If you have symptoms of vulval cancer, you will usually begin by seeing your GP, who will examine you. If they think that your symptoms could be caused by cancer, they will refer you to a doctor who specialises in women’s cancers (gynaecological cancer specialist).
Your GP may also arrange for you to have a blood test and chest x-ray to check your general health.
At the hospital the specialist will ask you about your general health and any previous medical problems you have had. They will also examine your vulval area. They can usually do this during an outpatient appointment.
The vulva is an intimate and private part of the body. Some women find it embarrassing or upsetting to have a vulva examination. If you feel this way, let your doctor or nurse know so they can give you support.
A vulva biopsy is when a doctor takes a small sample of tissue from the affected area of the vulva. They send this to a laboratory to be examined under a microscope.
If your vulva examination and biopsy show that you have cancer of the vulva, your doctor will arrange some more tests. These are to see 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 doctor or specialist nurse will explain this to you.
You may have some of the following tests:
You may have blood samples taken to check your general health and how well your liver and kidneys are working. We have more detailed information about having a blood test.
This uses x-rays to take a picture of your chest, to check your lungs and heart.
CT (computerised tomography) scan
A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body.
An MRI scan uses magnetism to build up a detailed picture of areas of your body.
A PET-CT scan is a combination of a CT scan, which takes a series of x-rays to build up a three-dimensional picture, and a positron emission tomography (PET) scan.
A cystoscopy is an examination of the lining of the bladder. It may be done to check if the cancer has spread to the tube that you pass urine through (urethra) or to the bladder. You may have this test under a local anaesthetic using a gel to numb the opening of the urethra. Sometimes a cystoscopy is done as part of an examination under a general anaesthetic.
The doctor or nurse gently passes a thin tube with a camera and light on the end (a cystoscope) through your urethra into the bladder. If there are any abnormal areas, they can use the cystoscope to take biopsies. The test should only take a few minutes. You may have symptoms, such as a burning pain when passing urine, for a few days after the test. Speak to your doctor if your symptoms get worse or do not go away after a couple of days.
A proctoscopy is an examination of the lower end of the large bowel (anus and rectum). You will be asked to lie curled on your left side while the doctor gently passes a tube (proctoscope) into your back passage. The doctor can see any abnormal areas by using a tiny light and camera on the end of the proctoscope. If necessary, they can take a small sample of cells (biopsy).
A proctoscopy can be uncomfortable. Tell the doctor or nurse if you find it painful. You should be able to go home as soon as the proctoscopy is over. Sometimes you may have a proctoscopy as part of an examination under anaesthetic.
Examination under anaesthetic (EUA)
This is an examination of the vulva, vagina and cervix, done under a general anaesthetic. It allows your doctor to examine you thoroughly and check the extent of the cancer without causing you discomfort. They may also remove small samples of tissue (biopsy). You may have some light bleeding for a couple of days after an EUA. Your doctor or nurse can tell you more about the examination and what to expect afterwards.
A common place for vulval cancer to spread is to the lymph nodes in the groin. Your doctor will examine these nodes to see if they look or feel swollen.
Having swollen lymph nodes does not necessarily mean that the cancer has spread. An infection, for example, can also cause lymph nodes to swell.
If any of your lymph nodes are swollen, your specialist may suggest that you have one of the following tests:
Ultrasound scan of the groin
Ultrasound uses sound waves to make up a picture of a particular area of the body. If the ultrasound of the lymph nodes is abnormal, the doctor will do a fine needle aspiration of the node or nodes.
Fine needle aspiration (FNA)
This is a quick and simple test. First, the doctor injects some local anaesthetic into the skin of your groin to numb the area. Using the ultrasound scan as a guide, the doctor puts a fine needle into the lymph node and withdraws a sample of cells into the syringe.
The cells are examined under a microscope to see if they contain any cancer cells. If they do, all your remaining lymph nodes will need to be removed or treated with radiotherapy.
The sentinel nodes are the first nodes that lymph fluid drains to from your vulva. This means that if the cancer has spread to nearby nodes, the sentinel nodes are the ones that are most likely to be affected.
An SLNB can tell your doctors more about your situation and help them plan the best treatment for you. It is not a treatment.