Workup/Staging

Question 1

What staging exams/studies contribute to the FIGO stage?

Answer 1

Exams/studies that contribute to the FIGO stage include clinical exam of the pelvis and vagina (possibly under anesthesia), cystoscopy, and proctosigmoidoscopy in women with locally advanced Dz, CXR, LFTs, and alk phos.

Question 2

What imaging studies can be obtained but are not required in order to assign an FIGO stage?

Answer 2

Advanced imaging such as CT, MRI, and PET do not contribute to the FIGO stage (but still should be used to assess the Dz extent and plan therapy).

Question 3

What is the AJCC 8th edition/FIGO staging for vaginal cancer?

Answer 3

T1a/I: Tumor confined to the vagina, measuring ≤2 cm

T1b/I: Tumor confined to the vagina, measuring >2 cm

T2a/II: Tumor invading paravaginal tissues but not to pelvic sidewall, measuring ≤2 cm

T2b/II: Tumor invading paravaginal tissues but not to pelvic sidewall, measuring >2 cm

T3/III: Tumor extending to the pelvic sidewall and/or involving the lower-third of the vagina and/or causing hydronephrosis or nonfunctioning kidney

T4/IVA: Tumor invading the mucosa of the bladder or rectum and/or extending beyond the true pelvis (bullous edema is not sufficient evidence to classify a tumor as T4)

N1/III: Pelvic or inguinal LN mets

MI/IVB: DM

Question 4

A vaginal cancer is never considered a vaginal primary if it involves either of what 2 structures?

Answer 4

Cancer involving the vulva or cervix is never considered to be a vaginal primary (even if the bulk of Dz lies in the vagina).

Question 5

When working up a presumed vaginal cancer primary, what other 3 sites should be evaluated for synchronous in situ or invasive Dz?

Answer 5

When working up a presumed vaginal cancer primary, always evaluate for synchronous cervical, vulvar, and/or anal Dz.