How is vulvar cancer diagnosed?

You might have some or all the following tests to confirm a diagnosis of vulvar cancer.

Once cancer of the vulva is suspected, you should be referred to a gynaecologic oncologist. This is a doctor who has specialist training in cancer of the female reproductive system.

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Physical examination

The gynaecologic oncologist will do a full pelvic examination. This will include examining your vulva and the inside of your vagina to check for any lumps or swellings. The doctor will also feel your groin and pelvic area to check for any swollen glands, and may also check your rectum.

Colposcopy

A colposcopy is a closer examination of the vulva and vagina using a colposcope, which is a small low-powered microscope that allows the doctor or specialist nurse to see the area in more detail.

A colposcope looks like a pair of binoculars sitting on a large stand. It does not enter the body – the doctor inserts an instrument called a speculum into your vagina and then views a magnified picture of the vagina, cervix and vulva through the colposcope.

Some colposcopes are fitted with a camera that is connected to a TV screen. This may allow you to watch what the doctor is doing. You should feel free to ask the doctor or nurse to explain what is happening.

Biopsy

A small sample of tissue will be taken from any abnormal areas and sent to a pathologist to be examined under a microscope.

Further tests

If the above tests show that you have vulvar cancer, further tests may be necessary to find out whether any cancer cells have spread (metastasised) to other parts of the body. This is called staging. The results will help you and your doctor decide on the best treatment for you.

You may have 1 or more of the following tests.

Chest X-ray and blood tests

These are necessary to assess your general health and to check if the cancer has spread to the lungs.

CT, MRI or PET scans

Computerised tomography (CT) or magnetic resonance imaging (MRI) scans allow doctors to see pictures of the organs and other structures (including tumours) in your body.

Your doctor may also ask for a positron emission tomography (PET) scan (a type of nuclear imaging test).

Examination under anaesthetic

An examination of the vulva may be carried out under a general anaesthetic. This allows the doctor to examine you thoroughly without causing any discomfort, and to check the extent of the cancer.

Endoscopy

Endoscopy refers to any procedure where the doctor inserts a thin tube in the body to look inside. There are different types of endoscopies, depending on the area of the body your doctor wants to examine. These tests are usually only done if the doctor thinks the cancer may have spread to different areas.

Cystoscopy

Cystoscopy is a test that allows the doctor to look at the interior lining of the bladder and the urethra, to see if the cancer has spread to this region. The cystoscope is a slender tube with a lens and a light that is inserted into the urethra and moved into the bladder.

Ureteroscopy

Ureteroscopy is a procedure to look inside the ureters to check for abnormal areas. Ureters are long, thin tubes that carry urine from the kidneys to the bladder.

A ureteroscope is inserted through the bladder and into the ureters, to see if cancer has spread to this region. A ureteroscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.

Ureteroscopy and cystoscopy may be done during the same procedure.

Proctosigmoidoscopy

Proctosigmoidoscopy is a procedure to look inside the rectum and part of the colon to check for abnormal areas. A thin, tube-like instrument with a light and a lens for viewing is inserted into the rectum. The instrument is called a proctoscope or a sigmoidoscope, and may also have a tool to remove tissue to be checked under a microscope for signs of disease.

Staging and grading

The stage of a cancer is a term used to describe its size and whether it has spread beyond its original area of the body.

The grade of a cancer describes how quickly the tumour is likely to grow.

Knowing the grade and stage of the cancer helps doctors decide on the most appropriate treatment.

Staging

If tests find vulvar cancer, one of the following stages will be used to describe your cancer:

Stage 0 (carcinoma in situ): Abnormal cells are found on the surface of the vulval skin. These abnormal cells may become cancer and spread into nearby normal tissue.
Stage 1: Cancer is found only in the vulva and/or in the perineum, which is the space between the opening of the rectum and the vagina.
Stage 2: Cancer is found in the vulva and/or the perineum and can be of any size with extension into adjacent perineal structures such as the lower urethra, vagina and anus.
Stage 3: Cancer is found in the vulva and/or perineum, and has spread to nearby tissues such as the lower part of the urethra (the tube through which urine passes), the vagina, the anus (the opening of the rectum) and nearby lymph nodes.
Stage 4: Cancer has spread beyond the urethra, vagina and anus into the lining of the bladder or the bowel, or it may have spread to the lymph nodes in the pelvis or to other parts of the body including the pelvic bone.