Vulvar Cancer Screening and Diagnosis

Accurate diagnosis, screening tests and staging for vulvar cancer.

Vulvar cancer is rare, with only about 4,000 women diagnosed each year. In most cases, abnormal or precancerous cells can grow slowly for many years on the vaginal lips, clitoris, or vaginal glands. When pre-cancer or cancer is found early, treatment is likely to be the most effective.

There are several types of vulvar cancer:

• Squamous cell carcinoma affects the outer layers of the vulva. It is the most common type of vulvar cancer.
• Vulvar melanoma appears as a dark patch of skin. This is a rare vulvar cancer that grows quickly.
• Adenocarcinoma is very rare and begins in the glands in the vulva.
• Sarcoma begins in the connective tissue in the vulva.
• Verrucous carcinoma is an uncommon cancer that begins as a slow-growing wart.  

Signs and symptoms of vulvar cancer

Vulvar cancer has no signs or symptoms in its early stages. Later, it may cause symptoms that are similar to other health conditions. Symptoms may include:

• Bumps with a white, pink, or red appearance and a raw or wart-like surface
• Rough area of white skin 
• Intense or persistent itching
• Pain or burning when urinating
• Pain during sexual intercourse
• Bleeding or discharge unrelated to menstruation
• Sores, lumps, or ulcers that last for more than a month
• Changes to the shape of the vulva

See your doctor as soon as possible if you have abnormal bleeding, or if you have symptoms for more than two weeks. Your doctor can determine if any cells are in the precancerous or cancerous stage. Treatment is often the most effective when vulvar cancer is diagnosed in the early stages. 

Risk factors for vulvar cancer

Many women who have vulvar cancer do not have risk factors for the disease. However, even if you have several risk factors, it does not mean you will develop vulvar cancer. These are some factors that may put you at risk:

• Being aged 70 or older 
• Human papillomavirus (HPV)
• Genital warts, now or in the past
• Smoking
• HIV infection
• Abnormal cells, called vulvar intraepithelial neoplasia (VIN), on the surface of the vulva
• Abnormal Pap tests
• Sexual intercourse at a young age
• Many sexual partners
• Lichen sclerosus, a skin disorder that causes dryness and itching 
• Other genital cancers
• Melanoma or atypical moles on other parts of the body

Diagnosing vulvar cancer

While there is no standardized vulvar cancer testing or screening for patients, your doctor might find a suspicious cells or evidence of cancer through one of the following ways: 

Medical history: You will be asked about your family, any pregnancies, and sexual history. Please be honest and open with your doctor. We are here to help you. We are not here to make judgments.

Physical exam: The doctor will press on your abdomen to feel for lumps in the vagina. Also, your breasts and glands may be checked for lumps.

Pelvic exam: Your doctor will examine the vulva and inside of your vagina to check for lumps or sores that may signal vulvar cancer. 

Biopsies

If sores, lumps, or an abnormal patch of skin is found and it may indicate vulvar cancer, a biopsy will be done.  This is the only way to confirm the disease. 

Punch biopsy: Your doctor will use a circular tool, similar to a paper-hole punch, to remove small samples of tissue from the vulva. If the biopsy shows vulvar cancer is present and it may have spread to other areas of the body, more tests will be done. It is important to know where the cancer cells have moved to create a personalized treatment plan.

Diagnosing vulvar cancer 

These imaging tests will help determine the location of the cancer cells that may have moved into the vagina. When vulvar cancer is untreated, it can spread into the urethra, anus, and lymph nodes in the abdomen or pelvis, and other areas of the body.

• Computed tomography (CT): Using a computer, detailed and cross-sectional images of the pelvic area are made quickly with x-rays taken at various angles. Dye may be injected into a vein or given orally to help tissues and organs show up in the image. The images may show enlarged nodes or signs that the cancer has spread to the abdomen or other areas.
• Positron emission tomography (PET) scan: During this painless procedure, glucose (sugar) is mixed with a very small amount of a radioactive substance and injected into a vein. As you rest on a table, the solution is absorbed by certain organs and tissues. Then you will be moved into a tunnel scanner. The PET scanner traces the flow of the solution inside your body to find cancer cells. Those cells use more glucose than normal cells and show up brighter in the images.
• Magnetic resonance imaging (MRI): For advanced cases of vulvar cancer, MRI imaging is used to pinpoint if cancer cells have spread to the rectum, bladder, or other organs. Before the imaging begins, a contrast dye may be injected into a vein. This painless procedure involves resting on a table and sliding into a tunnel-shaped scanner for 30-60 minutes while pictures are taken. No radiation is used.
• Ureteroscopy: This test may be done if symptoms suggest that the cancer has spread to your bladder. During this procedure, a ureteroscope with a light and lens for viewing will look inside the two ureters – the thin tubes that lead from the kidneys to the bladder. Tissue may be removed to be checked for signs of cancer.
• Colonoscopy: If you have symptoms that the cancer has moved into your colon, your doctor will want you to have a colonoscopy. You will be sedated for this procedure. A thin, flexible and lighted tube with a small video camera on the end is inserted through the anus. During the procedure, the doctor can remove any cancerous cells. 

Staging vulvar cancer

Staging is the process of finding exactly where the cancer is located in your body. Your physical exam, biopsies, imaging, and other tests will help your doctors determine if it has spread away from the vulvar area and how much of it is in the body. 

A specially trained doctor called a pathologist will study the cells taken during the biopsy. The size, shape, and appearance of the cells help to identify the stage of cancer. That information will help your gynecologist and the tumor board decide about the best treatment options. 

These are the main stages of vulvar cancer. 

Stage 0: Precancerous cells are in the vulva only.
Stage 1: Cancer is only in the vulva or perineum, the area between the vagina and rectum.
Stage 2: Cancer has spread to the anus, vagina, or urethra. 
Stage 3: Cancer has spread to the anus, vagina, urethra, and a nearby lymph node. 
Stage 4: Cancer has spread to the anus, vagina, urethra, a lymph node, bones, and/or distant organs.

Our cancer team is available 24/7 to answer your questions. Call us at (888) 777-4167.