Prior to planning your treatment regimen, your doctor needs to know the grade of the tumor and the extent (stage) of the disease. A pathologist assigns the grade (1 to 3) to describe how abnormal the cancer cells look under a microscope. Grade 1 cancer cells are not as likely to grow and spread as Grade 3 cells. The stage is based on whether the tumor has invaded nearby tissues, whether the cancer has spread, and if so, to what parts of the body.
Your doctor may rely on the following tests to determine whether the cancer has spread:
- X-rays: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. To stage vaginal cancer, x-rays may be taken of the organs and bones inside the chest, and the pelvic bones.
- CT scan: Doctors often use CT scans to make pictures of organs and tissues in the pelvis or abdomen. An x-ray machine linked to a computer takes several pictures. You may receive contrast material by mouth and by injection into your arm or hand. The contrast material helps the organs or tissues show up more clearly. Abdominal fluid or a tumor may show up on the CT scan.
- MRI (Magnetic Resonance Imaging): Uses a large magnet, a computer, and radio waves to create detailed images that help determine how far the cancer has grown.
- PET scan (Positron Emission Tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
- Colposcopy: A procedure in which a colposcope (a lighted, magnifying instrument) is used to check the vagina and cervix for abnormal areas. Tissue samples may be taken using a curette (spoon-shaped instrument) and checked under a microscope for signs of disease.
- Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope (a thin, lighted tube) is inserted through the urethra into the bladder. Tissue samples may be taken for biopsy.
- Biopsy: A biopsy may be done to find out if cancer has spread to the cervix. A sample of tissue is cut from the cervix and viewed under a microscope. A biopsy that removes only a small amount of tissue is usually done in the doctor’s office. A woman may need to go to a hospital for a cone biopsy (removal of a larger, cone-shaped piece of tissue from the cervix and cervical canal). A biopsy of the vulva may also be done to see if cancer has spread there.
The stages of vaginal cancer
Stage 0 (Carcinoma in Situ): Abnormal cells are found in tissue lining the inside of the vagina. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
Stage I: Cancer has formed and is found in the vagina only.
Stage II: Cancer has spread from the vagina to the tissue around the vagina.
Stage III: Cancer has spread from the vagina to the lymph nodes in the pelvis or groin, or to the pelvis, or both.
Stage IV is divided into stage IVA and stage IVB:
- Stage IVA: Cancer may have spread to the lymph nodes in the pelvis or groin and has spread to the lining of the bladder or rectum and/or beyond the pelvis.
- Stage IVB: Cancer has spread to parts of the body that are not near the vagina, such as the lungs. Cancer may also have spread to the lymph nodes.
When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the original tumor. For example, if vaginal cancer spreads to the bladder, the cancer cells in the bladder are actually vaginal cancer cells. The disease is metastatic vaginal cancer, not bladder cancer. For that reason, it is treated as vaginal cancer, not bladder cancer. Doctors call the new tumor "distant" or metastatic disease.