Surgery for vulval cancer

Your surgeon will discuss with you the most appropriate type of surgery, depending on the stage of your cancer. 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 the section 'How surgery may affect your sex life'| .

The aim of surgery is to remove all of the cancer affecting the vulva. This is done by taking away the area of the 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 groins during surgery. Women who have larger tumours removed may need additional surgery to reconstruct the vulva.

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.

Checking the lymph nodes for cancer Back to top

The lymph nodes in the groin are usually the first place to which vulval cancer can spread, so most women have lymph nodes removed from one or both of their groins during surgery.

Lymph nodes are usually taken out during the operation to remove the cancer. This can be done through a cut in the groin. Afterwards, the lymph nodes that have been removed are checked for cancer. 

Having all of the lymph nodes taken from one or both groins 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 of their legs. This may happen months or years after their operation and is called lymphoedema| .

Doctors are researching whether there are reliable ways of checking the lymph nodes without removing all of them. It is 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 and so fewer women will be at risk of lymphoedema.

Very early stage vulval cancer| (stage 1a) and rare types of vulval cancer| such as basal cell, or verrucous carcinoma rarely spread to the lymph nodes. Women with very early stage cancer or one of these rare types of vulval cancer don’t usually need to have their lymph nodes removed.

Newer methods for checking the lymph nodes for cancer Back to top

Newer methods are being investigated in research trials to discover if they can reliably detect cancer that has spread to the lymph nodes in the groin. 

Sentinel node biopsy Back to top

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 cancer could spread to. If the sentinel nodes are free of cancer no further lymph nodes should have cancer in them and 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 cancer no further lymph nodes are removed. If there is cancer in one or more sentinel nodes, however, all the remaining lymph nodes will need to be removed or treated with radiotherapy| .

Ultrasound scan of the groin and needle biopsy Back to top

The scan is painless and only takes a few minutes. Some gel is spread onto your groin and a small device which 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 Back to top

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. You can see a diagram of the full anatomy of the vulva| . Women with stage 1a cancer don’t usually need lymph nodes removed.

 

 

The following diagrams show different types of radical partial vulvectomy (also called a partial vulvectomy), which removes part of the vulva.

How the operation is done will depend on where on the vulva the cancer is.

 

 

 

 

 

Radical vulvectomy takes out the entire vulva, including the inner and outer labia and the clitoris. The lymph nodes are also removed from one or both groins (lymph node dissection).

 

Reconstructing the vulva Back to top

If it is needed, surgery to reconstruct the vulva is 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 from where the cancer has been removed.

Surgery for vulval cancer that has spread (pelvic exenteration) Back to top

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 to take away any affected organs. This may involve a major operation and recovery can be difficult both physically and emotionally. Because of this, the operation is 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 is advanced.

Both a gynaecologist and a plastic surgeon may be involved in carrying out this type of operation. Before the operation you should be able to see both surgeons and your specialist nurse to talk things over. They can support you in deciding whether pelvic exenteration is right for you.

You may need to have plastic surgery to reconstruct any organs that are removed. This may involve repairing or making a new vulva, urethra (the tube that carries urine from the bladder to the outside) or vagina. If your bladder or part of your bowel is removed a new opening (stoma) may need to be made on your abdominal wall.

After the operation a stoma bag would be worn over the opening to collect urine, if your bladder has been removed, or to collect bowel motions if part of your bowel has been removed. If your operation involves making a stoma, a nurse who specialises in the care of people with stomas (a stoma nurse) will visit you before the operation. They will explain how to look after your stoma and can answer any of your questions. The stoma nurse will also visit you after the operation to help you. You can get more information about stomas from our list of useful organisations| .

Before your operation Back to top

If you smoke try to give up or cut down before your operation. This will help to reduce your risk of chest problems and will help your wound to heal after the operation. Your family doctor can give you information, help and support if you want to give up smoking.

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 surgery|  to prevent blood clots forming in your legs.

A member of the surgical team will discuss the operation with you. You will also be visited on the ward by the doctor who will give you your anaesthetic (the anaesthetist).

Make sure that you talk to your nurse or doctor about any questions or concerns that you have about the operation.

After your operation Back to top

The type of care you receive after the 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 minimal 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 taken away 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 get the results of these checks. Once your surgeon has the results they will talk them over with you. This will usually happen during your stay in hospital or at your first outpatient visit after your operation.