Recent updates to the FIGO staging system for cervical cancer, which incorporate advanced imaging results into staging [10], reflect the wide recognition that cross-sectional imaging provides actionable staging information not readily obtained by physical examination or conventional radiography. Moreover, the increasing use of definitive radiotherapy across all stages of vaginal cancer obligates the incorporation of advanced imaging into pretreatment evaluation, because it is essential for treatment planning. The rationale for optimizing staging accuracy in vaginal cancer, in part via the inclusion of cross-sectional imaging, is multifold. First, accurate initial staging is fundamental to prognostication [11], facilitating incorporation of expectations of treatment efficacy into goals of care. Second, proper initial staging permits selection of the most appropriate treatment based on extent of disease. Regarding local extent, for vaginal lesions deemed likely confined to the vaginal wall (stage I) based on clinical examination, exclusion of extravaginal invasion with further testing is essential for ensuring that planned definitive surgery is likely to achieve a disease-free margin or that a radiation field properly incorporates the tumor volume. Regional nodal metastases include pelvic nodal metastases, which are primarily detected with cross-sectional imaging, and inguinal nodes (in lower vaginal cancers), a subset of which can be identified on clinical examination. Pretreatment knowledge of suspicious nodes may impact the decision to pursue surgery versus radiation. In addition, the distribution of suspicious nodes has the potential to influence radiation-specific factors such as field and dose planning, including possible node-directed boost doses as employed in cervical cancer [12].
Staging and Follow up of Primary Vaginal Cancer. Recent updates to the FIGO staging system for cervical cancer, which incorporate advanced imaging results into staging [10], reflect the wide recognition that cross-sectional imaging provides actionable staging information not readily obtained by physical examination or conventional radiography. Moreover, the increasing use of definitive radiotherapy across all stages of vaginal cancer obligates the incorporation of advanced imaging into pretreatment evaluation, because it is essential for treatment planning. The rationale for optimizing staging accuracy in vaginal cancer, in part via the inclusion of cross-sectional imaging, is multifold. First, accurate initial staging is fundamental to prognostication [11], facilitating incorporation of expectations of treatment efficacy into goals of care. Second, proper initial staging permits selection of the most appropriate treatment based on extent of disease. Regarding local extent, for vaginal lesions deemed likely confined to the vaginal wall (stage I) based on clinical examination, exclusion of extravaginal invasion with further testing is essential for ensuring that planned definitive surgery is likely to achieve a disease-free margin or that a radiation field properly incorporates the tumor volume. Regional nodal metastases include pelvic nodal metastases, which are primarily detected with cross-sectional imaging, and inguinal nodes (in lower vaginal cancers), a subset of which can be identified on clinical examination. Pretreatment knowledge of suspicious nodes may impact the decision to pursue surgery versus radiation. In addition, the distribution of suspicious nodes has the potential to influence radiation-specific factors such as field and dose planning, including possible node-directed boost doses as employed in cervical cancer [12].