Vaginal cancer physical examination
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Overview
Complete pelvic examination is performed. During the speculum examination, the vagina should be inspected thoroughly, including visualization of the entire circumference and the fornices by moving the position of the speculum. Any abnormal areas or masses should be biopsied. The bimanual examination should include palpation of the vaginal walls for masses and evaluation for other pelvic masses. The groins should be palpated to assess for enlarged lymph nodes.
Physical Examination
- The lesion may be missed on initial examination if it is small and situated in the lower two-thirds of the vagina.
- During visual examination of the vagina, the anterior and posterior blades of the speculum obscure this area, so the tumor may be missed unless the vagina is inspected as the speculum is removed or the lesion is palpated on bimanual examination.
- Rectovaginal exam should also be performed to assess for parametrial and pelvic sidewall involvement and possible rectal involvement.
- The posterior wall of the upper one-third of the vagina is the most common site of primary vaginal carcinoma.
- The lesion may appear as a mass, a plaque, or an ulcer.
- Focused physical examination is performed to assess for metastatic disease.
- The inguinal area should be examined for enlarged lymph nodes.