Diagnosis of vulval cancer
Usually you begin by seeing your family doctor (GP). They will examine you and arrange any tests that may be necessary.
If there is any possibility of you having vulval cancer, you should be referred to a specialist in women’s cancers (gynaecological cancer specialist). Your doctor may also arrange for you to have a blood test and chest x-ray to check your general health.
The gynaecological cancer specialist will ask you about your general health. They will also examine your vulval area. This can usually be done at your outpatient appointment.
The vulva is an intimate and private part of the body, so some women, understandably, find it embarrassing or upsetting to have a vulval examination. If you feel this way, let your doctor or nurse know so that they can give you emotional support.
Before the examination, a nurse will help you to position yourself on a couch that may have special leg supports. The doctor may use a bright light and a magnifier to examine your vulva, so that the skin can be seen more clearly. They may then take small samples of tissue (biopsies) from any areas that look unusual (see below). This may be done under a local anaesthetic.
You’ll also have an internal examination to check your vagina, cervix and the neck of your womb for any abnormality. The doctor will use a speculum (a plastic or metal instrument) to hold the vaginal walls open. A liquid will be dabbed onto your cervix to help show up any abnormal areas more clearly. You may have a cervical smear test (a small sample of cells taken from the cervix). The doctor may also examine your back passage (anus).
If you have narrowing of the vagina due to lichen sclerosus, or if your vulva is too sore for a full examination, the specialist can arrange to examine you while you’re under a general anaesthetic.
This is the best way of diagnosing cancer of the vulva and is essential before the cancer is treated.
A doctor takes a small sample of tissue (biopsy) from the abnormal area of the vulva. The biopsy is then sent to a laboratory to be examined under a microscope.
A biopsy can often be done as an outpatient procedure, using a local anaesthetic to numb the area. Before the biopsy is taken, some anaesthetic will be injected into the skin of the vulva to numb it. This may sting for a few seconds. There shouldn’t be any pain when the sample of tissue is taken from your vulva, but you may feel a little discomfort. Your doctor may put one or two stitches in the area where the biopsy was taken from.
Occasionally, if your vulval area is very painful, you may have your biopsy taken while you’re under a general anaesthetic.
After a biopsy you may have slight bleeding, which will gradually settle. If the bleeding increases or persists, you should let your doctor know. You may have some soreness, which can be relieved by painkillers and taking a warm bath.
It will probably take about 7-10 days for the results of your tests to be ready. Waiting for your results can be a difficult time. It may help you to talk things over with a relative or close friend. You may also want to speak to a support organisation.