Tests for Vulvar Cancer

Medical history and physical exam

The first step is for the doctor to take your complete medical history to check for risk factors and symptoms. Then your doctor will physically examine you, including a pelvic exam. The doctor will feel your uterus, ovaries, cervix, and vagina for anything irregular. Your doctor will also look at your vagina and cervix (with a speculum) and may do a Pap test and an HPV test.

Biopsy

Certain signs and symptoms might strongly suggest vulvar cancer, but many of them can be caused by changes that aren't cancer. The only way to be sure cancer is present is for the doctor to do a biopsy. To do this, a small piece of tissue from the changed area is removed and examined under a microscope. A pathologist (a doctor specially trained to diagnose diseases with laboratory tests) will look at the tissue sample with a microscope to see if cancer or pre-cancer cells are present and, if so, what type it is.

The doctor might use a colposcope or a hand-held magnifying lens to select areas to biopsy. A colposcope is an instrument that stays outside the body and has magnifying lenses. It lets the doctor see the surface of the vulva closely and clearly. The vulva is treated with a dilute solution of acetic acid (like vinegar) that causes areas of vulvar intraepithelial neoplasia (VIN) and vulvar cancer to turn white. This makes them easier to see through the colposcope. Examining the vulva with magnification is called vulvoscopy.

Less often, the doctor might wipe the vulva with a dye (called toluidine blue) to find areas of abnormal vulvar skin to biopsy. This dye causes skin with certain diseases -- including VIN and vulvar cancer -- to turn blue.

Once the abnormal areas are found, a numbing medicine (local anesthetic) is injected into the skin so you won’t feel pain. If the abnormal area is small, it may be completely removed (called an excisional biopsy). Sometimes stitches are needed afterward.

If the abnormal area is larger, a punch biopsy is used to take a small piece of it. The instrument used looks like a tiny apple corer and removes a small, cylinder of skin about 4 mm (about 1/6 inch) across. Stitches aren't usually needed after a punch biopsy. Depending on the results of the punch biopsy, more surgery may be needed.

To learn more, see Testing Biopsy and Cytology Specimens for Cancer.

Seeing a specialist

If your biopsy shows that you have vulvar cancer, your health care provider will refer you to a gynecologic oncologist, a specialist in female reproductive system cancers. This specialist will also look at your complete personal and family medical history to learn about related risk factors and symptoms of vulvar cancer. The doctor will do a complete physical exam to evaluate your general state of health, paying special attention to the lymph nodes, particularly those in your groin region, to check for signs of cancer spread.

Depending on the biopsy results, more tests may be done to find out to find out the size of the tumor, how deeply it has grown into tissues at the place it first started, if it has grown into nearby organs, and if it has metastasized (spread to other parts of your body). This is called staging. The stage of your cancer is the most important factor in selecting the right treatment plan. (See Vulvar Cancer Stages for more details.)

Here are some of the tests that may be done:

Imaging tests

Imaging tests use sound waves, x-rays, magnetic fields, or radioactive substances to create pictures of the inside of your body.

Chest x-ray

An x-ray of your chest may be done to see if cancer has spread to your lungs.

Computed tomography (CT) scan

A CT scan is an x-ray test that makes detailed cross-sectional images of your body. CT scans are not often needed, but they might be done in women with large vulvar tumors or enlarged lymph nodes. They can also be helpful in deciding whether to do a sentinel lymph node procedure to check groin lymph nodes for cancer spread. (This is discussed in more detail in Surgery for Vulvar Cancer).

Magnetic resonance imaging (MRI)

An MRI uses radio waves and strong magnets instead of x-rays to make images of the body. Like a CT scanner, it produces cross sectional slices of the body. MRI images are very useful in examining pelvic tumors. They can show enlarged lymph nodes in the groin. But, they're rarely used in patients with early vulvar cancer.

Positron emission tomography (PET) scan

A PET scan uses a form of radioactive sugar that's put into the blood. Body cells take in different amounts of the sugar, depending on how fast they're growing. Cancer cells grow quickly and are more likely to take up larger amounts of the sugar than normal cells. A special camera is then used to create a picture of areas of radioactivity in the body.

This test can be helpful for spotting collections of cancer cells, and seeing if the cancer has spread to lymph nodes. The picture from a PET scan is not as detailed as a CT or MRI scan, but it provides helpful information about whether abnormal areas seen on these other tests are likely to be cancer or not.

PET scans are also useful when your doctor thinks the cancer has spread, but doesn’t know where (although they aren’t useful for finding cancer spread in the brain). PET scans can be used instead of several different x-rays because they scan your whole body. Often, a machine that combines a PET scanner and a CT scanner (called a PET/CT) is used, which gives more information about areas of cancer and cancer spread.

Other tests to look for cancer

These tests aren't often used, but if the doctor suspects the cancer has spread to nearby organs, other tests may be used to look for it. These tests let the doctor directly look inside your body for signs of cancer. You may be given drugs to put you into a deep sleep (general anesthesia) while the test is done.

Cystoscopy

The doctor uses a lighted tube to check the inside lining of your bladder. Some advanced cases of vulvar cancer can spread to the bladder, so any suspicious areas noted during this exam are biopsied. This procedure also can be done using a local anesthetic, where the area is just numbed, but some patients may need general anesthesia.

Proctoscopy

This lets the doctor look at the inside of the rectum using a thin, lighted tube. Some advanced cases of vulvar cancer can spread to the rectum. Any suspicious areas are biopsied.

Examination of the pelvis while under anesthesia

Putting the patient into a deep sleep (under anesthesia) allows the doctor to do a more thorough exam that can better evaluate how much the cancer has spread to internal organs of the pelvis.

Blood tests

Your doctor might also order certain blood tests to help get an idea of your overall health and how well certain organs, like your liver and kidneys, are working.