Further tests after diagnosis

After being diagnosed with vulval cancer, you may have further tests to check your general health and find out whether the cancer has spread. Tests you may have include:

  • Blood tests – to check your general health
  • Chest x-ray – this checks your lungs and heart
  • CT (computerised tomography) scan – this uses x-rays to build up a three-dimensional picture of the inside of your body
  • MRI (magnetic resonance imaging) scan – this uses magnetism to build up a picture of your body
  • PET/CT (positron emission tomography) scan – this is combination of a CT scan and a PET scan which measures the activity of cells
  • EUA (examination under anaesthetic) – this allows the doctor to examine the vulva and surrounding area while you are under general anaesthetic.

Waiting for your test results can be difficult. It can help to talk about your worries with someone close to you.

Further tests for cancer of the vulva

If your vulval 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:


Blood tests


Chest x-ray

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. The scan takes 10 to 30 minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with.

CT scan
CT scan

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You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It is important to let your doctor know if you are allergic to iodine or have asthma, because you could have a more serious reaction to the injection.

You will probably be able to go home as soon as the scan is over.

Someone having a CT scan

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos


MRI scan

An MRI scan uses magnetism to build up a detailed picture of areas of your body. The scanner is a powerful magnet so you may be asked to complete and sign a checklist to make sure it is safe for you. The checklist asks about any metal implants you may have, such as a pacemaker, surgical clips or bone pins, etc.

You should also tell your doctor if you have ever worked with metal or in the metal industry as very tiny fragments of metal can sometimes lodge in the body. If you do have any metal in your body, it is likely that you will not be able to have an MRI scan. In this situation, another type of scan can be used. Before the scan, you will be asked to remove any metal belongings including jewellery.

Some people are given an injection of dye into a vein in the arm, which does not usually cause discomfort. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test, you will lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It is also noisy, but you will be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.


PET-CT scan

This 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 PET scan uses low-dose radiation to measure the activity of cells in different parts of the body.

PET-CT scans give more detailed information about the part of the body being scanned. You may have to travel to a specialist centre to have one. You cannot eat for six hours before the scan, although you may be able to drink. A mildly radioactive substance is injected into a vein, usually in your arm. The radiation dose used is very small. You will wait for at least an hour before you have the scan. It usually takes 30 to 90 minutes. You should be able to go home after the scan.


Cystoscopy

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 (see below).

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.


Proctoscopy

This 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.


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).

During the EUA, your doctor may look into your bladder (cystoscopy) and the lower end of your large bowel (proctoscopy) to see if 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 the examination and what to expect afterwards.


Lymph node assessment

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 an ultrasound and a fine needle aspiration to check them.

You may be offered a sentinel lymph node biops (SLNB) (see below). This is a small operation that can tell your doctors more about your situation and help them plan the best treatment for you. It is usually done at the same time as the operation to remove the cancer.

Ultrasound scan of the groin

Ultrasound uses sound waves to make up a picture of a particular area of the body. It is painless and only takes a few minutes.

Once you are in a comfortable position, some gel is spread onto your groin. A small device like a microphone, which produces sound waves, is passed over the area. A computer converts the sound waves into a picture. 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.


Sentinel lymph node biopsy (SLNB)

If the cancer is under 4cm in size and only in one place, your doctor may suggest a test called a sentinel lymph node biopsy.

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.

If the sentinel nodes do not contain cancer cells, it is unlikely that other lymph nodes are affected. This means you will not need to have surgery to remove them.

If they do contain cancer cells, all your remaining lymph nodes will need to be removed or treated with radiotherapy.

Having a sentinel lymph node biopsy

An SNLB is a small operation done under a general anaesthetic.

A few hours before the operation, the surgeon injects a tiny amount of radioactive liquid close to the cancer. The liquid makes the sentinel lymph nodes radioactive.

During the operation, the doctor injects a blue dye into the same area. The dye stains the sentinel lymph nodes blue so the surgeon can see them.

The surgeon uses a probe that detects radioactivity to help them find the sentinel lymph nodes. The sentinel nodes are then removed. They are sent to a laboratory and examined under a microscope to see if they contain cancer cells.

If you are eligible for an SLNB, you may have it as part of a clinical trial. Your doctor or nurse will be able to tell you whether it is suitable for you.

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