Tests that Help Evaluate Vaginal Cancer
Your doctor took a biopsy from your vagina to know that you have cancer. Your doctor may request other tests to learn more about your type of cancer and its specific location. This will help decide the treatment that is likely to be most effective for you. With these tests, doctors can tell the stage, which is the extent of the vaginal cancer. A cancer’s stage is one of the most important factors in deciding which treatment to use.
These tests use instruments or machines to allow your doctor to see inside your body and find the cancer. Many of these tests create detailed images for your doctor to view. They help show if the cancer has spread. Here are some of the tests you may have to learn the stage of vaginal cancer.
Pelvic Exam Under General Anesthesia
To more thoroughly view your vagina and stage the cancer, your doctor may do a pelvic exam using general anesthesia. This means you will be asleep while it is happening. You may also have the following 2 procedures while you’re anesthetized.
Cystoscopy
Your doctor may do this test to see if the cancer has spread to your bladder. You have this test in a hospital or outpatient surgery center. During a cystoscopy, the doctor looks at the inside of your bladder with a special instrument called a cystoscope, which is a thin, flexible tube with a tiny camera on the end. For this test, you lie on your back with your knees up and slightly apart. The doctor or nurse cleans your urethra (the hole where you urinate) and applies some numbing medication. Or you may be given general anesthesia so you fall to sleep and don’t feel anything.
Then, the doctor or nurse passes the small cystoscope through your urethra and into your bladder. Water or saline solution flows through the scope into your bladder. This stretches your bladder wall, giving the doctor a better view. You may have some discomfort or feel an urge to urinate. If needed, the doctor may take a small tissue sample called a biopsy to check for cancer. The whole test takes between 5 and 20 minutes. You will need a ride home after the test. You may feel a burning sensation when you urinate for a few days after the test.
Proctoscopy
This test lets your doctor see if the cancer has spread to the rectum or the bottom part of the large intestine. For this test, the doctor uses a special instrument called a sigmoidoscope to see the inside of your rectum and lower colon. This is a thin, flexible or rigid tube with a tiny camera attached.
For this test, you undress from the waist down and put on a hospital gown. This may be done under general anesthesia with the cystoscopy. You lie on the exam table on your left side with your knees up toward your chest. The doctor gently inserts the sigmoidoscope through your rectum and into your large intestine. Air blows through the scope to allow for better viewing. The air may cause cramps. You may feel like you need to take a bowel movement. After the test, you will expel the air by passing gas.
Chest X-Ray
Doctors use this test to find out if the cancer has spread to the lungs. It may also be done before surgery to be sure you have no heart or lung problems. You stand in front of an X-ray scanner and hold your breath as the picture is taken. The test does not hurt, but the X-ray plate may feel cold against your skin.
Computed Tomography Scan (CT Scan)
Your doctor may order a CT scan to see if the cancer has spread to the lymph nodes or to other internal organs such as the liver or lungs. Unfortunately, CT scans have not been helpful in finding smaller amounts of cancer in the pelvic lymph nodes.
A CT scan uses X-rays to take pictures of the body from many angles. To have the test, you lie still on a table as it gradually slides through the center of the CT scanner. Then the scanner directs a continuous beam of X-rays at your pelvis. A computer uses the data from the X-rays to create many pictures of your pelvis, which can be used together to create a three-dimensional picture. A CT scan is painless and noninvasive. You may be asked to hold your breath one or more times during the scan.
In some cases, you may be asked to drink a contrast dye 4 to 6 hours before the scan. And you may be asked not to eat anything in the time between drinking the contrast dye and the scan. IF you are a diabetic, you may be asked to take steroids before the contrast is given and you may be told not to take some of your diabetes medications before the test. The contrast dye will gradually pass through your system and exit through your bowel movements.
Magnetic Resonance Imaging (MRI)
An MRI may be done to find if cancer has spread. An MRI uses radio waves and magnets to create detailed images of the inside of your body. For this test, you lie still on a table as it passes through a tube-like scanner. The scanner directs a continuous beam of radiofrequency radiation at the area being examined. A computer uses the data from the radio waves to create a three-dimensional picture of the inside of your body. You may need more than one set of images. Each one may take 2 to 15 minutes, so the whole scan may take an hour or more. This test is painless and noninvasive. Ask for earplugs if they aren’t offered since there is a loud thumping noise during the scan. If you’re claustrophobic, you may receive a sedative before this test.
Positron-Emission Tomography (PET) Scan
A PET scan may be able to show cancers that have spread but that do not show up with other imaging tests. Because PET scans your whole body, your doctor may order one instead of ordering multiple X-rays of different places on your body.
For this test, you first either swallow or are injected with a sugar solution that contains a mildly radioactive substance. Cancer cells absorb this sugar, and the radioactive material shows up during the image from the scan. It may take a few hours to more than a day for the sugar to reach the targeted organ. During this time, you’ll usually remain at the testing location. To have the scan, you’ll need to lie still on a table that is pushed into the PET scanner, a machine that rotates around you taking pictures that show where the glucose is in your body. The process takes about 45 minutes. A PET scan is painless and noninvasive. But if you’re sensitive to the sugar, you may have nausea, headache, or vomiting.
Advances in Diagnosing Vaginal Cancer
Although less research is being devoted to this rare cancer, researchers are making advances in detection.
One recent study looked at positron-emission tomography’s (PET scans) effectiveness in learning the stage or spread of this cancer. The study found that PET scans were more than twice as effective in locating vaginal cancer as a computed tomography (CT scan). The PET scan could also detect tumors in lymph nodes twice as often as a CT scan. This study may help doctors better pinpoint vaginal cancer. It may also help them treat it more effectively. That’s because many women are treated with radiation rather than surgery. And since radiation is directed only to sites that have cancer, it is important to know where all of the tumor is located. This is especially true if it is in the lymph nodes so that radiation can be delivered to the right spots.
Before PET scans become the standard of care for women with vaginal cancer, the findings of this study will likely need to be proven in a larger study.
Also, another advance in surgical therapy for vaginal cancer includes a minimally invasive approach. Surgeons have demonstrated that laparoscopic techniques can be used to evaluate lymph nodes in women with vaginal and cervical cancers.
