Vaginal and vulvar cancers

Diagnosis

Epworth uses a range of diagnostic tests to thoroughly investigate signs and symptoms of underlying health concerns.

Below is an overview of common tests used to diagnose vaginal and vulvar cancers:  

Physical examination

Your GP or specialist may perform a general physical examination to understand your current health. This may include an examination of your vagina, groin and pelvic area and may include an internal pelvic floor examination. 

Biopsy

Tissue samples are taken and looked at under a microscope to determine if cancer cells are present. Biopsies may be performed on the cervix via colposcopy, or taken from the vagina or vulvar lining via hysteroscopy, or lesions in the pelvis or abdomen via laparoscopy or at an open procedure (laparotomy).

A colposcope and hysteroscope are magnifying instruments used to look closely at the vagina, cervix, vulva and uterus.

Blood test

Your doctor may order several blood tests to check your overall health and to detect proteins produced by cancer cells. These proteins are called tumour markers. 

Ultrasound

An ultrasound may be one of the first tests you encounter following a blood test and physical exam. Your doctor may recommend an abdominal and/or a transvaginal ultrasound. 

• Abdominal ultrasound
  The sonographer moves a small device (transducer) over your abdominal area.
  
• Transvaginal ultrasound
  A small transducer wand is inserted into the vagina to provide a clearer picture of both ovaries, uterus, bladder and bowel. 

Medical imaging

Depending on the types of cancer being investigated, your doctor may order an MRI (magnetic resonance imaging), CT (computerised tomography), or PET (positive emission tomography) scan to be performed. Upon formal diagnosis, medical imaging will allow your care team to examine and stage cancer. 

Staging - Investigating the extent of the cancer

Staging helps your care team and specialists to create a unique treatment plan. During your initial diagnostic tests, your care team may be able to stage your cancer at the same time during a biopsy or CT, MRI, or PET scans. 

What does my cancer stage mean?

Staging is a term used to describe the size of the cancer and whether it has spread. Staging helps your care team and specialists to create a unique treatment plan.

Vulvar cancer staging

Stage 1

Early cancer where the tumour is relatively small and found only in the vulva or perineum.

Stage 2

Cancer is found in the vulva and has spread to the lower urethra, vagina or anus.

Stage 3

Cancer has spread from the vulva or perineum to the nearby lymph nodes.

Stage 4

Sometimes called advanced cancer, stage 4 means cancer has spread to the upper urethra, upper vagina or to more distant parts of the body.

Grading of vulvar cancer

Grading provides a guide to how quickly the cancer may grow and spread. Low grade cancer cells (grade 1) are slow growing, while high grade (grade 3) look more abnormal and grow and spread rapidly.

Vaginal cancer staging

Stage 1

Early cancer where the tumour is relatively small and found only in the vagina.

Stage 2

Cancer has begun to spread through the wall of the vagina, but not into the pelvic wall.

Stage 3

Cancer has spread to the pelvis and may also be present in lymph nodes close to the vagina.

Stage 4

Sometimes called advanced cancer, stage 4 means cancer has spread to the pelvis, lining of the bladder or bowel or to a distant part of the body.

Grading of vaginal cancer

Grading provides a guide to how quickly the cancer may grow and spread. Low grade cancer cells (grade 1) are slow growing, while high grade (grade 3) look more abnormal and grow and spread rapidly.

Prognosis

Prognosis refers to the expected outcome of the disease related to the stage and grade. Your doctor can provide an idea about the general prognosis for people with the same type and stage of vulvar or vaginal cancer. In most cases, the earlier vulvar and vaginal cancers are detected and diagnosed, the better the success of treatment.

Treatment

Why choose Epworth for cancer care?

Treatment overview

Depending on the stage and type of cancer, your treatment plan may recommend surgery, chemotherapy prior to or after surgery, or a combination of chemotherapy and radiotherapy. Some cancers are cured with surgery alone and others require a combination of treatments. 

