Vaginal cancer differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Syed Musadiq Ali M.B.B.S.[2]

Overview

Vaginal cancer must be differentiated from cervical carcinoma, rectal carcinoma, uterine carcinoma, vaginal lymphoma, vaginal cyst, vaginal node of endometriosis, and uterine fibroids.

Differential diagnosis

For large lesions consider invasion of the vagina by:

• Cervical carcinoma
• Rectal carcinoma
• Uterine carcinoma

Malignant involvement of the vagina from metastatic spread is much more common, and except for isolated reports of metastases from extragenital cancers, the most common cause of metastatic disease is direct local invasion from the female urogenital tract. Therefore some authors state the diagnosis of primary vaginal carcinoma should be diagnosed only if other gynecologic malignancies have been excluded.

Other differential considerations include:

• Vaginal lymphoma

Diseases with similar symptoms (bleeding or vaginal discharge) are the following:

• Vaginal cyst
• Vaginal node of endometriosis
• Uterine fibroids

	Clinical Features	Physical Examination	Diagnostic Findings
Vaginal Carcinoma	Dysmenorrhea Dyspareunia Vaginal bleeding after intercourse.	gross erosion, ulcer, or mass in vagina pelvic or parametrial metastasis Leg edema suggests lymphatic or vascular obstruction	There is no screening test for vaginal cancer. HPV vaccine can prevent the strains of HPV responsible for most cervical, vaginal and vulvar cancers.	Cervical Carcinoma	Dysmenorrhea Dyspareunia Vaginal bleeding after intercourse. Watery, bloody vaginal discharge,foul odor	Endophytic enlarged, indurated cervix whose surface is smooth, "barrel shaped cervix." Adnexal masses superficial ulceration, exophytic tumor in the exocervix, or infiltration of the endocervix Lateral displacement of the cervix	Pre-cancerous changes in a biopsy,cervical intraepithelial neoplasia (CIN).  Hypoechoic, vascular mass on MRI Colposcopic visualization confirms the diagnosis
Rectal Carcinoma	Dark or red blood in stool Mucus in stool Narrow stool Abdominal pain Painful bowel movements Iron deficiency anemia	On DRE, fixation of the lesion to the anal sphincter, Proctoscopy determine the distance between the distal tumor margin and the dentate line.	Carcinoembryonic antigen (CEA) is higher than normal
Submucous uterine leiomyomas	Menorrhagia Pelvic pressure and pain Infertility Peak age of onset 25 to 44 years of age	Mobile uterus with an irregular contour	Transvaginal ultrasound will demonstrate the presence of myomas
Uterine Carcinoma	Vaginal bleeding, spotting, or discharge Difficulty or pain when urinating Dyspareunia Pain in the pelvic area	Endometrium is thicker than usual Uterus and Adnexal masses	Increased serum cancer antigen-125  Transvaginal Ultrasound endometrial thickness greater than 5 mm
Vaginal Lymphoma	Presence of a painless mass in the area Abnormal vaginal bleeding or discharge Pain during and bleeding after intercourse Abdominal pain and back pain Unintentional weight loss	Painless enlargement of one or more lymph nodes	Lymph node biopsy is the definitive test for diagnosing
Endometriosis	Dysmenorrhea Dyspareunia Bleeding Common in women between 55 to 65 years	Nodules in the posterior fornix Adnexal masses Fixed retroverted uterus Lateral displacement of the cervix	Increased serum cancer antigen-125  Nodules of the recto vaginal septum and hypoechoic, vascular mass on MRI Laproscopic visualization confirms the diagnosis
Adenomyosis	Abnormal uterine bleeding Dysmenorrhea Common in women aged 40 and 50 years	Diffuse uterine enlargement always less than size corresponding to less than 12 weeks of gestation	Asymmetric thickening of the myometrium on MRI