Diagnosis of vulvar cancer

Diagnosis is the process of finding out the cause of a health problem. Diagnosing vulvar cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and do a physical exam. 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 process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as vulvar cancer. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of vulvar cancer.

The following tests are usually used to rule out or diagnose vulvar cancer. Many of the same tests used to diagnose cancer are used to find out the stage (how far the cancer has progressed). 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, risk factors 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
• 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 colposcope (a lighted magnifying instrument) to examine the vulva, the vagina and the cervix.

A colposcopy is done after symptoms and signs appear that suggest you may have a precancerous condition of the vulva. A colposcopy may also be done if you have symptoms and signs of vulvar cancer.

A colposcopy is done in much the same way as a Pap test. The doctor places a speculum in the vagina. The speculum is a plastic or metal device that separates the walls of the vagina so the doctor can clearly see the entire cervix, vagina and vulva. The doctor may wash the area with solutions that makes it easier to see abnormal areas. The doctor then uses a colposcope to carefully examine the outside surface of the cervix and the entire vagina and vulva. The colposcope is positioned outside the opening of the vagina, rather than inserted into the vagina. If there is an abnormal area on the vulva, the doctor may do a biopsy during the colposcopy.

It is 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. These should be avoided because they can interfere with the procedure and may affect the test results.

A pregnant woman can have a colposcopy if her doctor recommends it.

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

A punch biopsy is the most common type of biopsy used to diagnose vulvar cancer.

A surgical biopsy may be done to completely remove a small lump or abnormal looking area. This type of surgical biopsy is called an excisional biopsy.

A fine needle aspiration 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 examined to see if it contains cancer cells. The sentinel node is the first lymph node in a chain or cluster of lymph nodes that receives lymph fluid from the area around a tumour. Cancer cells will most likely spread to these lymph nodes first.

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

A 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 functioning and can help find abnormalities. Blood chemistry tests are used to stage vulvar cancer and 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 x-ray uses small doses 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.

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. If a woman has a large vulvar tumour, an endoscopy may be done to see if cancer has spread to the inside of the bladder or rectum. It may also be done to help stage more advanced vulvar cancers.

A cystoscopy is a procedure that uses a type of endoscope (called a cystoscope) to examine inside the bladder and urethra. It is done to find out if cancer has spread to these organs. Doctors can do a biopsy at the same time as a cystoscopy if they find an abnormal area during the exam.

A sigmoidoscopy is a procedure that uses a type of endoscope (called a sigmoidoscope) to examine inside the sigmoid colon (the last part of the colon) and the rectum. It is done to find out if cancer has spread to the rectum. Doctors can do a biopsy at the same time as a sigmoidoscopy if they find an abnormal area during the exam.

The doctor may do a pelvic exam and digital rectal exam (DRE) at the same time as a cystoscopy or sigmoidoscopy. These exams allow the doctor to check if cancer has spread to surrounding structures.

Find out more about a cystoscopy and a sigmoidoscopy.

A computed tomography (CT) scan uses special x-ray equipment to make 3-D 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 nearby organs and tissues in the pelvis
• 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 response to treatment and check if cancer has come back (recurred).

A dye (contrast medium) may be injected into a vein (given intravenously) before the CT scan. The dye can help the doctor see structures of the body better than without contrast. Tell your doctor or the radiology staff if you have had an allergic reaction to a contrast medium in the past.

Find out more about CT 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 3-D 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.

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

Find out more about MRIs.

An intravenous pyelogram (IVP) is a special x-ray of the urinary system. It may be used to see if cancer is blocking (obstructing) the ureters (the tubes that connect the kidneys to the bladder). 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).

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 3-D colour images of the area being scanned.

A PET scan is sometimes used to see if cancer has spread to the lymph nodes.

Find out more about PET scans.

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