How is vulval cancer diagnosed?
Usually you begin by seeing your doctor, who will examine you.
If there is a chance you have vulval cancer, you should be referred to a gynaecologic oncologist. A gynaecologic oncologist is a doctor who specialises in diagnosing and treating cancer of women’s reproductive organs (including the vulva). This specialist is very experienced with gynaecological cancers and is the best type of doctor for you to be seen and treated by.
Your doctor may also arrange for you to have a blood test and chest X-ray to check your general health. At the clinic or hospital, the gynaecologic oncologist will take your medical history and do a full medical examination.
Vulvoscopy
The medical procedure will include an examination of your vulva. A colposcope may be used to identify any abnormal areas.
The colposcope is like a small microscope with a bright light that can magnify areas so that the cells can be seen more clearly. The colposcope remains outside the body. A biopsy will be taken.
Internal vaginal examination
You will also have an internal examination to check your vagina and cervix for any abnormality.
A Cervical Screening Test may be done if you haven’t had one recently. Some women with skin conditions called lichen planus or lichen sclerosus can have narrowing of the vagina, so they may need to have the smear under a general anaesthetic.
The doctor may also examine your rectum to check for any abnormal lumps.
Biopsy
A biopsy is the best way to diagnose cancer of the vulva. This means removing a sample of tissue from the affected area of the skin.
First, an injection of local anaesthetic is given where the abnormal cells occur on the vulva. The doctor then takes a small amount of these cells (a biopsy) so that a pathologist can examine them under a microscope, to confirm whether cells are cancerous and, if so, to show which type of vulval cancer it is.
Further tests
Even after a diagnosis is made, further tests are often needed to determine the size and position of the cancer, and whether it has spread. This process is called staging.
The results will help you and your doctor decide on the best treatment for you.
The following tests are most often used with cancer of the vulva.
Blood test
A sample of your blood is taken to check the number of cells in your blood, and to see how well your kidneys and liver are working.
Chest X-ray
A chest X-ray is taken to check that your lungs and heart are healthy.
CT scan
A CT (computerised tomography) scan is a series of X-rays that builds up a 3-dimensional picture of the inside of the body.
The scan is painless and takes between 10 and 30 minutes.
Before the scan, you will be asked to drink a special liquid that shows up on X-ray. You may also need to have an injection of a contrast medium into a vein in your arm.
People who are allergic to iodine may also be allergic to the dye used in a CT or magnetic resonance imaging (MRI) scan. If you think you may have such an allergy, tell your doctor before the scan.
MRI
MRI is similar to a CT scan, but uses a magnetic field instead of X-rays to build up cross-sectional pictures of your body.
Some people are given an injection of dye into a vein in the arm to improve the image.
During the test, you will be asked to lie very still on a couch inside a long chamber for up to an hour.
An MRI is painless but some people find that lying in the cylinder is noisy and claustrophobic. If you feel uncomfortable, you can communicate with the technologist who is carrying out the scan through a microphone and speaker inside the scanner. You will also be able to see the technologist through a window.
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.
Cystoscopy
Cystoscopy is a procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope (a thin, lighted tube) is inserted through the urethra into the bladder. Tissue samples may be taken for biopsy.
Proctoscopy
Proctoscopy is a procedure to look inside the rectum and anus to check for abnormal areas. A proctoscope (a thin, lighted tube) is inserted into the anus and rectum. Tissue samples may be taken for biopsy.
Intravenous pyelogram
An intravenous pyelogram is a series of X-rays of the kidneys, ureters and bladder to find out if cancer has spread to these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters and bladder, X-rays are taken to see if there are any blockages. This procedure is also called intravenous urography.
