Diagnosis of vulval cancer
How is vulval cancer diagnosed?
If you have symptoms, you usually begin by visiting your GP. If they think that your symptoms could be caused by cancer, they will refer you to a specialist clinic or doctor. This is often a gynaecological cancer specialist. This is a doctor who specialises in female reproductive system cancers.
The main tests for vulval cancer are:
- an examination of the vulva
- taking a small sample of any areas that look abnormal – this is called a biopsy.
You usually have these tests during an outpatient appointment. You may have them under a general anaesthetic if:
- the vagina has become narrower due to lichen sclerosus (LS) or lichen planus (LP)
- a full examination of the vulva would be painful.
Vulval examination
The vulva is an intimate and private part of the body. If you are worried or embarrassed about having this test, tell the doctor or nurse so they can give you support. If it would make you feel more comfortable, you can ask whether you can have someone with you during the test.
For the test, you will undress from the waist down. The doctor or nurse will give you something to cover your pelvic area with. You then lie down on your back on a bed or examination couch. Your doctor or nurse will ask you to lie with your knees bent and apart. Some clinics have a bed with foot or leg supports you can rest your legs on.
The doctor may use a bright light and a magnifier to examine the vulva. This helps them see the skin more clearly. They may take small samples of tissue from any areas that look abnormal. This is called a biopsy.
The doctor may also check the vagina and cervix. To do this, they put an instrument called a speculum into the vagina. This holds the vagina open so they can see the cervix. It should not hurt. But sometimes it can feel uncomfortable.
The doctor may also gently put a gloved finger into the back passage (rectum) to feel for any abnormal areas there. Your doctor will explain what to expect. Tell your doctor about any concerns you may have about this test.
Vulval biopsy
A biopsy is a procedure to remove a small sample of tissue. The doctor collects samples from the affected area of the vulva. They send these to a laboratory to be examined under a microscope.
Before taking a sample, the doctor numbs the skin of the vulva with a small injection of local anaesthetic. This may sting for a few seconds. It should not hurt when they take the sample of tissue. But sometimes it can feel uncomfortable.
If the vulval area is painful, the biopsy is usually taken under a general anaesthetic.
After the biopsy, you may have some bleeding for a few days. This should gradually stop. If it continues or gets worse, tell your doctor.
Try to keep the area clean. If you can, it helps to rinse with plain water after passing urine (peeing) and after a bowel movement. It is best to use sanitary pads rather than tampons until the bleeding has settled. If you feel sore, taking painkillers or having a warm bath can help.
It usually takes about 7 to 10 days for the results of the biopsy to be ready. Waiting for your results can be difficult. It may help to talk to a relative or close friend.
You can also talk to our cancer support specialists for free on the Macmillan Support Line, 8am to 8pm, 7 days a week. Call 0808 808 00 00.
Further tests for vulval cancer
If the biopsy result shows cancer, your doctor will arrange further tests to check whether the cancer has spread. This is called staging. The results will help you and your doctor decide on the best treatment for you. Some tests may be repeated during and after treatment to check your progress.
Your cancer doctor or specialist nurse will explain which of the following tests you may need.
-
Blood tests
You may have blood samples taken to check your general health and how well your liver and kidneys are working.
-
Vulvoscopy and colposcopy
The doctor uses a microscope called a colposcope to look closely at the vulva and surrounding areas. They may also look inside the vagina and the womb. This may be done as an outpatient. Or it may be done during an exam under anaesthetic (EUA).
-
Exam under anaesthetic (EUA)
This is an examination of the vulva, vagina, cervix and anus. It is done under a general anaesthetic. It lets your doctor examine you fully and check the extent of the cancer without causing you discomfort. They may also remove small samples of tissue. This is called a biopsy.
During the EUA, your doctor may also sometimes look into your bladder (cystoscopy) and the lower end of your large bowel (proctoscopy) to check whether the cancer has spread.
You may have some light bleeding for a couple of days after an EUA. Your doctor or nurse can tell you more about this test and what to expect afterwards.
-
CT scan
A CT scan makes a detailed picture of the inside of the body. The picture is built up using x-rays taken by the CT scanner. The scan uses radiation, but this is very unlikely to harm you. It will not harm anyone you come into contact with.
