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Tests and diagnosis
By Mayo Clinic staffTo check for vulvar cancer, your doctor will first conduct a physical examination, including a pelvic exam. If your doctor finds any irregularities, you'll likely need further testing.
Biopsy
Because signs and symptoms of vulvar cancer can also be caused by a noncancerous (benign) condition, your doctor will need to confirm a diagnosis by removing a small sample of tissue (biopsy) from the irregular area for analysis under a microscope. By examining this tissue, a doctor can usually tell if your condition is benign or cancerous.
To select the best tissue to sample, your doctor may swab a blue dye across your vulva. This dye will react with certain diseased areas, including those affected by a precancerous condition or by vulvar cancer, causing them to turn blue.
Your doctor might also use a special lighted microscope called a colposcope. The colposcope magnifies the surface, helping your doctor identify areas of abnormal cell growth that can't be seen by the naked eye. Your doctor may also swab the area with a weak acetic acid solution (similar to vinegar), which can cause areas affected by a precancerous condition or by vulvar cancer to turn white, making them even more visible.
Once your doctor determines which area to biopsy, the area will be numbed with a local anesthetic. There are two types of biopsies:
- Excisional biopsy. If the abnormal area is small, your doctor may use a scalpel to make an incision through your skin and remove the entire tumor. Your doctor will use a local anesthetic to numb the area and may use stitches to sew up the area depending on how much tissue is removed.
- Punch biopsy. If the irregular area is larger, your doctor may remove a portion of it with a small incision or punch biopsy technique. This technique uses a small cookie-cutter-like device to remove a cylindrical piece of skin about one-sixth of an inch (4 millimeters) across. Stitches aren't required after punch biopsy.
Staging tests
Staging tests help determine the size and location of your cancer and whether it has spread. They also help your doctor determine the best treatment for you. To gather this information, your doctor may use the following tests:
- Cystoscopy. Using a lighted tube, your doctor examines the inside surface of your bladder. Later stages of vulvar cancer may spread to this area. If your doctor finds irregularities, he or she will remove a sample for biopsy. You may need local or general anesthesia depending on how large a sample is needed.
- Pelvic examination under anesthesia. With general anesthesia, your doctor can do a more thorough examination of your pelvis for potential spread of the cancer.
Imaging tests also can help determine if your cancer has spread. These tests may include:
- Chest X-ray. This X-ray of your chest will determine whether the cancer has spread to your lungs.
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Computerized tomography. Computerized tomography — also called CT or CT scan — is an X-ray technique that produces more-detailed images of your internal organs than do conventional X-ray exams. This test can take as little as a few seconds in newer machines. A CT scan can help your doctor see if cancer has spread to your liver or other organs.
Some CT scans may require you to ingest a contrast medium or have a contrast medium administered through intravenous injection before the scan. A contrast medium blocks X-rays and appears white on images, which can help emphasize structures in your body. There's a slight risk of allergic reaction when using an intravenous contrast medium. Let your doctor know if you've ever had a reaction to contrast medium in the past.
CT scans can give your doctor more accurate information about the position and size of the tumor and can reveal swollen lymph nodes that may contain cancer.
- Magnetic resonance imaging (MRI). This test uses a magnetic field and radio waves to create cross-sectional 3-D images of your body. Because of the strong magnet used for this test, you'll be asked to remove any metal jewelry, glasses, and items of clothing with metal clasps or buttons before the start of the test. MRI scans can take up to an hour, the space is confined, and during the test you'll hear a loud, thumping noise. If you're afraid of enclosed spaces, ask your doctor if you might be more comfortable with a light sedative. If the noise of the test bothers you, most MRI centers have headphones so that you can listen to music. MRI scans can provide a wealth of information in one test, with the potential to spot everything from an enlarged lymph node in the pelvis to a distant spread of the cancer to places such as the brain or spinal column.
- Positron emission tomography (PET). Unlike other scanning techniques, a PET scan doesn't produce clear structural images of organs. Instead, it shows images containing areas of more or less intense color to provide information about chemical activity within certain organs and tissues. Tumors often use more energy than healthy tissue does and may absorb more of a radioactive tracer, which allows the tumors to appear on the scan. This test is helpful in determining whether your cancer has spread to your lymph nodes or elsewhere in your body. Some centers may offer a CT-PET scan combination.
Results of staging tests
Your doctor may refer to your tumor using the initials T, N and M. T stands for tumor extent. N is for lymph node spread, and M is for the distant spread of the cancers. Each of these letters has subcategories that further help doctors define the stage of your vulvar cancer.
- Stage 0 is an early cancer that hasn't spread past your skin's surface.
- Stage I signifies a deeper tumor, but one that is less than about three-quarters of an inch (2 centimeters). This cancer hasn't spread to your lymph nodes or other areas.
- Stage II tumors are those that still haven't spread, but are larger than about three-quarters of an inch (2 centimeters).
- Stage III cancer has spread to lymph nodes, nearby tissue or both.
- Stage IVA signifies a cancer that has spread to the lymph nodes on both sides of your pelvis or to the urethra, bladder, rectum or pelvic bone.
- Stage IVB is a cancer that has spread (metastasized) to distant sites in your body, such as your lungs or brain.
