Prior to planning your treatment regimen, your doctor needs to know the grade of the tumor and the extent (stage) of the disease. A pathologist assigns the grade (1 to 3) to describe how abnormal the cancer cells look under a microscope. Grade 1 cancer cells are not as likely to grow and spread as Grade 3 cells. The stage is based on whether the tumor has invaded nearby tissues, whether the cancer has spread, and if so, to what parts of the body.
To learn the extent of disease, the doctor may order some of the following tests:
- Pelvic exam: The doctor checks the vagina, uterus, bladder and rectum for any irregularities. To see the upper part of the vagina and the cervix, the doctor inserts an instrument called a speculum into the vagina. A Pap test is also done, which involves taking a sample of cervical tissue.
- Colposcopy: A procedure in which a colposcope (a lighted, magnifying instrument) is used to check the vagina and cervix for abnormal areas. Tissue samples may be taken using a curette (spoon-shaped instrument) and checked under a microscope for signs of disease.
- Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope (a thin, lighted tube) is inserted through the urethra into the bladder. Tissue samples may be taken for biopsy.
- X-ray: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. To stage vulvar cancer, x-rays may be taken of the organs and bones inside the chest, and the pelvic bones.
- CT scan: Doctors often use CT scans to make pictures of organs and tissues in the pelvis or abdomen. An x-ray machine linked to a computer takes several pictures. You may receive contrast material by mouth and by injection into your arm or hand. The contrast material helps the organs or tissues show up more clearly. Abdominal fluid or a tumor may show up on the CT scan.
- MRI (Magnetic Resonance Imaging): Uses a large magnet, a computer, and radio waves to create detailed images that help determine how far the cancer has grown.
- PET scan (Positron Emission Tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
The stages of vulvar cancer
Stage I: Cancer has formed and is found in the vulva only or in the vulva and perineum (area between the rectum and the vagina). The tumor is 2 centimeters or smaller and has spread to tissue under the skin.
Stage II: The cancer is found in the vulva or the vulva and perineum, and the tumor is larger than 2 centimeters.
Stage III: The cancer is of any size that is found only in the vulva or the vulva and perineum and has spread to tissue under the skin and to nearby lymph nodes on one side of the groin. Or it may have spread to nearby tissues such as the lower part of the urethra and/or vagina or anus, and may have spread to nearby lymph nodes on one side of the groin.
Stage IV: Cancer has spread to nearby lymph nodes on both sides of the groin, or has spread beyond nearby tissues to the upper part of the urethra, bladder, or rectum; or has attached to the pelvic bone and may have spread to lymph nodes. Stage IV also includes cancer that has spread to distant parts of the body.
When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the original tumor. For example, if vulvar cancer spreads to the bladder, the cancer cells in the bladder are actually vulvar cancer cells. The disease is metastatic vulvar cancer, not bladder cancer. For that reason, it is treated as vulvar cancer, not bladder cancer. Doctors call the new tumor "distant" or metastatic disease.