Vaginal cancer differential diagnosis

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


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:

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:

Diseases Clinical manifestations Para-clinical findings Gold standard
Symptoms Physical exam Lab Findings Imaging Histopathology

vaginal bleeding

Abnormal vaginal dyscharge Pelvic


Itching or

burning of the vulva

Other Genitourinary/ Gastrointestinal symptoms B symptoms Abdominal pain Gynecological examinations Abdominal


HPV Pap smear STI Panel Ultrasound MRI CT Scan
Vaginal cancer[1][2][3][4]


+ +/- +/- + Ultrasound: MRI:
  • Isointense on T1-weighted images
  • Soft-tissue mass with intermediate-to-high signal intensity on T2-weighted images
Biopsy findings:
Cervical cancer[5][6][7][8][9][10][11][12] + + + +


+ ± ±Chlamydia T2-weighted MRI :
  • Ovoid, heterogeneous tumor distending the cervical canal with stromal involvement.
PET/CT scan:
Cervical polyp[13][14][15] + May reveal presence of tumor CT contrast may show presence of a well defined mass
Cervical leiomyoma[16][17][18][19][20][21][22][23] + + + ±
  • Well circumscribed hyperechoic mass
T2-weighted MRI:
  • Hypointense masses
  • Homogeneous


  • Red degeneration
Cervical lymphoma[24][25][26] + + +
  • Irregularity
  • Well-defined, solid, concentric, hypoechoic mass
MRI: Diffuse heterogeneous uterine/cervical mass & hypoechoic enlarged iliac lymph nodes
Cervical sarcoma[27][28][29][30] ± + ± + + MRI: N/A
Cervical erosion(Ectropion)[31][32][33][34][35] + + ± + - N/A N/A N/A
Cervicitis[36][37][38][39] + + +/- To detect complications like PID N/A N/A N/A
IUD use[40][41][42] ± + +/- ± To detect IUD location and pregnancy N/A N/A N/A Physical exam and ultrasound
Pelvic inflammatory diseases[43][44] + +
  • Fever


Thickened fluid filled fallopian tubes N/A May show endometritis
Endometriosis[45][46][47][48][49][50] ± + +
  • Unilocular/multilocular cysts contating thin/thick septations
  • Increased vascularity showing increased doppler flow
  • Hyperintensity on T1 weighted images
  • Hypointensity on T2 weighted images
Presence of endometrial tissue outside the uterus
Adenomyosis[51][52][53][54][55] + +/- +/- MRI:
  • Thickened junctional zone
Cervical ectopic pregnancy[56][57] + T2-weighted MRI:
  • Hypointense large mass

T1-weighted MRI:

  • Partially hyperintense mass
DES exposure (Clear cell adenocarcinoma)[58][59][60] + +/- +/- +/- + - To determine uterine extent To detect metastases
Paget's disease of vulva to cervix[61][62][63] ±
  • Hyperintense on diffusion weighted images
Nabothian cyst[64][65][66][67] + -
  • Intermediate or slightly high signal intensity on T1-weighted
  • High signal intensity on T2-weighted images
  • Small cysts not visible on CT
  • Large cysts seen as focal low attenuation region
Rectal cancer[68][69][70][71][72] - - + - Weight loss + LLQ + NL + - - +/- Endoscopic/transrectal US detects tumor extent Determine tumor stage Determine tumor stage Colonoscopy with biopsy
Submucous uterine leiomyoma[73][74][75] Menorrhagia - + - - + Enlarged, irregular, firm, nontender uterus + - - - Provides information on no: of fibroids, size, vascularization, relationship with endometrial cavity & serosal surface Not required Not required Physical examination with Ultrasound
Uterine cancer[76][77][78][79] + + - + + - - - Thickened endometrial lining >4cm Not required Histologic diagnosis
Vaginal lymphoma[80][81][82] + + + + Abdominal/pelvic pain - + Palpable mass between rectum & vagina +/- - - - Diffuse mass in external cervical orifice & invading the vagina Diffuse mass in external cervical orifice & invading the vagina Not required CD20 & CD79a positive Immunohistochemistry & biopsy
Vaginal polyp[83][84][85][86] Postmenopausal bleeding + + + - + Mass protruding from vagina +/- - - - To exclude uterine hyperplasia/carcinoma To determine the extent N/A Benign tissue/premalignant cells Excisional biopsy
Vaginal adenosis[87][88] +/- +/- +/- - - - Palpable cysts,nodularity or ulcers - - - - N/A N/A N/A Columnar cells in the ectocervix Biopsy with histopathological examination


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