Surgery for vulvar cancer

Surgery is the main treatment for vulvar cancer. Your gynaecological oncologist will talk to you about the most suitable type of surgery, as well as the risks and any possible complications.

All tissue removed during surgery is examined for cancer cells by a pathologist. The results will help confirm the type of vulvar cancer you have and its stage.

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Types of vulvar surgery

The type of operation recommended depends on the stage of the cancer. Depending on how far the cancer has spread, you may have one of the following types of surgery.

Local excision

Local excision

Wide local excision 

The surgeon cuts out the cancer, as well as a small border of healthy tissue (called the margin).

Radical local excision

The surgeon cuts out the cancer with a deeper margin. May be done together with a lymph node dissection.

Partial vulvectomy

Partial vulvectomy

The affected part of the vulva is removed. The surgeon may also take out a small border of healthy tissue around the
cancerous tissue (a wide local
excision). This may mean that a large part of the vulva is removed.

Complete vulvectomy

complete vulvectomy

The surgeon removes the entire vulva, sometimes including the clitoris. A complete radical vulvectomy also removes deep tissue around the vulva. Usually, nearby lymph nodes are also removed – this is called a lymph node dissection.

   — Trudy

Other surgical procedures

Lymph node dissection

The lymph nodes (also called lymph glands) are part of the lymphatic system. Cancer cells can spread from the vulva to the lymph nodes in the groin, so your doctor may suggest removing these nodes from one or both sides. This is called an inguinal lymph node dissection or lymphadenectomy.

Sentinel lymph node biopsy

Before a lymph node dissection, the surgeon may perform a sentinel lymph node biopsy. This test helps to identify which lymph node the cancer is most likely to spread to first (the sentinel lymph node).

You will usually have an anaesthetic, then a small amount of radioactive dye will be injected near the site of the cancer. The dye will flow to the sentinel lymph node, and the surgeon will remove it. If a pathologist finds cancer cells in the sentinel lymph node, the remaining nodes in the area may need to be removed.

A sentinel lymph node biopsy can help the doctor avoid removing more lymph nodes than necessary and minimise side effects such as lymphoedema. Your doctor will talk to you about this type of biopsy and the associated risks.

Sometimes, the removal of lymph nodes in the groin can stop or slow the natural flow of lymphatic fluid. When this happens, it can cause one or both legs to swell. This is known as lymphoedema – go here for more information and some tips on managing this side effect.

Reconstructive surgery

The surgeon will aim to remove all of the vulvar cancer while preserving as much normal tissue as possible. However, it is essential to remove a margin of healthy tissue around the cancer to reduce the risk of the cancer coming back (recurring) in the same area.

Most women will be able to have the remaining skin drawn together with stitches, but if a large area of skin is removed, you may need a skin graft or skin flap. To do this, the surgeon may take a thin piece of skin from another part of your body (usually your abdomen or thigh) and stitch it onto the operation site. It may also be possible to move flaps of skin in the vulvar area to cover the wound. The graft or flap will be done as part of the initial operation, sometimes with the assistance of a reconstructive (plastic) surgeon.

Pelvic exenteration

This operation is very rarely done for vulvar cancer, but may sometimes be considered for advanced cancer that has spread beyond the vulva. A pelvic exenteration removes all the affected organs, such as the lower bowel, bladder, uterus and vagina. Because the bladder and bowel are removed, the surgeon will make two openings (stomas) in the abdomen so that urine and faeces can be collected in stoma bags. Your surgeon will only recommend this surgery if you are fit enough to make a good recovery.

Video: What is surgery?

Learn more about surgery in this short video.

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This information was last reviewed in October 2018
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