How is vulvar cancer diagnosed?

Your doctor will ask to do a physical examination of your groin and pelvic area, including the genitals. You will remove your clothing from the waist down, then lie on a table with your knees up and legs apart. If you feel embarrassed or scared about this examination, let your doctor know. A nurse may be present, but you can also ask for a family member or friend to be in the room with you for support.

Although the vulva is the outer part of your genitals, the doctor may also do an internal examination at the same time to check your vagina and cervix. This involves the doctor gently inserting an instrument with smooth, curved sides (speculum) into your vagina. A lubricant is used to make the speculum easier to insert. The sides of the speculum spread the vaginal walls apart so the doctor can see the vagina and cervix. If you have a skin condition (such as lichen planus or lichen sclerosus) that has narrowed the vagina, this examination may be done under a general anaesthetic.

The doctor uses a magnifying instrument called a colposcope to look at the vulva, vagina and cervix in detail. The colposcope is placed near your vulva but does not enter your body. A colposcopy that examines the vulva is sometimes called a vulvoscopy, and one that examines the vagina may be called a vaginoscopy.

You will lie on your back on an examination table or semi-upright on a colposcopy chair, with your knees up and apart. The doctor will use a speculum to spread the walls of the vagina apart, and then apply a vinegar-like liquid or iodine to your vulva and vagina. This makes it easier to see abnormal cells through the colposcope. The liquid may sting or burn, and you may have a brown discharge afterwards. During a colposcopy, the doctor will usually take a biopsy from the vulva and/or the vagina.

You will be advised not to have sex or put anything in your vagina (e.g. tampons, medicine) for 24 hours before a colposcopy. Talk to your doctor about whether you should take over-the-counter pain medicines about an hour before the procedure to ease discomfort.

During a colposcopy, your doctor will usually take a small tissue sample (biopsy) from the vulvar area and possibly also the vaginal area. A biopsy is the best way to diagnose vulvar cancer.

The doctor will usually put a local anaesthetic into the affected area of your vulva to numb it before the biopsy. There should not be any pain when the sample is taken, but you may feel a little discomfort.

If large areas of the vulva look suspicious, you may have several biopsies taken under general anaesthetic. This is known as vulvar mapping and it helps the doctor plan the best treatment for you.

After the biopsy, your vulva may bleed a little. Sometimes stitches are needed to close up the wound. Your doctor will explain how much bleeding to expect afterwards and how to care for the wound. You may have some soreness, which can be relieved by taking painkillers. You will be advised not to have sex or put anything in your vagina (e.g. tampons, medicine) for 24 hours after the biopsy.

The tissue sample will be sent to a laboratory, and a specialist doctor called a pathologist will look at the cells under a microscope. The pathologist will be able to confirm whether or not the cells are cancerous, and which type of vulvar cancer it is. 

If you haven’t had one recently, your doctor may do a cervical screening test. This test has replaced the Pap test.

The cervical screening test looks for cancer-causing types of HPV in a sample of cells taken from the cervix or vagina. While the speculum is in place for the physical examination, the doctor will use a small brush or swab to remove some cells from the surface of the cervix. This can feel slightly uncomfortable, but it usually takes only a minute or two.

The sample is sent to a laboratory to check for HPV. If HPV is found, the pathologist will do an additional test on the sample to check for cell changes.

Once the cancer is confirmed, you may have some of the following tests to determine the size of the cancer and find out whether it has spread.

Blood tests – These check your general health, and how well your kidneys and liver are working.

Chest x-ray – This painless scan produces an image of your lungs.

CT scan – A CT (computerised tomography) scan uses x-ray beams to create detailed pictures of the inside of your body. Before the scan, you may be given a drink or injection of a dye called contrast that makes the pictures clearer. The CT scanner is large and round like a doughnut. You will lie on a flat table that moves in and out of the scanner. The scan is painless and takes 5–10 minutes.

MRI scan – An MRI (magnetic resonance imaging) scan uses a magnet and radio waves to create detailed pictures of the inside of your body. Sometimes dye is injected before the scan to make the pictures clearer. You will lie on a treatment table that slides into a metal cylinder that is open at both ends. The machine can be quite noisy, but you will usually be given earplugs or headphones. If you think you may become distressed or are claustrophobic, talk to the medical team beforehand – they may offer you medicine to help you relax.

Ultrasound – Uses soundwaves to create a picture of an area of your body. It may be used to check the lymph nodes in your groin.

PET–CT scan – A PET (positron emission tomography) scan combined with a CT provides more detailed information about the cancer. Only some people need this test, and it is currently not funded by Medicare for vulvar cancer.

Proctoscopy – The doctor uses a slender tube with a camera and light (proctoscope) to look inside the rectum and anus. This can be done under local or general anaesthetic.

Cystoscopy – The doctor uses a slender, flexible tube with a camera and light (cystoscope) to look inside the urethra and bladder. This can be done under local or general anaesthetic.