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Your doctor may find vulvar cancer during a routine visit, even if you don’t have symptoms. If you’re having symptoms of vulvar cancer, your doctor will ask you about:
Your health history
Your family’s history of cancer
Your other risk factors, such as history of smoking or HPV infection
The doctor may also do certain tests to find out if you have vulvar cancer. Here are some of the tests doctors use to diagnose or rule out vulvar cancer. It is very important that your particular findings be put into context by an expert. Gynecologic oncologists are subspecialists with advanced training in the diagnosis, treatment, and surveillance of female cancers including vulvar cancer.
A pelvic exam is recommended as a regular screening for women. You can have this exam in your doctor’s office. For this exam, you remove your clothes from the waist down and put on a medical gown. You lie on your back on an exam table and bend your knees. You place your feet in supports called stirrups at the end of the table. This position allows the doctor to examine your vulva, vagina, cervix, uterus, ovaries, fallopian tubes, rectum, and bladder. During a pelvic exam, your doctor will inspect your vulva for changes. If the doctor sees something suspicious, he or she may recommend a biopsy. This is when some of the tissue is removed so it can be checked under a microscope. A biopsy can help tell the difference between a precancerous condition and an invasive cancer.
The Pap test is a way to check cells from the cervix and the vagina. It can be done at the same time as a pelvic exam. The doctor uses a tool called a speculum to hold open and widen your vagina. The speculum allows the doctor to see the upper portion of your vagina and cervix, which is the area that connects the vagina to the uterus. While using the speculum to widen the vagina, your doctor swabs your cervix to collect cells. A doctor, who is a specialist called a pathologist, examines these cells under a microscope. This test is not a test for vulvar cancer, but it can check for other gynecologic problems, such as certain infections or cervical cancer.
This test checks for the presence of human papillomavirus (HPV) which is a group of viruses that often cause warts on the genital areas. Certain types of HPV can cause vulvar cells to change and become precancerous. Your doctor may choose to do this test at the same time as a Pap test.
For this test, your doctor uses a tool called a colposcope to magnify your cervix, vagina, and vulva. This lets your doctor choose suspicious looking spots of tissue to remove and examine. During a colposcopy of the vulva, the doctor treats your skin with a diluted solution of acetic acid, the main ingredient in vinegar. It causes suspicious areas to turn white and makes them easier to see. If the doctor sees abnormal tissue, he or she may remove it for testing (biopsy).
A biopsy is the only way for your doctor to know for sure if you have cancer. If your doctor sees an abnormal area, he or she may do a biopsy by removing a small piece of tissue from your vulva. You may be numbed first with a local anesthetic. If the abnormal area is small, your doctor may completely remove it. If it's bigger, the doctor may punch out a portion of skin using an instrument that looks like a tiny apple corer. You usually don’t need stitches after this procedure. You may feel some pressure, but probably will have little or no pain. For larger areas, the doctor may cut out a small part of the skin with a scalpel and sew together the skin’s edges with surgical thread (suture). Commonly, the doctor will also remove some surrounding normal skin around the abnormal areas. A pathologist will then check the cell samples for cancer. The results of the biopsy usually take one week to come back to your doctor from the lab. Depending on the extent of the cancer, you may need more surgery and your doctor may also need to biopsy lymph nodes to see if the cancer has spread.
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