Surgery for vulval cancer
Your surgeon will discuss the most appropriate type of surgery with you. Before your operation, make sure you’ve talked it over fully with them.
You will also be able to speak to a gynaecological nurse specialist, who can give you information and support before and after your operation. Some of the issues that vulval surgery raises are discussed in our section on sexuality.
The aim of surgery is to remove all of the cancer affecting the vulva. This is done by taking away the area of skin where the cancer is, and a border (margin) of healthy tissue all around it. Most women also have lymph nodes removed from one or both sides of the groin during surgery. Women who have larger tumours removed may need additional surgery to reconstruct the vulva.
Checking the lymph nodes for cancer
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The lymph nodes in the groin are usually the first place that vulval cancer can spread to, so most women have lymph nodes removed from one or both sides of their groin during surgery. However, women who have very early-stage vulval cancer (stage 1A) or rare types of vulval cancer that tend not to spread, such as basal cell or verrucous carcinoma, won’t usually need to have any lymph nodes removed.
Lymph nodes are usually taken out during the operation to remove the cancer. This can be done through a cut in the side of the groin. Afterwards, the lymph nodes that have been removed are checked for cancer.
Having all the lymph nodes removed from one or both sides of the groin can affect fluid drainage from the legs and vulva. As a result, some women may develop a build-up of fluid in one or both legs. This may happen months or years after their operation and is called lymphoedema.
To reduce the risk of lymphoedema, doctors are researching whether there are reliable ways of checking the lymph nodes for cancer without removing all of them. It’s hoped that in the future this will mean that only women who definitely have cancer in their lymph nodes will need to have them removed. This would mean that fewer women will be at risk of lymphoedema.
Other methods for checking the lymph nodes for cancer are being investigated in research trials. These include sentinel node biopsy and needle biopsy using an ultrasound scan:
Sentinel node biopsy
This method involves removing and checking one or more specially selected lymph nodes, called sentinel nodes, for cancer. The sentinel node is the first node that fluid drains to from the vulva, so it’s the first lymph node the cancer could spread to. If the sentinel nodes are free from cancer, it’s likely that no further lymph nodes have cancer cells in them and that no more lymph nodes need to be removed.
To find the sentinel node(s), the surgeon injects a tiny amount of radioactive liquid close to the cancer a few hours before the operation. Then during the operation, they inject a blue dye into the same area. The nodes that stain blue and take up the radioactive liquid are the sentinel nodes. These nodes are removed and tested for cancer cells.
If the sentinel nodes don’t contain any cancer cells, then no further lymph nodes are removed. However, if there are cancer cells in one or more sentinel nodes, all the remaining lymph nodes will need to be removed or treated with radiotherapy.
Ultrasound scan of the groin and needle biopsy
This method involves having an ultrasound scan, which is painless and only takes a few minutes. Some gel is spread onto your groin and a small device that produces sound waves is passed over the area. The sound waves produce a picture of your lymph nodes, which can be seen on a computer screen. The doctor will look for changes in the size or appearance of the lymph nodes.
A small sample of cells (biopsy) may be taken from a lymph node during the scan. First, the doctor injects some local anaesthetic into the skin of your groin to numb the area. This may sting for a few seconds. Using the ultrasound images to guide them, the doctor then puts a small needle into a lymph node and withdraws a sample of cells into a syringe. The sample is then sent to a laboratory where it will be checked for cancer cells.
Surgery to remove cancer of the vulva
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Different operations may be used to treat cancer of the vulva, depending on the size and position of the cancer. If the cancer is very small it may be possible to remove only a small area of the vulva, but if the cancer is larger a more major operation will be needed.
Radical wide local excision (also called a radical local excision or wide local excision
This operation takes away the cancer and a border (margin) of healthy tissue, usually at least 1cm, all around the cancer. Lymph nodes are usually also removed from the groin, on the same side as the cancer (lymph node dissection). However some women, such as those with stage 1A vulval cancer, won’t usually need to have any lymph nodes removed.
Radical partial vulvectomy
The following diagrams show different types of radical partial vulvectomy (also called a partial vulvectomy).
This operation removes part of the vulva. How the operation is done and whether the lymph nodes are removed from one or both sides of the groin will depend on where on the vulva the cancer is:
This operation removes the entire vulva, including the inner and outer labia and the clitoris. The lymph nodes are also removed from one or both sides of the groin.
Reconstructing the vulva
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If surgery is needed to reconstruct the vulva, it’s usually done at the same time as the operation to remove the cancer.
If only a small amount of skin is removed from your vulva, it may be possible to stitch the remaining skin neatly together. However, if a larger area of skin is taken away, you may need to have skin flaps or a skin graft. A skin flap is made from a piece of skin close to the vulva. The flap of skin is moved (rotated) onto the vulval area to cover the wound. A skin graft involves the surgeon taking a piece of skin from another part of the body (usually the thigh or abdomen) and attaching it over the area the cancer has been removed from. If you need surgery that involves a skin graft or skin flap, a plastic surgeon will also be involved in the surgery.
Surgery for vulval cancer that has spread (pelvic exenteration)
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If the cancer has spread to organs close to the vulva, such as the womb, bladder and/or lower bowel, it may still be possible to remove the cancer with surgery and to take away any affected organs. This will involve a major operation, known as a pelvic exenteration. Recovery following this type of operation can be difficult both physically and emotionally, so it’s not done very often. But surgery can be worthwhile for some women, as it may be able to completely remove the cancer even when it’s advanced.
If this type of operation is suitable for you, your hospital team will give you detailed information about it. You can also get support from other useful organisations.
If you smoke, try to give up or cut down before your operation. This will help reduce your risk of chest problems, such as a chest infection, and will help your wound to heal after the operation. Your GP can give you information, help and support if you want to give up smoking, and you can also read our information about it.
You’ll usually be admitted to hospital the day before your operation. However, women who have very small early-stage cancers may not need to be admitted the day before their surgery. They may go into hospital, have their surgery and go home on the same day or the following day.
A member of the surgical team will discuss the operation with you. You’ll also be visited on the ward by the doctor who will give you your anaesthetic (the anaesthetist).
You’ll be given special elastic stockings (TED stockings) to wear during and after the operation
You are usually admitted to hospital a day before your operation, but some women who have very small early stage cancers may have their surgery and go home on the same day or the following day. You will be given special elastic stockings (TED stockings) to wear during and after the operation to prevent blood clots forming in your legs.
Make sure that you talk to your nurse or doctor about any questions or concerns that you have about the operation.
The type of care you receive after your operation, and the speed of your recovery, will depend on the type of surgery you have. If the cancer is very small and only a small amount of skin is removed, your wound is likely to heal quickly. If your lymph nodes are removed, and particularly if you have more major surgery (such as a radical vulvectomy), healing and recovery will take longer.
All the tissue that was removed from your vulva will be carefully checked after the operation. If your lymph nodes were removed they will also be examined for signs of cancer. It takes a few days to a week to get the results of these checks. Once your surgeon has the results they’ll talk them over with you. This will usually happen during your stay in hospital or at your first outpatient visit after your operation.