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 test results help 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 while under anesthesia
Computed tomography (CT) scan
Magnetic resonance imaging (MRI)
Positron emission tomography (PET) scan
Sentinel lymph node biopsy
Pelvic exam while under anesthesia
You’ll receive medicine to put you into a deep sleep. Then 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. Tests that may also be done during this pelvic exam include:
In this test, your healthcare provider uses an instrument (colposcope) to look at your cervix. (The colposcope stays outside of your body.) The colposcope has magnifying lenses (like binoculars). Through it, your healthcare provider can very closely look at the surface of your vulva to check for any abnormal areas that may be cancer.
Your healthcare provider puts a special tool through your urethra into the bladder. This is called a cystoscope. It has a light and lens. This allows your healthcare provider to check your bladder and urethra to see if cancer has spread to these areas.
This is another visual inspection. In it, your healthcare provider uses a lighted tube to check for cancer that may have spread to your rectum and anus.
This test uses a special dye and X-rays to look at your kidneys, ureters, and bladder. During this test, your healthcare provider injects dye into a vein. Then he or she takes X-rays as the dye passes through your urinary tract. This test may be used to check for cancer spread to these areas.
You may have a CT scan of your chest, 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 X-ray dye, or contrast medium, just before the scan. Or you may receive the dye as an injection through your vein from an intravenous (IV) line. The dye helps images show up more clearly on the X-rays. The dye may cause a warm feeling in your face or chest. Tell your healthcare provider if you’re allergic to or have had a reaction to the dye. A CT scan can show enlarged lymph nodes, which may contain cancer. It can also help look for cancer in other organs.
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. 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.
For this test, a 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.
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.
Sentinel lymph node biopsy
If you have swollen or enlarged lymph nodes, you may need a sentinel lymph node biopsy. This is when your healthcare provider removes your lymph nodes to check for cancer cells. It’s done because cancer often first spreads to nearby lymph nodes.
In a group of lymph nodes, cancer is most likely to go to one or two lymph nodes first. These lymph nodes are called sentinel lymph nodes. 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 closets 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, which travels to the lymph nodes. The lymph node that shows up with radioactivity 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.
He or she checks 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 lymph node has cancer cells, your healthcare provider will take out all of the lymph nodes in that region. This is called lymph node dissection.
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.
March 21, 2017
Goodman, Howard, MD,Stump-Sutliff, Kim, RN, MSN, AOCNS