Vulvar Cancer

Your healthcare provider will ask about your medical history, potential risk factors and symptoms. Diagnosis often involves multiple tests.

Tests to diagnose vulvar cancer

Tests may include:

• Pelvic exam: Your provider will visually inspect your vulva, checking for unusual skin changes. They’ll insert one or two gloved, lubricated fingers inside your vagina to feel for any lumps or other signs of cancer. They may use a similar technique to check your rectum. They may use a tool called a speculum to widen your vagina so they can check for abnormalities.
• Pap smear: Your provider may take a sample of cells during the pelvic exam and test them for cancerous changes. They may perform an HPV test on the sample to see if you have an infection.
• Colposcopy: Your provider may use a lighted, magnifying instrument called a colposcope to view your vulva, vagina and cervix (the organ between your vagina and uterus) in more detail. They may apply a special solution that can highlight abnormal cells, making them easier to see.
• Biopsy: Your provider may remove a sample of abnormal tissue to test it for cancer cells. A biopsy is the only way to know for sure whether you have vulvar cancer.

Tests to determine cancer spread

If you have cancer, your provider will perform additional tests to see if it’s spread beyond your vulva. Without treatment, vulvar cancer may spread to your vagina or other nearby organs, lymph nodes in your pelvis and eventually your bloodstream. Cancer that’s spread (metastatic cancer) is harder to treat.

Tests may include:

• Scope exams: You may receive a cystoscopy to check for cancer spread in your urethra (the tube that carries your pee) or bladder. A proctoscopy checks for cancer cells in your rectum or anus.
• Imaging tests: X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI) and positron emission tomography (PET) scans can show if the cancer has spread from your vulva to other tissues.
• Sentinel node biopsy: Your provider may remove the lymph node closest to your tumor (the sentinel node) to test for cancer cells. With vulvar cancer, tumors usually drain into sentinel lymph nodes in your groin.

What are the stages of vulvar cancer?

Vulvar cancer staging allows healthcare providers to determine if your cancer’s spread beyond your vulva. This information guides treatment decisions. There are four main stages:

• Stage I: Early-stage vulvar cancer is only on your vulva or perineum (area between your rectum and vagina). Stage I consists of Stages IA or IB based on tumor size and how far it reaches into nearby tissue.
• Stage II: The tumor (of any size) has spread into the lower part of your urethra, the lower part of your vagina or anus.
• Stage III: Cancer has spread to one or more nearby lymph nodes. Stage III consists of Stages IIIA, IIIB, and IIIC based on the number and size of the lymph nodes involved.
• Stage IV: Cancer has spread into the upper part of your urethra, vagina or other body parts. Stage IV consists of Stages IVA and IVB based on if the spread is localized near your vulva or spread distantly.

Ask your healthcare provider to explain the details of what your cancer stage means for your treatment.