Expert consensus
Initial investigations include MRI imaging of the pelvis, cystoscopy and vaginoscopy. These examinations should be carried out under general anesthesia and include a bimanual recto-vaginal examination. During these procedures, biopsies should be taken, which can be achieved by polypectomy or incisional biopsy without resection of the vaginal wall. Care should be taken to collect an adequate amount of tissue during the procedure in order to establish the diagnosis and for further molecular or genetic analysis. Complete surgical resection of vaginal tumors prior to chemotherapy is often impossible and unnecessary. The good response to chemotherapy precludes the need for aggressive upfront surgical resection. Therefore, primary tumor resection should be avoided with the exception of very small, localized and well circumscribed tumors that can be grossly excised with minimal compromise to normal local structures.
Spread to regional lymph nodes (inguinal lymph nodes) is extremely uncommon. Therefore, routine surgical lymph node evaluation is not recommended. Suspicious lymph nodes at initial imaging should be evaluated surgically during primary surgery/biopsy.