Your stage of cancer tells how much cancer there is and how far the disease has spread. By using the physical exam and tests, your doctor can identify the stage of your vaginal cancer. A cancer's stage is one of the most important factors in deciding how to best treat the cancer. Doctors use the FIGO system, developed by the International Federation of Gynecology and Obstetrics, to stage vaginal cancer. Doctors also use the TNM system, which the American Joint Committee on Cancer developed. TNM is an acronym for Tumor, Lymph nodes, and Metastasis.
You may need a number of tests, so that your doctors can stage your vaginal cancer. The tests include a careful examination of your cervix and vagina, and imaging tests, such as:
Chest X-ray. Doctors use this test to figure out if the cancer has spread to your lungs.
Computed tomography (CT) scan. In this test, an X-ray beam moves around your body and takes pictures from many angles. The computer combines these pictures, which show a detailed cross-section of the inside of your body.
Magnetic resonance imaging (MRI). An MRI uses magnets and radio waves to take pictures of the inside of your body; it is similar to a CT scan. MRIs can show more detail and can help your doctor determine the location and size of your cancer.
Your doctor may also perform some procedures, using a scope, to determine your stage of vaginal cancer. These tests may include:
Proctosigmoidoscopy. In this test, your doctor uses a proctoscope, a thin tube with a light at the end, to examine your rectum and part of your colon to see if the cancer has spread to either place. Doctors usually perform this test if your cancer is near your rectum and colon.
Cystoscopy. In this test, your doctor looks at your bladder to see if the cancer has spread there. Your doctor may recommend this test if your cancer is causing symptoms of bladder irritation, such as blood in your urine and pain during urination.
Preinvasive disease, stage 0, is when the cancer cells are in the lining (epithelium) of your vagina and have not spread to other layers. This stage is also called carcinoma in situ. Doctors frequently refer to stage 0 vaginal cancer 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 severe), VAIN 2, and VAIN 3 (the most severe). The FIGO system does not use Stage 0.
Invasive vaginal cancer is staged as follows:
Stage I. In stage I, the cancer has grown through the lining of your vagina, but is confined to the vaginal mucosa, the outermost layer of vaginal tissue. The cancer has not spread to nearby tissues.
Stage II. In stage II, the cancer has spread to the tissues next to your vagina, but not to lymph nodes, your pelvis, or other organs.
Stage III. In stage III, the cancer has spread to the wall of your pelvis and may have spread to nearby lymph nodes. The cancer 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 also have spread beyond the pelvis to lymph nodes. The cancer has not spread to distant organs.
Stage IVB. In stage IVB, the cancer has spread to distant organs, like the lungs.
When you are diagnosed with cancer, it is natural for you to feel shocked and distressed. Fortunately, the majority of patients diagnosed with vaginal cancer can be cured with appropriate treatment. These feelings may make it difficult for you to think of everything you want to ask you doctor. It often helps to make a list of questions. To help remember what your doctor says, you may take notes, or ask your doctor if you may use a voice recorder. You also may want to have a family member or friend with you when you talk to your doctor, to take part in the discussion, take notes, or just listen.