Diagnosis of vulvar cancer

Diagnosis is the process of finding out the cause of a health problem. Diagnosing cancer often means first ruling out other health conditions that share similar symptoms with cancer. It can be a very worrying time for you and your loved ones. Sometimes this process is quick. Sometimes it can feel long and frustrating. But it's important for doctors to get all the information they need before making a diagnosis of cancer.

Diagnosing vulvar cancer usually begins with a visit to your family doctor. Your doctor will do a physical exam and ask you about any symptoms you may have. Based on this information, your doctor may refer you to a specialist or order tests to check for vulvar cancer or other health problems.

The following tests are usually used to rule out or diagnose vulvar cancer. Many of the tests that are used to diagnose cancer are also used to find out the stage (how far the cancer has spread). Your doctor may also order other tests to check your general health and to help plan your treatment.

Your health history is a record of your symptoms and risks and all the medical events and problems you have had in the past. Your doctor will ask questions about your history of:

• symptoms that suggest vulvar cancer
• human papillomavirus (HPV) and genital tract infections
• vulvar intraepithelial neoplasia (VIN)
• melanoma or cervical, vaginal or anal cancer
• a weakened immune system

A physical exam allows your doctor to look for any signs of vulvar cancer. During a physical exam, your doctor may:

• do a pelvic exam (also known as an internal exam)
• examine the vulva, vagina and anus
• do a digital rectal exam to check the rectum
• feel the groin for swollen lymph nodes

Find out more about physical exams, pelvic exams and digital rectal exams (DREs).

A colposcopy is a procedure that uses a lighted magnifying instrument called a colposcope to examine the vulva, the vagina and the cervix. This procedure is also called vulvoscopy when it’s done to specifically check the vulva for abnormal cells.

You may need a colposcopy if you have symptoms and signs that suggest a precancerous condition of the vulva or vulvar cancer.

A colposcopy is like a Pap test. The doctor inserts a plastic or metal device (called a speculum) into the vagina. The speculum widens the vagina so the doctor can clearly see the entire cervix, vagina and vulva. The doctor may wash the area with a solution to make it easier to see any abnormal areas.

The doctor then uses a colposcope to carefully check the outside surface of the cervix and the entire vagina and vulva. They place the colposcope outside the opening of the vagina, rather than inserting it into the vagina. If there is an abnormal area on the vulva, the doctor may do a biopsy during the colposcopy.

It’s better to have a colposcopy when you aren’t menstruating. Avoid sexual intercourse, vaginal douches, vaginal medicines and contraceptive (spermicidal) creams, foams and gels (except as directed by your doctor) for 48 hours before the test. They can interfere with the procedure and affect the test results.

Talk to your healthcare team if you’re pregnant to determine the best timing for a colposcopy.

During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. A report from a pathologist will show whether or not cancer cells are found in the sample.

A punch biopsy removes a sample of all the layers of skin (epidermis, dermis and subcutaneous tissue) in an abnormal area. It’s the most common type of biopsy used to diagnose vulvar cancer.

A surgical biopsy removes tissues from a small lump or abnormal area. It’s called an excisional surgical biopsy if it completely removes the lump or abnormal area.

A fine needle aspiration collects a sample of cells with a very thin needle. It may be done on an enlarged lymph node in the groin.

A sentinel lymph node biopsy removes the sentinel lymph node so it can be checked to see if it contains cancer cells. A sentinel lymph node is the first lymph node in a chain or group of lymph nodes that cancer is most likely to spread to.

Find out more about a punch biopsy, a surgical biopsy, a fine needle aspiration (FNA) and a sentinel lymph node biopsy.

A complete blood count (CBC) measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to gather information about your general health.

Find out more about a complete blood count (CBC).

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are working and can help find problems. Blood chemistry tests used to diagnose vulvar cancer include the following.

Blood urea nitrogen (BUN) and creatinine may be measured to check kidney function. Increased levels could mean that cancer has spread to the ureter, bladder or kidneys.

Alanine aminotransferase (ALT), aspartate transaminase (AST) and alkaline phosphatase may be measured to check liver function. Increased levels could mean that cancer has spread to the liver.

Find out more about blood chemistry tests.

An endoscopy allows a doctor to look inside the body using a flexible tube with a light and lens on the end. This tool is called an endoscope. An endoscopy may be done:

• when the vulvar tumour is large
• to help stage more advanced vulvar cancers
• to screen for other cancers associated with Paget disease of the vulva

A cystoscopy checks inside the bladder and urethra with a cystoscope (a type of endoscope). It’s done to find out if cancer has spread to these organs.

A proctoscopy checks the entire rectum with a proctoscope (a type of endoscope). It’s done to find out if cancer has spread to the rectum.

A colonoscopy checks the lining of the entire colon and rectum using an endoscope. It may be done to screen for colorectal cancer linked to Paget disease of the vulva.

The doctor can do a biopsy at the same time if they find an abnormal area during an endoscopy. They may also do a pelvic exam and digital rectal exam (DRE) at the same time as an endoscopy to check if cancer has spread to surrounding structures.

Find out more about a cystoscopy and a colonoscopy.

Some people feel very uncomfortable during tests for vulvar cancer. An examination under anesthesia (EUA) lets the doctor check the vulva, vagina, cervix and nearby areas without causing discomfort. This helps the doctor see how much the cancer has spread and make a better treatment plan.

An x-ray uses small amounts of radiation to make an image of parts of the body on film. A chest x-ray is used to see if vulvar cancer has spread to the lungs.

Find out more about x-rays.

A computed tomography (CT) scan uses special x-ray equipment to make 3D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.

A CT scan is used to:

• check the size of the tumour
• find out if cancer has spread to the liver and lungs
• find out if cancer has spread to lymph nodes
• guide a needle for a biopsy

A CT scan may also be used to help doctors determine a prognosis, measure the response to treatment and check if the cancer has come back (recurred).

Sometimes a contrast medium (contrast dye) is used with a CT scan to show organs and structures more clearly. It is usually injected into a vein in the hand or arm. Tell the technologist or radiologist if you are breastfeeding or if you have any allergies or sensitivities to iodine, seafood or contrast dyes.

Find out more about CT scans.

A positron emission tomography (PET) scan uses radioactive materials called radiopharmaceuticals to look for changes in the metabolic activity of body tissues. A computer analyzes the radioactive patterns and makes 3D colour images of the area being scanned.

A PET scan is sometimes used to see if cancer has spread to the lymph nodes. It may be combined with a CT scan (called a PET-CT scan).

Find out more about PET scans.

Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3D pictures.

An MRI is used to find out if cancer has spread to nearby organs and tissues in the pelvis or to the lymph nodes in the groin.

An MRI may also be used to help doctors determine a prognosis, measure response to treatment and check if cancer has come back.

Find out more about MRIs.

An intravenous pyelogram (IVP) is a special x-ray of the urinary system that uses a contrast medium called radiopaque iodine. It may be used to see if cancer is blocking the ureters. An IVP may not be needed if a CT scan using a contrast medium or an MRI has been done.

Find out more about intravenous pyelograms (IVPs).

To make the decisions that are right for you, ask your healthcare team questions about a diagnosis.