Before diagnosing vulval cancer, your GP will ask you about your symptoms and look at your medical history to see what illnesses you have had in the past.
Your vulva will be examined to see if there are any lumps or unusual areas of skin.
If you would prefer to be examined by a woman doctor or you would like a nurse present during the examination, let your GP's surgery know in advance of your appointment.
Referral to a gynaecologist
Your GP will probably refer you to a gynaecologist for further testing. A gynaecologist is a specialist in treating conditions of the female reproductive system.
Colposcopy and biopsy
Gynaecologists often use an instrument called a colposcope to look for any abnormalities in the vulva, cervix and vagina.
A colposcope is a small microscope with a light on the end of it. During the examination (colposcopy), a tissue sample will also be taken from the place where the cancer might be, using a special instrument. This is called a biopsy.
You may have additional biopsies where samples of tissue are removed from the lymph nodes near your vulva. This is to check whether cancer has started spreading through your lymphatic system.
Anaesthetic cream is applied to your vulva and an injection of local anaesthetic is given, so the biopsy should not hurt. You may have slight bleeding and soreness afterwards.
The tissue sample is then checked in a laboratory to find out whether you have cancer and what type of cancer it is. Your doctor will usually see you up to ten days later, when the results come through.
Further testing
If the results of the biopsy suggest that you have cancer and there is a risk that the cancer may have spread, you will probably need further testing to assess how widespread the cancer is.
These tests are described below.
- Cystoscopy – an examination of the inside of the bladder. It is done to see if the cancer has spread to the bladder. A thin, hollow viewing tube is inserted into the bladder to look for tumours and take a tissue sample.
- Proctoscopy – an examination of the inside of the rectum. The doctor either uses a gloved finger on an instrument called a proctoscope to check for abnormalities such as growths on the wall of the anus.
- CT scan – a computerised X-ray that can take detailed pictures of the inside of the body. It is useful for showing up cancer tumours and checking whether cancer cells have spread.
- MRI scan – a scan that uses radio waves and magnets to produce detailed pictures of the inside of the body. It is used to check whether cancer has spread.
- X-ray – you may have a chest X-ray to check that cancer has not spread to your lungs.
Staging
Once the results of the tests are complete it should be possible to tell you what stage cancer you have.
Staging is a measurement of how far the cancer has spread. The lower the stage, the greater the chance of a complete cure.
The staging system for vulval cancer is as follows:
Stage 1 – the cancer is confined to the vulva. Stage 1 is further divided into two sub-types:
- Stage 1A – the cancer is less than 2cm in size
- Stage 1B – the cancer is larger than 2cm in size
Stage 2 – the cancer has spread beyond the vulva to other nearby parts of the body such as the lower vagina, anus or lower urethra (the tube you urinate out of), but the lymph nodes are unaffected.
Stage 3 – the cancer has now spread into nearby lymph nodes. Stage 3 is divided into three sub types:
- Stage 3A – the cancer has spread into one lymph node and the area of spread is more than 5mm OR the cancer has spread into one or two lymph nodes but the area of spread is less than 5mm
- Stage 3B – the cancer has spread into two or more lymph nodes and the area of spread is more than 5mm OR the cancer has spread into three or more lymph nodes but the area of spread is less than 5mm
- Stage 3C – the cancer has begun spreading through the outer covering of at least one of the lymph nodes
Stage 4 – the cancer has spread away from the vulva and perineum (the area of skin and tissue between the anus and the genitals) to other parts of the body. Stage 4 is divided into two sub types:
- Stage 4A – the cancer has spread into the upper urethra or into the lining of the vagina, bladder, rectum or the bones of the pelvis OR the cancer has caused lymph nodes to become stuck to underlying tissue or caused open sores (ulcers) to develop in the groin
- Stage 4B – the cancer has spread to more distant parts of the body such as the lungs, liver or the lymph nodes that are contained in the pelvis
Stage 1 and 2 vulval cancers are regarded by most experts as early stage cancers with a relatively good chance of a complete cure.
Stage 3 and 4 vulval cancers are usually regarded as advanced-stage cancers and a cure for this types of cancers may not always be possible.
- Biopsy
A biopsy is a test that involves taking a small sample of tissue from the body so it can be examined.
Bladder
The bladder is a small organ near the pelvis that holds urine until it is ready to be passed from the body.
Colposcopy
A colposcopy is a procedure where a doctor uses a special magnifying lens, known as a colposcope, to look at the cervix through the opening of the vagina.
Cystoscopy
A cystoscopy is a procedure to view the inside of the bladder using a thin instrument with a light and a tiny telescope (cystoscope), which is inserted into the urethra.
Lungs
Lungs are a pair of organs in the chest that control breathing. They remove carbon dioxide from the blood and replace it with oxygen.
MRI
MRI stands for magnetic resonance imaging. It involves the use of magnets and radio waves to take detailed pictures of inside the body.
Nodules
A nodule is a small growth or lump of tissue.
Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.
X-ray
An X-ray is a painless way of producing pictures of inside the body using radiation.
