Tests That Help Evaluate Vulvar Cancer

Your doctor took a biopsy from your vulva in order to diagnose you with vulvar cancer. He or she may request more tests to learn more about your specific type of cancer and its specific location. Test results help decide which treatment is likely to be most effective for you. Here are some tests you may have to evaluate vulvar cancer.

Cystoscopy

This test lets the doctor see if the cancer has spread to your bladder. You have this test done in a hospital or outpatient surgery center. During a cystoscopy, the doctor looks at the inside of your bladder with a special instrument called a cystoscope.

You lie on your back with your knees up and slightly apart. The doctor or nurse cleans your urethra and applies some numbing medication. You may have general anesthesia instead, so that you fall asleep and don’t feel anything during the test. The doctor will then pass the cystoscope through your urethra and up into your bladder. Water or saline solution flows through the scope into your bladder. This stretches your bladder wall, giving the doctor a better view. You may have some discomfort or feel an urge to urinate. If needed, the doctor can take a tissue sample to check for cancer, called a biopsy. The whole test takes between 5 and 20 minutes. You will need a ride home after the test. You may feel a burning sensation when you urinate for a few days after the test.

Proctoscopy

This test checks to see if the cancer has spread to your rectum or to the bottom part of your large intestine. For it, the doctor uses a special instrument called a sigmoidoscope.

You undress from the waist down and put on a hospital gown. You lie on your left side on the exam table and pull your knees up toward your chest. The doctor gently inserts the sigmoidoscope through your rectum and into your large intestine. Air blows through the scope to allow for better viewing. The air may cause cramps. You may feel like you need to have a bowel movement. If the doctor sees any suspicious spots, he or she may remove them with a biopsy. After the test, you will expel the air by passing gas.

Pelvic Exam Under Anesthesia

During this procedure, you receive anesthetic that allows you to sleep. This lets the doctor perform a more thorough pelvic examination. Doctors may do this before a wide local excision or more involved surgery.

Lymphoscintigraphy

Doctors may use this procedure to pinpoint a few lymph nodes that are most likely to contain cancer prior to surgery. If these don’t contain cancer, then there is no need to remove the others. This may spare you more involved surgery that can cause side effects.

To perform a lymphoscintigram, a doctor injects a radioactive substance into the area around the tumor. The substance moves to the lymph node where the cancer would likely spread first. This test will help guide your physician where to make the incision to locate the sentinal lymph node.

Chest X-Ray

Doctors use this test to find out if the cancer has spread to your lungs. You may have it done before surgery to be sure you have no heart or lung problems. You stand in front of an X-ray scanner and hold your breath while a picture is taken. The test does not hurt, but the X-ray plate may feel cold against your skin.

Computed Tomography Scan (CT Scan)

Your doctor may order a CT scan to see if the cancer has spread to the lymph nodes or to other internal organs such as the liver or lungs. A CT scan uses X-rays to take pictures of the body from many angles. These special X-rays are more sensitive than a typical X-ray. Unfortunately, CT scans have not been helpful in finding smaller amounts of cancer in the pelvic lymph nodes.

To have the test, you lie still on a table as it gradually slides through the center of the CT scanner. Then the scanner directs a continuous beam of X-rays at your pelvis. A computer uses the data from the X-rays to create many pictures of your pelvis, which can be used together to create a 3-dimensional picture.

You may be asked to hold your breath one or more times during the scan. In some cases, you need to drink a contrast dye 4 to 6 hours before the scan, and you may not eat anything in the time between drinking the contrast dye and the scan. The dye helps some of the organs show up better during the test. The contrast dye will gradually pass through your system and exit through your bowel movements.

Magnetic Resonance Imaging (MRI)

MRIs can also help determine if cancer has spread. MRIs use radio waves and magnets to create images of your body. For this test, you lie still on a table as it passes through a tubelike scanner. The scanner directs a continuous beam of radiofrequency radiation at the area being examined. A computer uses the data from the radio waves to create a 3-dimensional picture of the inside of your body. You may need more than one set of images. Each one may take 2 to 15 minutes, so the whole scan may take an hour or more. Ask for earplugs because there is a loud thumping noise during the scan. If you’re claustrophobic, you may be given a sedative before having this test.

Positron-Emission Tomography (PET) Scan

Doctors often combine a PET scan with a CT scan. It may be more effective than a CT scan alone or than an MRI at detecting small cancers that have spread. Because PET scans your whole body, your doctor may order one instead of ordering multiple X-rays of different places on your body.

For this test, you either swallow or are injected with a sugar that has a mildly radioactive substance. Cancer cells absorb this sugar, and the radioactive material shows up during the image from the scan. It may take a few hours, or sometimes more than a day, for the sugar to reach the targeted organ.

To have the scan, you lie still on a table that is pushed into a machine that rotates around you, taking pictures that show where the glucose is in your body. The process takes about 45 minutes. If you’re sensitive to the sugar, you may have nausea, headache, or vomiting.