How is Vulvar Cancer Diagnosed?

How do doctors test for vulvar cancer?

Diagnosing vulvar cancer typically begins with a medical history and physical examination.

If a suspicious area is identified, a biopsy is required to confirm whether cancer is present.

Medical history and physical examination

Your healthcare professional will ask about your symptoms, medical history, and possible risk factors.

Questions may include:

• How long have you experienced itching, pain, or irritation?

• Have you noticed any lumps, sores, or skin changes?

• Have you been diagnosed with HPV or lichen sclerosus?

• Have you previously had vulvar, cervical, or vaginal precancer?

• Have you received treatment for the symptoms?

During the examination, the clinician will inspect the vulva and may feel the lymph nodes in the groin.

A pelvic examination may also be performed to evaluate nearby structures.

Vulvar biopsy

A biopsy is the most important test for confirming vulvar cancer. During a biopsy, a clinician removes a small sample of tissue from the suspicious area. The tissue is sent to a pathology laboratory, where a pathologist examines the cells under a microscope.

Common approaches include:

Punch biopsy

A small, circular instrument removes a sample of tissue from the suspicious area.

Incisional biopsy

A portion of the abnormal tissue is removed for examination.

Excisional biopsy

The entire suspicious lesion is removed when appropriate. Local anesthetic is typically used to numb the area.

What does a vulvar biopsy show?

A pathology report may identify:

• Whether the lesion is benign, precancerous, or cancerous

• The type of vulvar cancer

• Tumor grade

• Depth of invasion, when assessable

• HPV-associated or HPV-independent features

• Other characteristics relevant to treatment

Additional testing may be performed on tumor tissue. For example, p16 immunohistochemistry can help identify HPV-associated squamous cell carcinoma, while p53 staining may help characterize certain HPV-independent tumors. These tests help pathologists classify the disease.

Imaging tests

If invasive vulvar cancer is confirmed, imaging may be recommended to determine whether the disease has spread. Not everyone with early-stage vulvar cancer needs every imaging test.

Magnetic resonance imaging (MRI)

MRI can help evaluate tumor size, depth, and involvement of nearby tissues.

Computed tomography (CT)

CT scans may be used to examine the pelvis, abdomen, or other areas for signs of cancer spread.

Positron emission tomography (PET/CT)

PET/CT combines metabolic imaging with anatomical imaging to help identify areas that may contain cancer.

Ultrasound

Ultrasound may be used to evaluate suspicious groin lymph nodes, sometimes alongside a needle biopsy.

Sentinel lymph node biopsy

The sentinel lymph node is the first lymph node, or group of nodes, most likely to receive cancer cells spreading from the primary tumor. During a sentinel lymph node biopsy, a surgeon uses a tracer to identify and remove these nodes. The lymph nodes are examined for cancer cells.

Sentinel lymph node biopsy may be appropriate for selected patients with early-stage vulvar squamous cell carcinoma, depending on tumor size, location, and other clinical findings. Not all patients are candidates.

What happens after a vulvar cancer diagnosis?

Once cancer is confirmed, your healthcare team will determine the stage and recommend a treatment plan. Care is often coordinated by a gynecologic oncologist, a physician specializing in cancers of the female reproductive system.