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 suitable type of surgery. A gynaecological nurse specialist will also give you information and support before and after your operation. It is important to ask them any questions you have and talk about any worries you have about the surgery.

The aim of surgery is to remove all the cancer affecting the vulva. The surgeon will remove the area of skin where the cancer is, and a border (margin) of healthy tissue all around it. In the same operation, the surgeon will also take samples (biopsies) from the lymph nodes from one or both sides of the groin.

Women who have larger tumours may need more surgery to reconstruct the vulva (see below).

Some operations may change how your vulva looks and feels, which can affect your sex life. This can be difficult to deal with. Your team will explain any possible changes and give you support to help you cope.


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.

Wide local excision

This operation takes away the cancer and a border (margin) of healthy tissue all around the cancer. The operation is sometimes called a radical local excision. The margin is usually at least 1cm wide. This helps to lower the risk of the cancer coming back.

You may have lymph nodes removed from one or both sides of the groin as well, depending on where the cancer is.

Wide local excision
Wide local excision

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Removing part of the vulva – partial vulvectomy

If the tumour is larger, more of the vulval skin will be removed. This is to make sure there is a border (margin) of healthy tissue all around the cancer. This operation is sometimes called a radical partial vulvectomy.

You may have lymph nodes removed from one or both sides of the groin as well, depending on where the cancer is.

The following three diagrams show different types of radical partial vulvectomy.

Radical partial vulvectomy - upper
Radical partial vulvectomy - upper

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Radical partial vulvectomy - lower
Radical partial vulvectomy - lower

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Radical partial vulvectomy - side
Radical partial vulvectomy - side

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Removing the whole vulva – vulvectomy

This operation removes the whole vulva, including the inner and outer labia and the clitoris. It is also called a radical vulvectomy.

The lymph nodes are also removed from one or both sides of your groin.

Radical vulvectomy
Radical vulvectomy

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Reconstructing the vulva

Depending on the size of the area that is removed, you may need to have surgery to reconstruct the vulva. It is usually done at the same time as the operation to remove the cancer. But it can also be done at a later time.

If only a small amount of skin is removed from the vulva, the surgeon may be able to stitch the re-maining skin neatly together. This will also depend on the site of the cancer.

If a larger area of skin is removed, you may need to have a skin graft or skin flap. Skin grafts and flaps are done by a plastic surgeon.

Skin grafts

The plastic surgeon will take a piece of skin from another part of the body (usually the thigh or buttock) and place it over the area where the cancer was removed. The place where the skin is taken from is known as the donor site. The place where it is moved to is called the grafted area. The amount of skin that is taken depends on the area to be covered. Your doctor or specialist nurse will tell you more about this.

Skin flaps

A skin flap is a slightly thicker layer of skin than a graft. It is taken from an area close to the vulva. The flap is cut away, but left partially connected so it still has a blood supply. It is moved over the wound and stitched in place. If you have a skin flap, you may need to stay in hospital for a few days.

Skin flap surgery is very specialised. You may have to travel to a different hospital to have it. If you need a skin flap, your doctor will be able to tell you more about it.


Surgery for vulval cancer that has spread

If the cancer has spread to organs close to the vulva, such as the womb, bladder or lower bowel, you will usually be offered a combination of radiotherapy and chemotherapy. It may still be pos-sible to have an operation 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 is not done very often. But for some women this operation may be the only way to completely remove the cancer.


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
  • find out information about the stage of the cancer, which helps when making decisions about other treatments.

Early-stage vulval cancer (stage 1A ) and some rarer types of vulval cancer do not usually spread to the lymph nodes. Your doctor will tell you more about whether they will need to remove lymph nodes.

If you have had a sentinel lymph node biopsy (SLNB) and no cancer cells were found, you will not need to have any lymph nodes removed. Your doctor can tell you if you can have a SLNB.

Removing many lymph nodes 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 the operation and is called lymphoedema.

Back to Surgery

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.