Diagnosing vulva cancer

Wednesday 30 November, 2011

On this page: Vulvoscopy ι Biopsy ι Internal examination ι Further tests ι Staging vulvar cancer ι Prognosis ι Which health professionals will I see? ι Information reviewed by

If you have symptoms of vulvar cancer, your doctor will do a physical examination. Local anaesthetic may be used to numb the vulva and surrounding area. Your doctor may also do a blood test to check your general health.

You may have some of the following tests:

Vulvoscopy

During a vulvoscopy, the doctor uses a microscope called a colposcope (illustrated below) to examine your vulva.

Colposcopy You will lie on your back on an examination table with your legs spread. The doctor will apply some fluid to your vulva, which will make it easier to see abnormal cells. The doctor will use the colposcope - and sometimes a handheld magnifying glass - to look at your vulva.

Your doctor will usually take a small tissue sample (biopsy) during the vulvoscopy. A local anaesthetic will be used to numb the area before the biopsy is taken.

Biopsy

A biopsy is the best way to diagnose cancer of the vulva. The doctor will put a local anaesthetic into the suspicious area of your vulva to numb it and remove some skin. Your vulva may bleed a little, but it is usually not a large wound. Tell your doctor if you feel any pain, as you may be able to have more anaesthetic.

The tissue is sent to a laboratory where a specialist called a pathologist examines the cells under a microscope. The pathologist will be able to confirm whether or not the cells are cancerous.

Internal examination

Although the vulva is the outer part of your genitals, the doctor may also do an internal examination to look at the vagina, cervix, rectum and bladder.

If you haven't had one recently, your doctor may do a Pap test. During this test, the doctor puts an instrument with smooth, curved sides (speculum) into your vagina. The sides gently spread the vaginal walls apart so the doctor can see your vagina and cervix. A tool such as a brush or spatula is used to scrape some cells from the surface of the cervix.

The doctor may use a colposcope to look inside your vagina (see diagram above). During this examination, the doctor may take a biopsy.

You may also have a cystoscopy to examine your bladder and urethra, and a proctoscopy to look inside your rectum and anus. These will be done under a general anaesthetic.

Some women with skin conditions such as lichen planus or lichen sclerosus have narrowing of the vagina, so the internal examination will be done under a general anaesthetic.

Further tests

Sometimes further tests are needed to determine the size and position of the cancer, and whether it has spread:

  • Blood test - A blood sample 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 painless x-ray scan of your lungs, heart or abdomen.
  • Examination under anaesthetic - The doctor can give you a general anaesthetic so the vulva can be thoroughly examined without any pain.
  • CT scan - A computerised tomography scan. This scan takes three-dimensional x-rays of the inside of your body.
  • MRI scan - A magnetic resonance imaging scan. You will lie on the treatment table inside a cylinder that uses a magnetic field to create pictures of your body. Some women feel claustrophobic during this scan - your medical team may be able to give you medication to reduce this feeling.
Before a CT or MRI scan, you may be given an injection or asked to drink a liquid called a
contrast. This helps to make the images on the computer clearer.


Staging vulvar cancer

Based on test results, your doctor will tell you the stage of the cancer. This is a way to describe its size and whether it has spread beyond its original site.

Carcinoma in-situ (Stage 0)  Early cancer. Abnormal cells are found only on the surface of the vulval skin. 
Stage 1  Cancer is found only in the vulva and/or perineum. The affected area is 2 cm or less in size.
Stage 2   Cancer is found only in the vulva and/or perineum. The affected area is more than 2 cm in size. 
Stage 3  Cancer is found in the vulva and/or perineum, and has also spread to nearby tissues such as the urethra, vagina, anus or lymph nodes. 
Stage 4 Cancer has spread beyond the urethra, vagina and anus into the lining of the bladder or bowel. The cancer may also have spread to the lymph nodes in the pelvis or to other parts of the body. 

 

Your doctor may also tell you the grade of the cells. This tells you how quickly the cancer may develop. Low-grade cancer cells are slow growing and less likely to spread. High-grade cells look more abnormal and are more likely to grow and spread quickly.

Knowing the stage and grade of the cancer helps your doctor decide on the most appropriate treatment.

Prognosis

Prognosis means the expected outcome of a disease. You will need to discuss your prognosis and treatment options with your doctor, but it is not possible for any doctor to predict the exact course of your disease.

The earlier vulvar cancer is diagnosed, the better the chances of successful treatment and cure.

Test results, the type of vulvar cancer you have, the rate and depth of tumour growth, how well you respond to treatment, and other factors such as age, fitness and medical history are all important in assessing your prognosis.

Which health professionals will I see?

Your GP (general practitioner) will probably arrange the first tests to assess your symptoms. You will then be referred to a gynaecological oncologist.

You will be cared for by a range of health professionals who specialise in different aspects of your treatment. This is called a multidisciplinary team.

"Sometimes my extended family members would criticise and add further to the load. It was helpful for me to focus on the advice of the health care team." — Carer

Health professional

Role
gynaecological oncologist  a surgeon who specialises in treating gynaecological cancers, such as cancer of the vulva
radiation oncologist  prescribes and coordinates the course of radiotherapy 
medical oncologist  prescribes and coordinates the course of chemotherapy 
nurses care for you after surgery and during treatment, and provide support and assistance through all stages of your treatment 
dietitian  recommends the best eating plan to follow while you are in treatment and recovery
social worker, physiotherapist, counsellor,
sex therapist, psychologist 		 advise you on support services and help you get back to normal activities

 

This information was reviewed by:

Dr Greg Robertson, Gynaecological Oncologist, Royal Hospital for Women and St George Hospital; Jonathan Carter, Prof of Gynaecological Oncology, The University of Sydney and Head of Sydney Gynaecological Oncology Group, Sydney Cancer Centre; Belinda Fern, Consumer; Alicia Hiron, Consumer; Jayne Maidens, Clinical Nurse Consultant, Gynaecological Oncology Department, Royal North Shore Hospital; Anne Mellon, Clinical Nurse Consultant, Hunter New England Centre for Gynaecological Cancer, John Hunter Hospital; Fiona Pearce, Cancer Council NSW Helpline; Ann Tocker, Cancer Voices.

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