• Radiotherapy
  People with vaginal cancer are often recommended radiotherapy as their first line of treatment. Radiotherapy is the use of radiation (X-rays) to kill or injure cancer cells. 
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• Chemotherapy
  Chemotherapy is a common form of treatment that involves the use of anti-cancer drugs to kill or slow the growth of cancer cells. Chemotherapy is often used alongside other treatments such as radiotherapy and surgery. 
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• Surgery
  Surgery is often first line treatment for vaginal and vulvar cancer that has not spread beyond the uterus. Our oncologists perform more than 1,000 major gynaecological cancer operations each year and are leading experts in this field.
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Multidisciplinary Team (MDT) Assessment and Plan of Treatment

You will have access to an MDT to plan the management of your cancer. All members of the MDT have a special interest in gynaecological cancer, and include:

• Gynaecological oncologists
• Medical oncologists
• Radiation oncologists
• Gynaecology clinical nurse specialists/oncology liaison nurse
• Gynaecology histopathologists/cytologists
• Physiotherapists
• Radiologists
• Research staff
• Genetics counsellors
• Social workers
• Psychiatrist/psychologist
• Pastoral Care
• Rehabilitation team
  
  

Surgery

Types of vulvar cancer surgery:

Surgery is a common treatment for vulvar cancer, especially in the early stages of the disease. Some common types of surgery for vulvar cancer include:

• Excisional biopsy
  This procedure involves the removal of the entire tumour along with a small amount of surrounding healthy tissue.
• Wide local excision
  This procedure involves the removal of the tumour and a wider area of surrounding tissue to ensure that all of the cancer cells are removed.
• Radical vulvectomy
  This is a more extensive surgery that involves the removal of the entire vulva, including the clitoris, labia majora, and labia minora.
• Radical hysterectomy
  This is a surgical procedure in which the uterus, cervix, and part of the vagina are removed along with the vulva to treat advanced vulvar cancer.
  
   

Types of vaginal cancer surgery:

• Local excision
  Local excision is the removal of a small amount of tissue from the surface of the vagina where the cancer is located.
• Partial vaginectomy
  This procedure involves the removal of part of the vagina where the cancer is located, while preserving as much of the healthy tissue as possible.
• Radical vaginectomy
  This is a more extensive surgery that involves the removal of the entire vagina, including the cancerous tissue, and often also involves the removal of nearby lymph nodes.
• Pelvic exenteration
  This is a major surgical procedure that involves the removal of all organs in the pelvic region, including the vagina, cervix, uterus, ovaries, and bladder, in order to treat advanced vaginal cancer.
  
  
   

Radiotherapy

Epworth oncologists use radiation to cure, control and reduce gynaecological cancer cells for our patients. 

Radiotherapy at Epworth

Epworth offers patients radiotherapy through our provider, Icon. As Australia’s largest dedicated cancer care provider, Icon has a long history of delivering exceptional cancer care to the Australian community.

Supported by the latest world-class technology and evidence-based techniques, Icon’s highly experienced team of radiation oncologists, radiation therapists, physicists and nurses are committed to providing compassionate, exceptional care for patients and their loved ones.

What are the side effects of radiotherapy?

Side effect types and duration will vary from person to person. Some general side effects may include:

• Fatigue
• Skin irritation
• Feeling weak
• A stinging sensation when urinating
• Diarrhoea

Chemotherapy

Your medical oncologist will oversee your chemotherapy. These specialists work closely with surgeons, radiation oncologists, physicians, nurses, and allied health professionals to ensure that all elements of your care are coordinated.

Your medical oncologist will explain and discuss current treatment recommendations and the opportunity to participate in appropriate clinical trials.

How will I receive my treatment?

The treatment can be given orally, through an intravenous cannula, direct introduction to the affected organ/tissue or as a cream. Chemotherapy is often given in courses or cycles with periods of rest in between, allowing normal cells to recover.

Are there different types of chemotherapy?

Yes, there are many different types of chemotherapy. Your care team will explain which chemotherapy is best for your circumstance.

What are the side effects of chemotherapy?

Our team is here to support you throughout your cancer journey and will help you prevent and manage these potential and often temporary side effects.

Side effects may include:

• Nausea and vomiting
• Diarrhoea or constipation
• Fatigue
• Hair loss
• Muscle weakness
• Skin sensitivity to sunlight
• Loss of appetite

Epworth Wig salons

Head wear and wigs are offered to all Epworth patients experiencing hair loss at our convenient on-site salons. This service is provided via the generosity of our Epworth Medical Foundation donors so there is no cost to patients.

How do I prepare for chemotherapy?

• The Gynae Clinical Nurse Consultant and Oncology Liaison Nurse Consultant will provide education and a support pack for your information and explain the chemotherapy process.
• You may be able to use “cold caps” to prevent hair loss or may like to be fitted for a wig prior to starting chemotherapy in case you need it.
• Recovering from surgery, eating well, staying well hydrated, sleeping and exercising will all play a part in preparing for chemotherapy.
• You may choose to have your chemotherapy at one of Epworth’s Day Oncology Units or a unit closer to your home.
• If you have children or grandchildren from babies to age 18, you may like to read the Cancer Council book: Talking to Kids About Cancer. The ward team can provide a copy.