Tests for Vulvar Cancer

If you have any of the signs or symptoms of vulvar cancer, you should see a doctor. Certain signs and symptoms might mean you will need to have a biopsy. If the biopsy shows abnormal cells, more tests will be needed. This may mean referral to a gynecologist or gynecologic oncologist (a doctor who specializes in problems of the female genital system).

Medical history and physical exam

The first step is for the doctor to ask about your personal and medical history and discuss your risk factors and symptoms with you. The doctor will do a complete physical exam to evaluate your general state of health, paying special attention to the vulva and surrounding lymph nodes  Any abnormal findings, such as a mass or ulcer, may then be biopsied.

Pap test

If there is a concern about vulvar cancer, a Pap test is usually done to test for human papillomavirus (HPV).  During a Pap test, the doctor gently scrapes the outside of the cervix and vagina and takes a sample of cells for testing. During the test, you will usually feel some pressure as the doctor takes the sample of the cells, but there is usually no pain.

Biopsy of the vulva

Certain signs and symptoms might strongly suggest vulvar cancer, but many of them can be caused by changes that aren't cancer. The only way to be sure it is cancer is for the doctor to do a biopsy.

To do this, the doctor may use a colposcope, which is an instrument that stays outside the body and has magnifying lenses. It lets the doctor see the surface of the vulva closely and clearly. For this procedure, you will lie on the exam table as you do for a pelvic exam.

Examining the vulva with magnification is called vulvoscopy.  While using the colposcope, the doctor may apply a dilute solution of acetic acid (like vinegar) that causes areas of vulvar intraepithelial neoplasia (VIN) and vulvar cancer to turn white.  Less often, the doctor may apply a dye, called toluidine blue to find areas of abnormal vulvar skin. This dye causes skin with certain diseases -- including VIN and vulvar cancer -- to turn blue.

Once the abnormal areas are found, a numbing medicine (local anesthetic) is injected into the skin, so you won’t feel pain.

If the abnormal area is small, it may be completely removed (called an excisional biopsy). Sometimes you might need stitches afterward. 

If the abnormal area is larger, a punch biopsy is used to take a small piece of it. The instrument used looks like a tiny apple corer and removes a small, cylinder of tissue about 4 mm (about 1/8 inch) across. Stitches aren't usually needed after a punch biopsy. Depending on the results of the punch biopsy, more surgery may be needed.

After the tissue is removed during the biopsy, a pathologist (a doctor specially trained to diagnose diseases with laboratory tests) will use a microscope to see if cancer or pre-cancer cells are present. For vulvar cancer, the pathologist will generally order mutational studies (ie. BRAF, KIT) on the tissue to check for vulvar melanoma.

To learn more, see Testing Biopsy and Cytology Specimens for Cancer.

Depending on the biopsy results, more tests may be done to find out the size of the tumor, how deeply it has grown into tissues at the place it first started, if it has grown into nearby organs, and if it has metastasized (spread to other parts of your body). This is called staging. The stage of your cancer is the most important factor in selecting the right treatment plan. (See Vulvar Cancer Stages for more details.)

Imaging tests

Imaging tests are generally used to stage the cancer. It includes the use of sound waves, x-rays, magnetic fields, or radioactive substances to create pictures of the inside of your body.

Chest x-ray

An x-ray of your chest may be done to see if cancer has spread to your lungs.

Computed tomography (CT) scan

The computed tomography scan (a CT or CAT scan) makes detailed cross-sectional images of your insides. Instead of taking one picture, like a standard x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these pictures into an image of a slice of your body. Sometimes, a special dye called a contrast medium is given before the scan to show better details in the image. This dye can be injected into a patient’s vein or swallowed as a pill or liquid.

A CT scan can show information about the size, shape, and position of a tumor and can show if the cancer has spread to other organs. It can also help find enlarged lymph nodes that might have cancer cells. This information can be helpful in deciding whether to do a sentinel lymph node procedure to check groin lymph nodes for cancer spread. (This is discussed in more detail in Surgery for Vulvar Cancer).

Magnetic resonance imaging (MRI)

Magnetic resonance imaging (MRI) scans use radio waves and strong magnets instead of x-rays to make images of the inside of your body.  Like a CT scanner, this produces cross-sectional slices of your body.  Sometimes a contrast medium is given before the scan to create a clearer picture. This contrast medium is different from the contrast given during a CT scan.

MRI images may show exact location and size of the vulvar tumor, as well as any enlarged lymph nodes in the groin.

Positron emission tomography (PET) scan

A positron emission tomography or PET scan uses a mildly radioactive sugar that's put into your blood. The amount of radiation in the substance is too low to be harmful. Because cancer cells use sugar at a higher rate than normal cells, they absorb more of the radioactive sugar. The areas of radioactivity can be seen with a special camera.  A PET scan combined with a CT scan is called a PET-CT scan.

The picture is not finely detailed like a CT or MRI scan, but it provides helpful information about your whole body. PET scans are not often used in women with early vulvar cancer, but they may help find areas of cancer spread in more advanced vulvar cancers.

Endoscopic tests

These tests aren't often used, but if the doctor suspects the cancer has spread to nearby organs, endoscopic tests may be done. These tests let the doctor look inside your body for signs of cancer. You may be given drugs to put you into a deep sleep (general anesthesia) while the test is done.

Cystoscopy

This procedure lets the doctor look at the inside the bladder. It’s done to check for spread of vulvar cancer to the bladder. It can be done in the doctor’s office or clinic. You might be given an intravenous (IV) drug to make you drowsy. A thin tube with a lens and light is put into the bladder through the urethra. If suspicious areas or growths are seen, a biopsy will be done.

Proctoscopy

This procedure allows the doctor to look inside the rectum through a thin, lighted tube.  It’s done to check for the spread of vulvar cancer to the rectum. If suspicious areas or growths are seen, a biopsy will be done.

Blood tests

Your doctor might also order certain blood tests to help get an idea of your overall health and how well certain organs are working.  These blood tests generally include liver function tests, kidney function tests, and HIV.