Vulvar Cancer: Diagnosis

While having any risk factors or symptoms from the vulvar area does not mean you have vulvar cancer, it is important to discuss these concerns with your doctor. Your doctor may perform a complete physical exam, and carefully check the vulvar for signs of disease.  A biopsy is a procedure that removes a small piece of tissue from the vulvar.  It may be done during colposcopy, which uses a lighted magnifying instrument to check the vulvar for abnormal areas more clearly.  A tissue biopsy can then be studied by a Pathologist to check for signs of cancer.

It is also important to find out if the cancer has metastasized, or spread to another part of the body.  The process to find out if cancer has spread into the vulvar or metastasized is called cancer staging.  The following tests can be used in the staging process for vulvar cancer:

  • pelvic exam
  • colposcopy
  • cystoscopy (putting a small instrument with camera inside the bladder to check for signs of cancer) and
  • proctoscopy (putting a similar instrument inside the rectum)
  • X-ray
  • CT (computer tomography) scan
  • MRI (magnetic resonance imaging) scans
  • PET (positron emission tomography) scan

A general description of the different stages of vulvar cancer is as follows:

I   Cancer is limited to the vulvar area
IA   Cancer spread ≤ 2cm with a depth of < 1mm

Cancer spread >2cm, or with a depth of ≥1mm

II   Cancer can be any size, but has spread to nearby structures such as the anus, outer 1/2 of the urethra or the outer 1/3 of the vagina but NOT to the lymph nodes
III   Cancer can be any size, but has spread to the groin lymph nodes
IIIA   Cancer involving one lymph node ≥5mm or up to 2 lymph node <5mm
IIIB   Cancer involving 2 or more lymph nodes ≥5mm or 3 or more lymph nodes <5mm
IIIC   Any lymph node involvement with cancer on the outside of the nodes
IVA   Cancer involving fixed or ulderated groin lymph nodes OR spreading to structures near the vulvar, such as the lining of the bladder, the rectum, or bones
IVB   Cancer spreading to parts of body not near the vulva, including lymph nodes in the pelvis