Tests for vulval cancer

You usually have a number of tests to find out if the symptoms you have could be due to vulval cancer. If you have vulval cancer you then need more tests to find out how far it has grown.

The tests you might have include:

• a vulval examination
• taking a sample of tissue called a biopsy
• scans to look at your pelvis and the rest of your body

Some of these tests can make you feel uncomfortable and embarrassed. They can also be painful which can be distressing. Your GP or specialist will try to make you as comfortable as possible.

You can ask for someone else to be in the room with you if you want, to act as a chaperone. A chaperone can be a friend or relative, or a trained health professional such as a practice nurse or a specialist nurse. They can be with you during the test or examination.

Before any examination, your GP or specialist explain what they are going to do. Ask them if you are not clear about anything.

Tests your GP might do

Most people start by seeing their GP. They can do some tests to help them decide whether you need to see a specialist. This usually includes a vulval and internal examination.

Vulval and internal examination

To have a vulval examination, you lie down on your back with your knees up and legs apart. You may be asked to rest your legs on padded leg supports. Your doctor may use a strong light and magnifier to look at the vulva. If you cannot get into this position for any reason, they may be able to examine you while you are lying on your side with your knees drawn up.

Your GP may also do an internal examination. This is also called a pelvic examination. This is when they examine your pelvis and tummy (abdomen). The doctor puts 2 gloved fingers into your vagina. And at the same time, they press down on your abdomen with their other hand. They check for any changes or abnormalities. 

Tests your specialist might do

Depending on the results of your examinations, your GP may refer you to a specialist at the hospital. This is usually a gynaecologist or dermatologist who specialises in the treatment of vulval skin problems.

Your specialist usually does more tests. These include:

• vulvoscopy and colposcopy
• vulval biopsy
• blood tests
• scans to look at your pelvis and the rest of your body. This includes CT, MRI and PET-CT scans.

Vulvoscopy and colposcopy

During a vulvoscopy, the doctor uses a colposcope to look at the vulva. A colposcope is like a microscope that helps the doctor find any changes that might be too small to see with the naked eye. 

Your doctor may also look inside the vagina and womb. This is a colposcopy. They use a plastic or metal instrument called a speculum to open up the vagina. The colposcope does not go inside your vagina. The doctor looks through it from the outside.

During a vulvoscopy or colposcopy, your doctor might take samples of tissue from any abnormal areas. This is a biopsy. They may also feel the lymph nodes in your groin, to see if they are larger than usual. 

Examination under anaesthetic (EUA)

It may be too uncomfortable for some people to have an examination while they are awake. So in this situation, your doctor may suggest you have a general anaesthetic. The doctor can examine the vulva, vagina and cervix without it being uncomfortable for you.

Vulval biopsy

A vulval biopsy is the only way to find out whether or not you have vulval cancer or another vulval condition. During a biopsy, your doctor takes samples of tissue from your vulva. They send the samples to a laboratory and a doctor looks at them under a microscope to check for cancer.

You usually have a biopsy under local anaesthetic. This means that you are awake but won’t feel any pain.

Blood tests

A blood test can check your general health, including how well your liver and kidneys are working. The doctors will also check the number of blood cells.

Scans to look at your pelvis and the rest of your body

If you have a biopsy that shows that you have vulval cancer, then you usually have more tests to work out where and how big the cancer is. This is called staging the cancer.

The tests you might have include:

• MRI scan
• CT scan 
• PET-CT scan 

MRI scan

MRI stands for magnetic resonance imaging. It uses magnetism and radio waves to take pictures of the inside of the body.

An MRI scan can tell your doctor where the cancer is, how big it is and whether it has spread to the lymph nodes .

CT scan

CT (or CAT) scan stands for computed (axial) tomography. It is a test that uses x-rays and a computer to create detailed pictures of the inside of your body.

You might have a CT scan of your pelvis, abdomen and chest. It can tell your doctor whether the cancer has spread to other parts of the body.

PET-CT scan

A PET-CT scan combines a CT scan and a PET scan. The PET scan uses a mildly radioactive drug to show up areas of your body where cells are more active than normal. 

You might have a PET-CT scan to find out whether the cancer has spread.

Treatment

The tests you have helps your doctor find out if you have vulval cancer and how far it has grown. This is the stage of the cancer. 

This is important because doctors plan your treatment according to the stage of the cancer.

Coping with vulval cancer

Coping with a diagnosis of vulval cancer can be difficult. There is help and support available to help you and your family.