Diagnosis of vulval cancer

Usually you begin by seeing your GP, who will examine you. 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 gynaecologist will ask you about your general health. They will also examine your vulval area. This can usually be done at your outpatient appointment. If you have narrowing of the vagina due to lichen sclerosus, or if your vulva is too sore for a full examination, the gynaecologist can arrange for you to be examined under a general anaesthetic.

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 has special leg supports. The doctor will use a bright light and a magnifier to examine the vulva so that the skin can be seen more clearly. They may then take small samples of tissue (biopsies) from any areas of your vulva that look unusual.

You will also have an internal examination to check your vagina and cervix 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 on to your cervix to help show up any abnormal areas more clearly. You may have a cervical smear (a small sample of cells taken from the cervix). The doctor will also examine your back passage (anus).

Biopsy

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. But if the vulval area is too painful, you may have a biopsy taken under a general anaesthetic. 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.

After a biopsy you may have slight bleeding (let your doctor know if it’s more severe than this), and some soreness. Painkillers can help to relieve the soreness and taking a warm bath can also be soothing.

The doctor will usually see you about 7–10 days after the biopsy to give you the results. Waiting for the results can be a stressful time, and our list of support organisations| can help you to cope.