Diagnosis
If you have any symptoms of vulvar cancer, your doctor will thoroughly examine you and ask for information about your general lifestyle, health, and family history. If your doctor suspects vulvar cancer, he or she may recommend any of the following diagnostic procedures:
Pelvic Examination
Your doctor will feel your vulva, vagina, and rectum with gloved, lubricated fingers to check for any growths or abnormalities in your vulva or nearby organs. A rectal exam is important since it allows the doctor to feel deep in the pelvis for any growths which might not be felt on the vaginal exam. The doctor may also perform a Pap smear, a test in which a swab is used to take a tissue sample from the cervix/vagina. This sample is then sent to a laboratory to be examined for any abnormalities.
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Colposcopy
Your doctor uses a device called a colposcope to examine the surface of your vulva. A colposcope is a device with magnifying binocular lenses that allows your doctor to examine your vulva in great detail. A special solution, called acetic acid, will be applied to the cervix, vagina, and vulva to identify abnormal cells.
Biopsy
A biopsy is the only way to know for sure if cancer is present. If your doctor notices any abnormalities during the pelvic exam or colposcopy, he or she will remove a sample of abnormal tissue. Your doctor may also use the colposcope to illuminate the area of abnormal tissue and perform a punch or excisional biopsy. In a punch biopsy, the doctor removes a small cylinder of tissue for examination, and in an excisional biopsy, the doctor uses a scalpel to remove the entire lesion for examination. Your doctor will then send the sample to the laboratory to be examined under a microscope.
Chest X-Ray
X-rays use electromagnetic radiation to produce images of the inside of your body. Your doctor may perform a chest X-ray to see whether the cancer has invaded the lungs.
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Computed Tomography (CT) Scan
A computed tomography (CT) scan uses X-rays to produce an image of your body. A special dye may be injected into your veins, and you may be asked to drink a special fluid in order to make the internal organs stand out. A CT scan reveals the presence of tumors and whether or not the cancer has spread to other parts of the body. It produces detailed cross-sectional images of your body, and allows doctors to determine the exact size, shape, and position of the tumor. This study may be combined with PET scan (described below).
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Lymphoscintigraphy
Lymphoscintigraphy is an imaging technique designed to identify the first draining lymph node (sentinel lymph node) from a vulvar cancer. Dye is injected around the tumor to identify the lymph node drainage. The sentinel lymph node(s) will light up on a subsequent scan. This can help direct your surgeon for subsequent resection.
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Magnetic Resonance Imaging (MRI) Scan
Magnetic resonance imaging (MRI) uses radio waves and a powerful magnet to produce detailed images of body parts. Radio waves are absorbed by the body and then released in a certain pattern, which is translated by a computer in order to show "slices" of the body. MRI scans are very useful for detecting tumors in the pelvis as well as enlarged pelvic lymph nodes.
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Positron Emission Tomography (PET) Scan
For a PET scan, the doctor injects a radioactive substance into your bloodstream. This substance collects in malignant (cancerous) cells in your body. The doctor then uses a PET scanner to detect these areas of radioactivity and to find the exact location of cancer in your body. This study can be paired with a CT scan to completely localize the cancer.
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Cystoscopy
Your doctor may recommend a cystoscopy to determine if the vulvar cancer has spread to your bladder. In a cystoscopy, your doctor inserts a thin tube with a camera and light at one end into your urethra and uses it to examine the bladder. The doctor may take a sample for biopsy during this procedure.
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Proctoscopy
Your doctor may recommend a proctoscopy to determine if the vulvar cancer has spread to your rectum. In a proctoscopy, your doctor inserts a thin tube with a camera and light on the end into your rectum to examine the rectum and colon. The doctor may take a sample for biopsy during this procedure.
