Vulvar cancer is usually diagnosed with a biopsy. During a biopsy, your doctor will remove a small bit of tissue, usually from the center of the abnormal area to be sure that a representative sample is taken. A specialist will examine the tissue under a microscope to check for cancerous and precancerous cells.
Your doctor may use an instrument called a colposcope, which has magnifying lenses, to select the biopsy site. Before the colposcopy, your doctor will apply a vinegar solution to any suspicious-looking areas. It causes abnormal skin to turn white for a short time. Your doctor will be better able to see these areas through the colposcope. Your doctor may look at your cervix and vagina with the colposcope, too.
If your doctor sees abnormalities on different areas of the vulva, he or she may take multiple tissue samples. Small abnormal areas may be removed completely.
If the biopsy detects cancer, your doctor may do additional tests to determine if the cancer has spread beyond the vulva. For example, he or she may use a lighted tube to examine the inside of the bladder and rectum. He or she may also do a more thorough pelvic exam under anesthesia.
You may also need imaging tests. A chest x-ray may be done to see if cancer has spread to your lungs. Another type of imaging test is a computed tomography (CT) scan. It creates detailed pictures of internal organs with a rotating x-ray beam and a computer.
Your doctor may also recommend a sentinel node biopsy to check for cancer in nearby lymph nodes. At some medical centers, this involves injecting a radioactive substance that lymph nodes soak up. If the radioactive substance looks abnormal, it can signal the presence of cancer in the lymph nodes.
These selected nodes (sentinel nodes) may be removed to help doctors predict whether the cancer has spread to nearby pelvic organs or more distant parts of the body. Checking these lymph nodes for cancer will also help doctors determine your treatment options.
If vulvar cancer is diagnosed, it will be "staged." The stages—stage I to stage IV—indicate how far the cancer has progressed. Stage 0 indicates VIN. It means that abnormal cells are confined to one spot on the outer surface of the vulva. These abnormal cells have the potential to become cancerous.
Each higher stage means more vulvar cancer progression. Women with stage IV have very advanced cancer that has spread into other organs or to lymph nodes on both sides of the pelvis.