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Vaginal Cancer Diagnosis and Treatment - A Detailed Guide

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Vaginal cancer diagnosis and treatment demand a comprehensive approach, wherein various tests are recommended to diagnose vaginal cancer accurately before recommending a personalized treatment plan. Managing vaginal cancers through personalized treatment plans positively impacts treatment results, survival rates, and the quality of life after the treatment.

Procedures or Tests for Vaginal Cancer Diagnosis

Vaginal cancer causes various symptoms; it is important to see a specialist when these symptoms are persistent. The diagnosis begins with a physical examination, which is then followed by a battery of tests for a conclusive diagnosis. The following are the different tests recommended for vaginal cancer diagnosis:

Physical Exam and Medical History Assessment

If the patients experience gynecological symptoms that may indicate serious conditions, they should immediately consult with experienced gynecologists. The patients may expect a comprehensive physical examination to determine the cause of the symptoms. The doctor may inquire about the initiation, progression, frequency, and severity of the symptoms. The doctor may also perform a pelvic examination to detect any abnormal masses in the vagina, cervix, rectum, and bladder. The patients may also undergo a medical history assessment, as women who have a history of vaginal cancer or HPV infection are at increased risk of developing vaginal cancer.

Pap Smear Test and HPV test

Women, especially those with a high risk of developing vaginal cancer, may undergo Pap smear tests, a rarely recommended test for vaginal cancer diagnosis. The test determines the presence of abnormal cells that can potentially transform into cancerous cells. During the Pap smear test, the cervical and vaginal smears are collected and analyzed in the laboratory. The HPV test is usually performed along with the Pap smear test. The samples obtained during the Pap smear test may also be checked for the presence of human papillomavirus. However, a Pap smear does not serve as a confirmatory test for a vaginal cancer diagnosis. It is always performed with other tests to arrive at a conclusive diagnosis.

Biopsy

A biopsy is the only method available for confirming a vaginal cancer diagnosis. The symptoms of vaginal cancer are similar to those of various other gynecological conditions, such as endometriosis. Thus, it is important to rule out the presence of serious and malignant conditions at an early stage. During a biopsy, a tissue sample from the vagina is obtained and evaluated under the microscope for the presence of cancerous cells. .

Vaginal Ultrasound

Vaginal ultrasound uses sound waves to obtain images of the vagina and surrounding organs. The doctors recommend transvaginal ultrasound, which involves inserting a probe into the vagina to obtain the images. Ultrasound may help to detect the abnormal mass present in the vaginal tissues. However, ultrasound cannot detect if the mass is benign or malignant. Thus, if the mass is detected on transvaginal ultrasound, the patients are advised to undergo additional tests, such as a biopsy.

MRI (Magnetic Resonance Imaging)

An MRI scan may serve as an important tool in vaginal cancer diagnosis. It assists in diagnosing vaginal cancer, staging the disease, planning for treatment, and monitoring the treatment response. MRI is a commonly recommended imaging method for diagnosing various gynecological malignancies because of its high resolution for soft tissues. It also helps in determining the extent of the spread of vaginal cancer.

CT (Computed Tomography) Scan

A CT scan also assists in vaginal cancer diagnosis. Not only does it help in determining the position and size of the tumor in the vagina, but it also helps in comprehensively evaluating the nearby tissues, including lymph nodes. To obtain clearer images, a contrast agent is injected before the CT. In some cases, CT is also used to guide the needle to obtain a sample of the abnormal tissues from the vagina or other parts (CT-guided biopsy).

PET (Positron Emission Tomography) Scan

A PET scan uses radioactive substances to diagnose vaginal cancer. When the radioactive sugar substance is injected into the patient's blood, it is preferentially taken up by the cancer cells due to their rapid metabolism. A special tracer device then detects the accumulation of the radioactive sugar substance. In some cases, a PET scan is combined with a CT scan to improve the quality of the images. As one of the most effective vaginal cancer tests, a PET scan plays an important role in staging the disease, detecting cancer metastasis, optimizing treatment strategy, and assessing treatment response.

Colposcopy

Specialists recommend colposcopy in patients with abnormal Pap test or HPV test results. Colposcopy is done with the assistance of a colposcope that magnifies the superficial tissues of the vagina and the cervix. This is a painless procedure as there is no insertion of the instrument involved.

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What are Effective Vaginal Cancer Treatments?

Personalized vaginal cancer treatment is planned once the diagnosis and stage of vaginal cancer are confirmed. Specialists also consider parameters like the patient’s age, overall health status, underlying medical conditions, and preferences while devising a treatment plan. The following are the different vaginal cancer treatment options available:

Surgery

Surgery is one of the most common vaginal cancer treatments. In the early stages, especially when the disease is in a precancerous state, surgery is often recommended as a cure for vaginal cancer. Depending on the stage, vaginal cancer treatment may be unimodal (one treatment) or multimodal (a combination of different treatments). Surgery is often combined with chemotherapy, radiotherapy, and other treatments for better outcomes.

Surgery for vaginal cancer involves the removal of the abnormal tissues of the vagina, the vagina itself, and surrounding tissues of the vagina, depending on the stage of the disease.

