How does my doctor know I have vulvar cancer?

Your doctor may find vulvar cancer during a routine visit, even if you don’t have symptoms. If you’re having symptoms of vulvar cancer, your doctor will ask you about these things.

  • Your health history
  • Your family’s history of cancer
  • Your other risk factors, such as history of smoking or HPV infection

The doctor may also perform certain tests to check if you have vulvar cancer. You may need more than one of these tests. Here are some of the tests doctors use to diagnose or rule out vulvar cancer.

  • Pelvic Exam - A pelvic exam is recommended as a regular screening for women. You can have this exam in your doctor’s office. For this exam, you remove your clothes from the waist down and put on a medical gown. You lie on your back on an exam table and bend your knees. You place your feet in supports called stirrups at the end of the table. This position allows the doctor to look at or feel your vulva, vagina, cervix, uterus, ovaries, fallopian tubes, rectum, and bladder. The doctor uses a tool called a speculum to hold open and widen your vagina. This may pinch a bit. The speculum allows the doctor to see the upper portion of your vagina and cervix, which is the area that connects the vagina to the uterus. During a pelvic exam, your doctor will look at and feel your vulva, inspecting it for changes. If the doctor sees something suspicious, he or she may recommend a biopsy. A biopsy can help tell the difference between a precancerous condition and an invasive cancer.
  • Pap Test - The Pap test is a way to check cells from the cervix and the vagina. It can be done at the same time as a pelvic exam. Using the speculum to widen the vagina, your doctor swabs your cervix to collect cells. A special doctor called a pathologist examines these cells under a microscope. This test is not a test for vulvar cancer, but it can rule out other gynecologic problems, such as certain infections or cervical cancer.
  • HPV Test - This test checks for the presence of HPV, which is short for human papillomavirus. This virus usually goes away on its own. In rare cases, HPV can cause vulvar cells to change and become precancerous. Your doctor may choose to do this test at the same time as a Pap test.
  • Colposcopy of the Vulva - For this test, your doctor uses a tool called a colposcope to magnify your cervix, vagina, and vulva. This lets your doctor choose suspicious looking spots of tissue to remove and examine, which is called a biopsy. The doctor sends the removed cells to a lab to be checked for cancer.  During a colposcopy of the vulva, the doctor treats your skin with a diluted solution of acetic acid, the main ingredient in vinegar. It causes suspicious areas to turn white. If the doctor sees abnormal places, he or she may inject local anesthetic into your skin to make it numb. The doctor uses the hand-held colposcope to determine where to remove the tissue. If the abnormal area is small, your doctor may completely remove it with the biopsy.
  • Biopsy - A biopsy is the only way for your doctor to know for sure if you have cancer. If your doctor sees an abnormal area, he or she may perform a biopsy by removing a small piece of tissue from your vulva. You may be numbed first with a local anesthetic. The doctor will punch out a portion of skin using an instrument that looks like a tiny apple corer. You don’t need stitches after this procedure. You may feel some pressure, but probably will have little or no pain. For larger areas, the doctor may excise part of the skin with a scalpel and sew together the skin’s edges with surgical thread. Commonly, the doctor will also remove some surrounding normal skin around the abnormal areas. A pathologist will then check the cell samples for cancer. The results of the biopsy usually take one week. Depending upon the extent of the cancer, your doctor may also need to biopsy lymph nodes to see if the cancer has spread.

Treatment Options for Precancerous Lesions of the Vulva (VIN)

A colposcopy or a biopsy may show that you don’t have cancer but that you do have precancerous lesions in your vulva.

Vulvar cancer forms slowly. It usually begins with precancerous changes that may last for many years. You may have vulvar rashes, moles, lumps, or other changes that don’t go away. The term most often used for this condition is vulvar intraepithelial neoplasia (VIN). Intraepithelial means that the precancerous cells are confined to the surface layer of the vulvar skin, called the epithelium. Other terms for this precancerous condition are severe dysplasia and carcinoma in situ. The type of treatment your doctor will suggest depends on the type of disease and how far it has progressed. Your doctor may suggest one of these types of treatment.

  • Laser surgery to burn off the layer of abnormal cells. This is used for treating VIN but not invasive cancer.
  • Wide local excision to remove precancerous lesions and some surrounding normal cells
  • A topical prescription medication that you put on the skin of your vulva, such as Efudex (fluorouracil, also called 5-FU).

Because VIN may come back after treatment, be sure to keep all follow-up appointments with your doctor. Go back to your doctor if you have itching or burning on your vulva.