Vulvar Cancer: Diagnosis

Approved by the Cancer.Net Editorial Board, 12/2016

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find out what’s wrong and identify the cause of the problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

This list describes options for diagnosing this type of cancer. Not all tests listed below will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and medical condition

  • The results of earlier medical tests

Physical examination, including a pelvic exam, is the first step in diagnosing vulvar cancer. In the examination, the doctor inspects the vulva and then feels the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum to check for any unusual changes.

In addition to a physical examination, the following tests may be used to diagnose vulvar cancer:

  • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed during the biopsy is analyzed by a pathologist. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. The type of biopsy performed will depend on the location of the suspicious tissue.

    If the biopsy shows invasive vulvar cancer, the doctor will refer the woman to a gynecologic oncologist, who specializes in treating this type of cancer.

  • Chest X-ray. An x-ray is a way to create a picture of the structures inside of the body using a small amount of radiation.

  • Computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow (orally).

  • Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow (orally).

  • Endoscopy. An endoscopy allows the doctor to see inside the body with a thin, lighted, flexible tube called an endoscope. The woman may be sedated as the tube is inserted through the urethra into the bladder, called cystoscopy, or through the anus into the rectum, called proctoscopy or colonoscopy. Sedation is giving medication to become more relaxed, calm, or sleepy.

Surgical removal of vulvar cancer

If a biopsy shows that vulvar cancer is present and that it appears to only be in the vulva, in most patients the next step is surgery. In most patients the surgery includes a radical local excision or modified radical vulvectomy of the vulvar lesion (see “Surgery” in Treatment Options) plus a removal of lymph nodes from 1 or both groins, called inguinal-femoral lymph nodes.

The lymph nodes are tiny, bean-shaped organs that help fight infection. To determine whether a vulvar cancer has spread, or metastasized, it is necessary to remove groin lymph nodes during the surgery to determine whether the disease has metastasized to the lymph nodes.

The procedure for removing the groin lymph nodes is called a “lymphadenectomy.” If the cancer is only on one side of the vulva, removal of the lymph nodes may be done in the groin only on that side. If there are metastases to the groin lymph nodes, additional treatment may be necessary, using radiation therapy as described in Treatment Options.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. You may use the menu to choose a different section to continue reading in this guide.