Laser Surgery

Laser surgery is usually a non-invasive vaginal cancer treatment. It involves the use of high-energy radiation to vaporize and kill the abnormal cells. It is particularly effective in treating precancerous vaginal lesions; however, it is also used to treat large lesions. Laser surgery can be repeated if required and usually has mild side effects. It is not indicated for the treatment of invasive cancer.

Wide Local Excision

Wide local excision involves removing the cancerous tissues and a small portion of surrounding healthy tissues, called the margin. It is a relatively less invasive procedure compared to traditional vaginal cancer surgery. However, this procedure is associated with a higher risk of recurrence. The border tissues are tested for cancer. If the border tissues are free from malignant cells, it is known as a clear margin. Obtaining a clear margin is important as it lowers the chances of vaginal cancer recurrence.

Vaginectomy

Vaginectomy is removing part of the vagina (partial vaginectomy) or the complete vagina (complete vaginectomy). The type of vaginectomy performed, partial or complete, depends upon the extent of cancer spread in the vagina. After the removal of the vagina, the doctor may recommend vaginal reconstruction surgery. During this surgery, the doctor takes muscles and skin from another part of the body to reconstruct the vagina. In cases of advanced-stage vaginal cancer, the doctor may also advise the removal of surrounding organs in addition to the vagina.

Pelvic Exenteration

This procedure involves the removal of several organs in the pelvic region. Pelvic exenteration is recommended for advanced-stage vaginal cancers. It is also recommended if the cancer recurs or the patient does not respond to conservative therapy. During this procedure, the surgeon removes the ovaries, uterus, bladder, rectum, vagina, and fallopian tubes. If necessary, alternate pathways may be created for expelling urine and fecal matter out of the body after the procedure.

Radiation Therapy

Radiation therapy for vaginal cancer uses high-energy, ionizing radiation to kill cancer cells. It is usually combined with surgery or chemotherapy for better treatment results. There are two types of radiation therapy, i.e., external beam radiation therapy and brachytherapy. Usually, a combination of both types is used. Brachytherapy may be administered at a low dose rate or a high dose rate, depending on the extent of the cancer.

Chemotherapy

Chemotherapy for vaginal cancer involves the administration of anti-cancer drugs to kill the cancer cells by interfering with vital steps of their cell cycle. It is a commonly recommended treatment for metastatic vaginal cancer and is generally combined with surgery and radiation therapy. The drugs are administered orally, topically, or through injection. When used before surgery, it shrinks the tumor. It may also be used after the surgery to kill the residual cancer cells.

Targeted Therapy

There are several vital proteins and enzymes present in cancer cells that assist them in growth and proliferation. As one of the latest vaginal cancer treatments, targeted therapy interferes with the functioning of these substances and prevents the division, growth, and proliferation of cancer cells.

Immunotherapy

The immune system is the main protective barrier to cancer, as it identifies and kills abnormal cells in the body. However, cancer cells have certain molecular mechanisms that help them hide from the immune system. Immunotherapy drugs interfere with these mechanisms and make cancer cells more vulnerable to the attacks launched by the immune system. Further, immunotherapy drugs also strengthen the immune system.

Palliative Care

Palliative care is recommended for patients with terminal vaginal cancer. The goal of palliative care is to manage the symptoms and discomfort caused by the disease and improve the quality of life. Palliative care may involve the administration of surgery, chemotherapy, and radiation therapy. The palliative care team comprises oncologists, physicians, nurses, and other experienced and trained professionals.

Why Choose HCG for Vaginal Cancer Diagnosis and Treatment?

As a leading cancer treatment hospital in India, HCG Cancer Hospital has a dedicated department for the screening, diagnosis, treatment, and management of vaginal cancer. The hospital is equipped with all the testing facilities under a single roof for the timely diagnosis of vaginal cancer. The operation theater is equipped with advanced facilities to perform complex surgeries to treat vaginal cancer. The multidisciplinary team at HCG comprises medical oncologists, oncology surgeons, gynecologists, radiation therapists, experienced nurses, and paramedical staff, and these specialists carefully go through each case before recommending a treatment plan.

Conclusion

Vaginal cancer diagnosis is done through several methods, such as physical examination and medical history assessment, Pap smear test, CT scan, transvaginal ultrasound, PET scan, MRI, biopsy, and colposcopy. Vaginal cancer treatment options include surgery, radiation therapy, immunotherapy, chemotherapy, and palliative care. Surgery for vaginal cancer includes laser surgery, vaginectomy, wide local excision, and pelvic exenteration.

Frequently Asked Questions

Can blood tests detect vaginal cancer?

Although blood tests do not detect vaginal cancer, they may provide vital information about the overall health status of the patient. Blood tests are often written along with other tests in order to arrive at a conclusive diagnosis.

Vaginal cancer may occur at any age. However, younger women are relatively at lower risk compared to elderly women for developing vaginal cancer.

Like other types of cancer, vaginal cancer may also recur. However, the risk of recurrence depends upon various factors, such as the stage at which vaginal cancer was diagnosed the first time, the treatment recommended, the treatment response shown by the patient, and the presence of underlying conditions, such as HPV.

The symptoms of vaginal cancer are very similar to those of general gynecological conditions. When symptoms like abnormal vaginal discharge, vaginal pain and discomfort, vaginal bleeding, and pelvic pain are persistently experienced, it is important to see a doctor, as these could be signs of vaginal cancer.

A biopsy is usually considered the confirmatory test for vaginal cancer.