Vulval cancer - Diagnosing vulval cancer

Before examining your vulva, your GP will ask you about your symptoms and look at your medical history.

Your vulva will be examined for any lumps or unusual areas of skin. If you would prefer to be examined by a female doctor or you would like a nurse present during the examination, let your GP's surgery know in advance of your appointment.

Referral to a gynaecologist

Your GP will probably refer you to a gynaecologist for further testing. A gynaecologist is a specialist in treating conditions of the female reproductive system.

Colposcopy and biopsy

Gynaecologists often use a small microscope with a light on the end of it (a colposcope) to look for any abnormalities in the vulva, cervix and vagina. This is known as a colposcopy.

During the colposcopy, a tissue sample will also be taken if cancer is suspected. This is called a biopsy.

A local anaesthetic is given, so the biopsy should not hurt, although you may have slight bleeding and soreness afterwards.

The tissue sample is checked in a laboratory for cancer. Your doctor will usually see you up to ten days later, when the results come through.

You may have additional biopsies to remove tissue from the lymph nodes near your vulva. This is to check whether cancer has spread through your lymphatic system.

Further testing

If the results of the biopsy show cancer and there is evidence it may have spread, you will probably need further tests to assess how widespread it is.

These may include the following tests, described below.

• Cystoscopy – an examination of the inside of the bladder to see if the cancer has spread to the bladder. A thin, hollow tube is inserted into the bladder to look for tumours and take a tissue sample.
• Proctoscopy – an examination of the inside of the rectum. The doctor either uses a gloved finger on an instrument called a proctoscope to check for abnormalities such as growths on the wall of the anus.
• CT scan – a computerised X-ray that takes detailed pictures of the inside of the body. It is useful for showing up cancer tumours and checking whether cancer cells have spread.
• MRI scan – uses radio waves and magnets to produce detailed pictures of the inside of the body. It is used to check whether cancer has spread.
• X-ray – you may have a chest X-ray to check that cancer has not spread to your lungs.

Staging

Staging in vulval cancer is based on the findings from surgery and is an assessment of whether the cancer has spread. The lower the stage, the greater the chance of a complete cure.

The staging system for vulval cancer is:

Stage 1 – the cancer is confined to the vulva. Stage 1 is further divided into two sub-types:

• Stage 1A – the cancer is 2cm or less in size
• Stage 1B – the cancer is larger than 2cm in size

Stage 2 – the cancer has spread beyond the vulva to other nearby parts of the body such as the lower vagina, anus or lower urethra (the tube you urinate out of), but the lymph nodes are unaffected.

Stage 3 – the cancer has spread into nearby lymph nodes. Stage 3 is divided into three sub types:

• Stage 3A – the cancer has spread into one lymph node and the metastasis is 5mm or more in size OR the cancer has spread into one or two lymph nodes but each metastasis is less than 5mm
• Stage 3B – the cancer has spread into two or more lymph nodes and the metastases are each 5mm or more in size OR the cancer has spread into three or more lymph nodes but each metastatis is less than 5mm
• Stage 3C – the cancer has spread through the outer covering of at least one of the lymph nodes (extracapsular spread)

Stage 4 – the cancer has spread away from the vulva and perineum (the area of skin and tissue between the anus and the genitals) to other parts of the body. Stage 4 is divided into two sub types:

• Stage 4A – the cancer has spread into the upper urethra or lining of the vagina, or into the bladder, rectum or the bones of the pelvis OR the cancer has caused lymph nodes to become stuck to underlying tissue or caused open sores (ulcers) to develop in the groin
• Stage 4B – the cancer has spread to more distant parts of the body such as the lungs, liver or the lymph nodes that are contained in the pelvis

Stage 1 and 2 vulval cancers are regarded by most experts as early stage cancers with a relatively good chance of a complete cure.

Stage 3 and 4 vulval cancers are usually regarded as advanced-stage cancers and a cure for these types of cancers may not always be possible.