Vulvar Cancer: Tests After Diagnosis

What tests might I have after being diagnosed?

After a diagnosis of vulvar cancer, you’ll likely have other tests. These tests help your healthcare providers learn more about your cancer. They can help show if the cancer has grown into nearby areas or spread to other parts of your body. The tests may also help show how well you might tolerate treatments. This helps your healthcare providers decide the best ways to treat the cancer. If you have any questions about these or other tests, be sure to talk with your healthcare team.

The tests you may have can include:

• Pelvic exam either in the office or while under anesthesia

• Colposcopy

• Cystoscopy

• Proctoscopy

• Intravenous pyelogram (IVP)

• CT scan

• MRI

• Positron emission tomography (PET) scan

• Chest X-ray

• Sentinel lymph node biopsy (SLNB)

Exams

Pelvic exam

Your healthcare provider can do a thorough exam of your vulva and other organs in your pelvis. This is done to look for signs that the cancer has spread beyond the vulva. You may receive medicine to put you into a deep sleep (anesthesia).

Colposcopy

In this test, your healthcare provider uses an instrument (colposcope) to look at your cervix, vagina, and vulva. (The colposcope stays outside of your body.) The colposcope has a strong light and magnifying lenses. Through it, your healthcare provider can very closely look at the surface of these organs to check for any abnormal areas that may be cancer.

Cystoscopy

Your healthcare provider puts a special tool through your urethra into the bladder. This is called a cystoscope. It has a light and lens at the end which is put into the urethra. This allows your healthcare provider to check your bladder and urethra to see if cancer has spread to these areas.

Proctoscopy

This is a procedure to visually examine the inside of the anus and rectum. Your healthcare provider uses a lighted tube to check for cancer that may have spread to your rectum and anus.

Imaging tests

Intravenous pyelogram (IVP)

This test uses a special contrast dye and X-rays to look at your kidneys, ureters, and bladder. During this test, your healthcare provider injects contrast dye into a vein. Then they take X-rays as the contrast dye passes through your urinary tract. This test may be used to check for cancer spread to these areas or if the cancer has caused any blockages to the kidney.

CT scan

You may have a CT scan of your chest, belly (abdomen), and pelvis. This test uses a series of X-rays from many angles. A computer puts the images together into one detailed image. You may need to drink a special contrast dye, just before the scan. Or you may get the contrast dye as an injection through your vein from an IV (intravenous) line. The contrast dye helps images show up more clearly on the X-rays. The contrast dye may cause a warm feeling in your face or chest during the injection. Tell your healthcare provider if you’re allergic to or have had a reaction to the contrast dye. A CT scan can show enlarged lymph nodes, which may contain cancer. It can also help look for cancer in other organs.

MRI

An MRI uses large magnets and radio waves to take detailed pictures of the inside of your body. This test can show lymph nodes and tumors in the pelvis. For this test, you lie still on a table as it slides into a tube-like scanner. If you aren’t comfortable in small spaces, you may receive a medicine to relax you before the test. This is called a sedative. A special contrast dye may be given in the vein before the scan to make the pictures clearer. Tell your healthcare provider if you have any kidney problems before you get the contrast injection. The scanner directs a beam of radio waves at the area that’s being checked. You may need more than one set of images. Each one may take 2 to 15 minutes, but the full test may take an hour or more. This test is painless, but it's very noisy.

PET scan

For this test, a small amount of radioactive sugar is injected into your bloodstream. Cancer cells use more sugar than normal cells. So, the sugar will collect in cancer cells. Your healthcare provider uses a special camera to scan your whole body to see where the sugar has collected. A PET scan can sometimes show cancer in other areas of your body, even when it can’t be seen by other tests. This test is often used along with a CT scan. This is called a PET/CT scan.

Chest X-ray

A chest X-ray is done to see if there are any changes in your lungs. This may show that the vulvar cancer has spread to your lungs or chest. An X-ray uses a small amount of radiation to make an image of organs and bones inside of your body. The test can show enlarged lymph nodes in your chest. This test takes a few minutes and causes no pain. If the results are abnormal, your healthcare provider may advise a chest CT scan to look at the abnormal area closer.

Surgery

Sentinel lymph node biopsy

If your healthcare provider thinks the cancer has spread to your lymph nodes, you may need an inguinofemoral sentinel lymph node biopsy. The sentinel lymph node is the lymph node or nodes that are closest to the tumor. They are the most likely node or nodes to be affected first by the cancer. To look at the sentinel lymph node or nodes, your healthcare provider removes specific lymph nodes to check for cancer cells.

These results can help your healthcare provider decide what treatment you need.

During a sentinel node biopsy:

• The process starts with lymph node mapping. This is a way to find out which lymph node or nodes are closest to the tumor. These are the sentinel nodes. Your healthcare provider injects a small amount of radioactive tracer into your skin near the tumor site. It takes about an hour for the tracer to follow the same path as a cancer cell would to the nearest lymph node.

• Your healthcare provider uses a special device that detects radioactivity. This is called a Geiger counter. This helps to show where the cancer cells are most likely to go. Your healthcare provider may also inject a blue dye that travels to the lymph nodes. If this is done, your surgeon will look for nodes that have picked up a blue color from the blue dye. The lymph node that shows up with radioactivity or has turned blue is called the sentinel lymph node. Sometimes there is more than one sentinel node.

• Your healthcare provider makes a small cut to remove this sentinel lymph node.

• They check the sentinel lymph node for cancer cells.

• If it doesn’t have cancer cells in it, your healthcare provider will leave the other lymph nodes in place.

• If the removed sentinel lymph node has cancer cells, your healthcare provider may take out all of the lymph nodes in that region. This is called a complete inguinofemoral lymph node dissection or lymphadenectomy.

Working with your healthcare provider

Your healthcare provider will talk with you about which tests you'll have. Make sure to get ready for the tests as instructed. Ask questions and talk about any concerns you have.