Cancer screening exams can help find vulvar cancer at its earliest stage when the chances for successful treatment, optimal outcomes and fewer side effects are greatest. These tests are usually done when a patient is healthy and has no specific symptoms.

Not only are expert cancer researchers at the OSUCCC – James continually working to detect and diagnose vulvar cancer early, but they are also developing additional tests to detect and diagnose cancer even earlier, leading to improved outcomes, faster responses and fewer side effects.

If vulvar cancer is found at an early stage, the chances for successful treatment and recovery are great. Currently, for women at low risk for the disease, there are no recommended screening tests.

Vulvar Cancer Risk Factors

A risk factor is anything that increases your chances of developing vulvar cancer. The following factors may play a role in the development of vulvar cancer:

  • Having vulvar intraepithelial neoplasia (a precancerous condition in which changes happen in the skin cells covering the vulva)
  • Having human papillomavirus infection
  • Having a history of genital warts
  • Having many sexual partners
  • Having first sexual intercourse at a young age
  • Having a history of abnormal Pap tests

(Source: National Cancer Institute)

Not everyone with risk factors will get vulvar cancer. But having certain risk factors appears to increase your risk of developing the disease. If you are at high risk for vulvar cancer, talk to your doctor about tests to find out if you have early signs of the disease.

Diagnosing Vulvar Cancer

If symptoms suggest you might have vulvar cancer, your doctor will examine you and ask you about your medical history, including information about symptoms and any risk factors you may have.

If vulvar cancer is suspected, your doctor may recommend a vulvar biopsy.

Vulvar Biopsy

A vulvar biopsy is a procedure that removes a small piece of tissue from the affected area of the vulva. A pathologist will check the sample under a microscope for the presence of cancer cells.

Staging Vulvar Cancer

If you are diagnosed with vulvar cancer, staging is a way of determining the amount and location of your cancer. Staging is a key factor doctors use to choose treatment options.

The staging classification remains the same throughout treatment.

The following tests and procedures may be used in the staging process for vulvar cancer:

Pelvic Exam

During this exam the doctor will closely examine the vagina, cervix, uterus, fallopian tubes, ovaries and rectum. A Pap test may be done at this time. The doctor will be looking for any unusual lumps or changes in tissue.


A colposcopy is a procedure in which a colposcope — an instrument similar to a microscope with a light on the end — is used to check the cervical area for any abnormal tissues.


A cystoscopy is a procedure in which a cystoscope — a thin, flexible instrument with a light on the end — is used to check inside the bladder and urethra for any abnormal tissues.


A proctoscopy is a procedure in which a proctoscope — a thin, flexible tube with a light attached — is used to look inside the rectum and anus to check for any abnormal areas.

Imaging Tests

Imaging tests produce pictures of the inside of the body. There are several imaging tests that might be done to check for vulvar cancer. Imaging tests can also help determine the extent, or stage, of the disease.

Imaging tests may include one of the following:


An X-ray takes pictures of the inside of the body using high-energy beams. X-rays may be taken of organs, chest and pelvic bones to help stage vulvar cancer.

Computed Tomography Scan (CT Scan)

A type of X-ray test that produces detailed, cross-sectional images of your body.

Magnetic Resonance Imaging (MRI) Scan

MRI scans use radio waves and strong magnets instead of X-rays. MRI scans are helpful when the doctor may need to see the entire body.

Positron-Emission Tomography (PET) Scan

PET is useful if your doctor thinks the cancer may have spread to other parts of the body. This scan produces a detailed glucose map of the body. Cancer takes up glucose (sugar) faster than normal cells. The doctor can determine which cells contain more sugar, or which are cancerous and which are normal.

Intravenous Pyelogram or Intravenous Urography

A test in which a series of X-rays are taken of the kidneys, ureters and bladder. Before this test, the patient is given an injection of a special dye into the vein. This dye moves through the body and can help the radiologist and the doctor see if there are any blockages.

Sentinel Lymph Node Biopsy

This is a procedure in which the sentinel lymph node is removed, often during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor and the first place cancer may spread.

Using a radioactive blue dye injected into a vein prior to surgery, the surgeon will remove the first lymph node stained blue. A pathologist will view this tissue under a microscope to check for cancer cells. If no cancer cells are found, no more lymph nodes need to be removed.

Vulvar cancer is classified as one of four stages:

Stage I

In stage I, cancer has formed. The tumor is found only in the vulva or perineum (area between the rectum and the vagina). Stage I is divided into stages IA and IB.

  • In stage IA, the tumor is 2 centimeters or smaller and has spread 1 millimeter or less into the tissue of the vulva. Cancer has not spread to the lymph nodes
  • In stage IB, the tumor is larger than 2 centimeters or has spread more than 1 millimeter into the tissue of the vulva. Cancer has not spread to the lymph nodes

Stage II

In stage II, the tumor is any size and has spread into the lower part of the urethra, the lower part of the vagina, or the anus. Cancer has not spread to the lymph nodes.

Stage III

In stage III, the tumor is any size and may have spread into the lower part of the urethra, the lower part of the vagina, or the anus. Cancer has spread to one or more nearby lymph nodes. Stage III is divided into stages IIIA, IIIB and IIIC.

  • In stage IIIA, cancer is found in 1 or 2 lymph nodes that are smaller than 5 millimeters or in 1 lymph node that is 5 millimeters or larger
  • In stage IIIB, cancer is found in 2 or more lymph nodes that are 5 millimeters or larger, or in 3 or more lymph nodes that are smaller than 5 millimeters
  • In stage IIIC, cancer is found in lymph nodes and has spread to the outside surface of the lymph nodes

Stage IV

In stage IV, the tumor has spread into the upper part of the urethra, the upper part of the vagina or to other parts of the body. Stage IV is divided into stages IVA and IVB.

    • In stage IVA, cancer has spread into the lining of the upper urethra, the upper vagina, the bladder or the rectum or has attached to the pelvic bone; or cancer has spread to nearby lymph nodes and the lymph nodes are not movable or have formed an ulcer.
    • In stage IVB, cancer has spread to lymph nodes in the pelvis or to other parts of the body.

(Source: National Cancer Institute)

If you have received a vulvar cancer diagnosis, or if you want a second opinion or just want to speak to a vulvar cancer specialist, we are here to help you. Call 800-293-5066 or 614-293-5066 to make an appointment.

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The James Cancer Hospital and Solove Research Institute

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