What is surgery and what is it used for?

The aim of surgery is to remove all the cancer. The surgeon will remove the area where the cancer is, plus a border of healthy tissue around it. You may also need to have some lymph nodes removed.

The different types of surgery for vulval cancer are:

  • Radical wide local excision – you have the affected skin removed and usually the lymph nodes from the groin on the same side as the cancer.
  • Radical partial vulvectomy – the surgeon removes the part of the vulva where the cancer is. You may also have the lymph nodes on either or both sides of the groin removed.
  • Radical vulvectomy – the surgeon removes all of the vulva and the lymph nodes on one or both sides of the groin.

If you need the vulva reconstructed, your surgeon will usually do this during the same operation. Your surgeon can tell you more about this.

Rarely, women with vulval cancer which has spread can have an operation to remove all the affected organs in the pelvis.

Surgery for vulval cancer

Your surgeon will talk with you about the most appropriate type of surgery. A gynaecological nurse specialist will also give you information and support before and after your operation.

The aim of surgery is to remove all the cancer affecting the vulva. The surgeon will take away the area of skin where the cancer is, and a border (margin) of healthy tissue all around it. In the same operation, they will also usually remove the lymph nodes from one or both sides of the groin. Women who have larger tumours may need more surgery to reconstruct the vulva.

Surgery to remove cancer of the vulva

There are different operations 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. If the cancer is larger you may need a more major operation.

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 all around the cancer. The margin is usually at least 1.5cm. Lymph nodes are also usually removed from the groin on the same side as the cancer.

Radical wide local excision
Radical wide local excision

View a large version

Read a description of this image

Radical partial vulvectomy (also called a partial vulvectomy)

Radical vulvectomy

Surgery to the lymph nodes

Most women have lymph nodes removed from one or both sides of their groin. This is to:

  • try to remove any cancerous lymph nodes – if vulval cancer spreads, it usually goes to the lymph nodes in the groin.
  • give information about the stage of the cancer, which helps when making decisions about other treatments.

Having many lymph nodes removed can affect fluid drainage from the legs and vulva. Because of this, some women develop increased swelling in one or both legs. This may happen months or years after their operation and is called lymphoedema.

Early-stage vulval cancer and rarer types of vulval cancer do not usually spread to the lymph nodes. Your doctor will tell you more about whether you’ll need to have lymph nodes removed.

Other ways of checking lymph nodes

Research is currently looking into other ways of checking the lymph nodes without removing lots of them. This aims to reduce the risk of lymphoedema. By using these other tests, only women who definitely have cancer in their lymph nodes need to have them removed.

Sentinel lymph node biopsy (SLNB)

This involves removing and checking one or more 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. 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 you won’t need to have any more lymph nodes 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.

If you are eligible for an SLNB, you may have it done as part of a clinical trial. Your doctor or nurse will be able to tell you whether a SLNB is suitable for you.

Ultrasound scan of the groin and needle biopsy

This 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 soundwaves is passed over the area. The soundwaves 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 as a guide, the doctor then puts a small needle into a lymph node and draws a sample of cells into a syringe. The sample is then sent to a laboratory, where it will be checked for cancer cells.

Reconstructing the vulva

If you need surgery 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, the surgeon may be able 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.

For a skin flap, the surgeon partly removes some skin near the vulva and transfers it on to the 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 placing it over the area where the cancer was removed.

If you need a skin flap or skin graft, a plastic surgeon will also be involved in the surgery.

Surgery for vulval cancer that has spread (pelvic exenteration)

If the cancer has spread to organs close to the vulva, such as the womb, bladder or lower bowel, it may still be possible to remove the cancer. This involves a major operation called a pelvic exenteration, where any affected organs are removed. Recovery following this type of operation can be difficult both physically and emotionally, so it’s not done very often. But this operation can be worthwhile for some women, as it may be able to completely remove the cancer, even when it’s advanced.

Back to Surgery explained

What happens before the surgery?

Your surgeon will discuss your surgery and how you can prepare with you – this is a good time to ask any questions you have.

Who might I meet?

A team of specialists will plan your surgery. This will include a surgeon who specialises in your type of cancer.