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.