How is Vaginal Cancer Diagnosed?

A vaginal cancer diagnosis usually begins when a healthcare provider finds an abnormal area during a pelvic exam or evaluates symptoms such as unusual vaginal bleeding, vaginal discharge, pelvic pain, or a lump in the vagina.

Several tests may be used during the diagnostic process. A pelvic examination and colposcopy can help doctors identify suspicious areas, but a biopsy is needed to confirm vaginal cancer. If cancer is found, imaging and other tests can help determine whether it has spread and guide treatment decisions.

Because vaginal cancer is rare, patients may be referred to a gynecologic oncologist, a doctor who specializes in cancers of the female reproductive system.

What symptoms can lead to a vaginal cancer diagnosis?

Some vaginal cancers are found before they cause noticeable symptoms. Others are discovered after a patient develops vaginal cancer symptoms.

Possible symptoms include abnormal vaginal bleeding, bleeding after sex, bleeding after menopause, unusual vaginal discharge, pelvic pain, pain during sex, a vaginal lump, or changes in urination or bowel movements.

These symptoms are much more commonly caused by conditions other than cancer. However, persistent or unexplained symptoms should be evaluated by a healthcare provider.

How is the vagina examined for cancer?

Your healthcare provider will usually begin by asking about your symptoms, medical history, and risk factors. This may include questions about previous HPV infection, abnormal cervical tests, cervical precancer, or cervical cancer.

During a pelvic exam, the healthcare provider examines the vagina, cervix, vulva, and surrounding tissues. A speculum may be inserted into the vagina so the vaginal walls and cervix can be examined more closely.

The provider may also feel the vagina and nearby structures for a mass or other abnormality. Because vaginal cancer can affect tissues within the pelvis, a thorough pelvic examination is an important part of the initial evaluation.

Can a Pap test detect vaginal cancer?

A Pap test is primarily used for cervical cancer screening, not as a routine screening test for vaginal cancer. However, a Pap test can sometimes identify abnormal cells from the vagina.

An abnormal Pap result does not diagnose vaginal cancer. If abnormal vaginal cells are identified, additional testing may be recommended to determine what caused the changes.

People with a history of cervical precancer, cervical cancer, vaginal precancer, or certain other gynecologic cancers may have different follow-up recommendations than people at average risk.

How is colposcopy used to diagnose vaginal cancer?

A colposcopy allows a healthcare provider to examine the vagina and cervix more closely using a magnifying instrument called a colposcope.

The colposcope remains outside the body. It provides a magnified view that can help the doctor identify abnormal areas that may not be easily visible during a standard pelvic examination.

If a suspicious area is identified, the doctor can select tissue from that area for a biopsy.

How does a biopsy confirm vaginal cancer?

A biopsy is required to confirm a vaginal cancer diagnosis. During a biopsy, a small sample of tissue is removed from a suspicious area and sent to a laboratory.

A pathologist examines the tissue under a microscope to determine whether cancer cells are present. If cancer is found, pathology can also identify the type of vaginal cancer.

Squamous cell carcinoma is the most common type. Less common types include vaginal adenocarcinoma, melanoma, and sarcoma.

Some precancerous changes in the vagina are associated with persistent human papillomavirus (HPV) infection. A biopsy helps doctors distinguish precancerous changes from invasive cancer.

What imaging tests are used after vaginal cancer is diagnosed?

Once a biopsy confirms cancer, imaging tests may be used to determine the size and location of the tumor and whether it has spread beyond the vagina.

Depending on your situation, your healthcare team may recommend a CT scan, MRI, PET/CT scan, chest imaging, or other tests.

MRI can provide detailed images of structures in the pelvis and may help doctors understand whether a vaginal tumor has grown into nearby tissues. CT and PET/CT imaging may be used to evaluate lymph nodes or look for cancer in other parts of the body.

Not every patient needs every type of imaging. Your healthcare team will choose tests based on the location of the tumor and other findings from your examination and biopsy.

Are endoscopic tests used to evaluate the pelvis?

In certain situations, endoscopic tests may be used to examine nearby organs if doctors are concerned that vaginal cancer has grown into them.

For example, cystoscopy uses a thin instrument to examine the inside of the bladder. Proctoscopy or similar procedures may be used to examine the rectum.

These procedures are not necessary for every patient. They are generally considered when symptoms, physical examination, or imaging suggests that cancer may involve nearby structures.

How is the stage determined after a vaginal cancer diagnosis?

After vaginal cancer is confirmed, doctors determine how far it has spread. This process is called staging.

The examination, biopsy, and imaging results help establish the extent of the disease. Vaginal cancer stages range from stage I, when cancer is limited to the vaginal wall, through stage IV, when it has invaded certain nearby organs or spread to distant areas.

For example, stage II vaginal cancer has spread through the vaginal wall into nearby tissue but has not reached the pelvic wall.

Your stage provides important information about the extent of your cancer and helps your healthcare team recommend treatment.

How does diagnosis affect vaginal cancer treatment options?

The results of your diagnostic and staging tests help determine the most appropriate vaginal cancer treatment options.

Treatment depends on factors such as the cancer's type, stage, size, and location, along with your overall health and previous treatments. Options may include radiation therapy, surgery, chemotherapy, or a combination of approaches.

Because vaginal cancer is uncommon, treatment planning may involve several specialists. Your gynecologic oncologist can explain which treatment options are appropriate for your individual diagnosis.

Are clinical trials available after a vaginal cancer diagnosis?

Clinical trials study new ways to prevent, diagnose, or treat cancer. They can be particularly important for rare cancers because fewer patients are available for large research studies.

Depending on your diagnosis and stage, you can ask your healthcare team whether there are clinical trials that may be appropriate for you.

Trials may investigate new medications, immunotherapies, radiation approaches, or combinations of existing treatments. Considering a clinical trial does not mean you have run out of standard treatment options.

What happens after vaginal cancer is diagnosed?

If your biopsy confirms vaginal cancer, your care team will bring together the information from your pathology, physical examination, imaging, and other tests to determine your stage and develop a treatment plan.

The American Cancer Society and other cancer organizations provide additional patient information about diagnosis and treatment, but your individual care plan should be based on your specific pathology and stage.

Your healthcare team can explain what each result means, whether additional testing is necessary, and what comes next. If possible, consider writing down questions before your appointment or bringing someone with you to help take notes and remember what was discussed.