells through the colposcope. The liquid may sting or burn, and you may have a brown discharge afterwards. During a colposcopy, the doctor will usually take a biopsy from the vagina.
You will be advised not to have sex or put anything in your vagina (e.g. tampons, medicine) for 24 hours before a colposcopy. Talk to your doctor about whether you should take over-the-counter pain relief about an hour before the procedure to ease discomfort.
During the colposcopy, your doctor will usually take a small tissue sample (biopsy) from the vagina. A biopsy is the best way to diagnose vaginal cancer. The doctor may put a local anaesthetic into the affected area of your vagina to numb it before the biopsy. There should not be any pain when the sample is taken, but you may feel a little discomfort.
If several areas of the vagina look suspicious, you may have several biopsies taken under general anaesthetic. After the biopsy your vagina may bleed a little. Ask your doctor how much bleeding to expect afterwards. You may have some soreness, which can be relieved by taking painkillers, and you will be advised not to have sex or put anything in your vagina for 24 hours after the biopsy.
The tissue sample will be sent to a laboratory, and a specialist doctor called a pathologist will examine the cells under a microscope. The pathologist will be able to confirm whether or not the cells are cancerous.
If the tests already described show that you have vaginal cancer, further tests may be needed to find out whether the cancer cells have spread.
Blood test – This checks the number of cells in your blood, and how well your kidneys and liver are working.
Chest x-ray – A painless scan that produces an image of your lungs.
Cystoscopy – The doctor uses a slender, flexible tube with a camera and light (cystoscope) to look inside the urethra and bladder. This can be done under local or general anaesthetic.
Proctoscopy – The doctor uses a slender tube with a camera and light (proctoscope) to look inside the rectum and anus. This can be done under local or general anaesthetic.
CT scan – A CT (computerised tomography) scan uses x-ray beams to create detailed, cross-sectional pictures of the inside of your body. Before the scan, you may be given a drink or injection of a dye called contrast that makes the pictures clearer. If you have the injection, you may feel hot all over for a few minutes. The CT scanner is large and round like a doughnut. You will lie on a flat table that moves in and out of the scanner. The scan is painless and takes 5–10 minutes.
MRI scan – An MRI (magnetic resonance imaging) scan uses a powerful magnet and radio waves to create detailed, cross-sectional pictures of the inside of your body. During the MRI scan, you will lie on a treatment table that slides into a metal cylinder that is open at both ends. Sometimes, dye will be injected before the scan to make the pictures clearer. The machine can be quite noisy, but you will usually be given earplugs or headphones. Some people feel anxious lying in the narrow cylinder. Tell your medical team beforehand if you feel concerned, as they may offer you some medicine to help you relax.