-
MRI scan
An MRI scan uses magnetism to build up a detailed picture of areas of the body.
-
PET or PET-CT scan
A PET scan uses a low dose of radiation to check the activity of cells in different parts of the body.
You may have a PET scan and a CT scan together. This is called a PET-CT scan. It can give more detailed information about cancer or abnormal areas seen on other scans.
Lymph node tests
A common place for vulval cancer to spread to is the lymph nodes in the groin. Your doctor will check these nodes for swelling. Having swollen lymph nodes does not always mean that the cancer has spread. For example, an infection can also cause lymph nodes to swell.
If any of your lymph nodes are swollen, your doctor may sometimes suggest you have an ultrasound and a fine needle aspiration to check them.
If the ultrasound shows abnormal lymph nodes, the doctor may do a fine needle aspiration. This is a quick and simple test. The doctor injects some local anaesthetic into the skin of the groin to numb the area. Using the ultrasound scan as a guide, the doctor puts a fine needle through the numbed area and into the lymph node to collect a small sample of cells.
Sometimes the doctor may use a slightly larger needle to take the biopsy. This is called a core biopsy.
The doctor will send the sample away to be checked under a microscope. If the sample shows cancer cells, the groin lymph nodes will be removed during an operation or treated with radiotherapy.
Sentinel lymph node biopsy (SLNB)
The sentinel nodes are the first lymph nodes that fluid drains to from the vulva. If the cancer has spread to nearby nodes, these sentinel nodes are most likely to be affected.
Your doctor may suggest checking the sentinel nodes for cancer cells with a test called a sentinel lymph node biopsy (SLNB). This test can find small amounts of cancer that cannot be felt as swelling or seen on a scan.
The SLNB is usually done at the same time as an operation to remove the cancer. Before the SLNB, you usually have a scan to show where the sentinel lymph nodes are in the groin.
For the scan, you undress from the waist down. You then lie down on your back. The doctor uses local anaesthetic cream or a spray to numb the area of the vulva affected by cancer. They gently inject a small amount of radioactive liquid. The liquid drains into the nearest lymph nodes. You have scans over the next 90 minutes to show how and where the liquid goes. The doctor may also make marks with a marker pen on your skin. These marks and the scan pictures are useful when you have the SLNB.
During the operation, the doctor injects a dye into the area of the vulva affected by cancer. The dye stains the lymph nodes so the surgeon can find them. The surgeon also uses a probe that detects the radioactive liquid from the scan. They carefully find the sentinel lymph nodes and remove them.
After surgery, the sentinel lymph nodes are sent to a laboratory. They are examined under a microscope to check whether they contain cancer cells. If they show cancer cells, the remaining groin lymph nodes will need to be removed with another operation. Or you may have radiotherapy. If the sentinel nodes do not contain cancer cells, it is unlikely that other lymph nodes are affected. You do not need to have further surgery or radiotherapy.
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
-
References
Below is a sample of the sources used in our vulval cancer information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk
Morrison J, Baldwin P, Hanna L, Andreou A, Buckley L, Durrant L, et al. British Gynaecological Cancer Society (BGCS) vulval cancer guidelines: An update on recommendations for practice 2023. European Journal of Obstetrics and Gynaecology and Reproductive Biology. 2024;292: 210–238. Available from: www.doi.org/10.1016/j.ejogrb.2023.11.013 [accessed July 2026].
The Royal College of Radiographers. The Royal College of Radiologists expert panel recommendations for radiotherapy treatment for vulval cancer. 2024. Available from: www.rcr.ac.uk/media/l1zjohkm/rcr-vulval-cancer-treatment-recommendations.pdf [accessed July 2026]
Date reviewed
Our cancer information meets the PIF TICK quality mark.
This means it is easy to use, up-to-date and based on the latest evidence. Learn more about how we produce our information.
The language we use
We want everyone affected by cancer to feel our information is written for them.
We want our information to be as clear as possible. To do this, we try to:
- use plain English
- explain medical words
- use short sentences
- use illustrations to explain text
- structure the information clearly
- make sure important points are clear.
We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.
You can read more about how we produce our information here.