The stage of cancer tells how much and how far the disease has spread. By using exams and tests, a doctor can tell the stage of a woman's vaginal cancer. A cancer's stage is one of the most important factors in deciding what treatment to have for the cancer. Vaginal cancer is staged using the FIGO system, developed by the International Federation of Gynecology and Obstetrics, as well as the TNM system developed by the American Joint Committee on Cancer.
To stage vaginal cancer, a number of tests are needed. These include a careful examination of the cervix and vagina during the physical exam and imaging tests such as:
Chest x-ray. Doctors use this test to figure out if the cancer has spread to the lungs.
Computed tomography (CT) scan. In this test, an x-ray beam moves around the body and takes pictures of the body from many angles. These pictures are combined by a computer and show a detailed cross-section of the body.
Magnetic resonance imaging (MRI). An MRI uses magnets and radio waves to take pictures of the inside of the body, a lot like a CT scan. MRIs can show more detail and can help a doctor figure out the location and size of the cancer.
Tests done with a scope may also be useful in determining a woman's stage of vaginal cancer. These may include:
Proctosigmoidoscopy. In this test, the doctor uses a proctoscope, a thin tube with a light at the end, to examine the rectum and part of the colon to see if the cancer has spread to either place. This test is usually done on women whose cancer is near the rectum and colon.
Cystoscopy. In this test, the doctor looks at the bladder to see if the cancer has spread there. It is recommended if the cancer is causing symptoms of bladder irritation, such as blood in the urine and pain during urination.
Preinvasive disease, stage 0, is when the cancer cells are in the lining (epithelium) of the vagina and have not spread to other layers. This stage is also called carcinoma in situ. Stage 0 vaginal cancer is also frequently referred to as vaginal intraepithelial neoplasia 3 (VAIN3). It may be a precursor to invasive vaginal cancer in some women. There are three grades of VAIN: VAIN 1 (the least invasive), VAIN 2, and VAIN 3 (the most invasive). The FIGO system does not use Stage 0.
Invasive vaginal cancer is staged as follows:
Stage I. In Stage I, the cancer has gone through the lining of the vagina but is confined to the vaginal mucosa, which is the outermost layer of vaginal tissue. It has not spread to nearby tissues.
Stage II. In Stage II, the cancer has spread to the tissues next to the vagina but not to the pelvis or other organs.
Stage III. In Stage III, the cancer has spread to the wall of the pelvis and/or to nearby lymph nodes. It has not spread to distant organs.
Stage IVA. In Stage IVA, the cancer has spread to organs near the vagina, like the bladder or the rectum. In this stage, the cancer may have also spread beyond the pelvis and to lymph nodes near the pelvis.
Stage IVB. In Stage IVB, the cancer has spread to distant organs, like the lungs.
When a person is diagnosed with cancer, shock and distress are natural reactions. These feelings may make it difficult for patients to think of everything that they want to ask their doctor. Often it helps to make a list of questions. To help remember what the doctor says, patients may take notes or ask the doctor whether they may use a tape recorder. Some patients also may want to have a family member or friend with them when they talk to the doctor to take part in the discussion, to take notes, or just to listen.