Surgery for vulvar cancer

Most women with vulvar cancer will have surgery. The type of surgery you have depends mainly on the size of the tumour and stage of the cancer. When planning surgery, your healthcare team will also consider other factors, such as your overall health.

Surgery may be done for different reasons. You may have surgery to:

• completely remove the tumour along with a margin of normal tissue around the tumour
• reduce pain or ease symptoms (called palliative surgery)

The following types of surgery are commonly used to treat vulvar cancer. You may also have other treatments before or after surgery.

A wide local excision removes the vulvar tumour along with 1 to 2 cm of healthy tissue around it (surgical margin). It is used for vulvar intraepithelial neoplasia (VIN) or very small vulvar tumours that have not grown deeper than 1 mm into the underlying tissue.

A vulvectomy is the surgical removal of all or part of the vulva. The different types of vulvectomy remove different amounts of tissue.

In a simple vulvectomy, all of the vulva is removed, but most of the underlying tissue is left in place. This surgery may be used to remove VIN that is found in several areas of the vulva.

With a radical vulvectomy, the deeper tissues under the vulvar skin are removed. There are 2 types of radical vulvectomy.

• A partial radical vulvectomy removes part of the vulva and the deeper tissues underneath the tumour. It may or may not include removing the clitoris. It is the most common type of vulvectomy used to treat vulvar cancer.
• A complete radical vulvectomy removes the whole vulva, the deeper tissues underneath the vulva and the clitoris. It can cause significant disfigurement and loss of sexual function.

Vulvar cancer can spread to the inguinal lymph nodes, which are in the groin. Removal (dissection) of the inguinal lymph nodes is an important part of staging and determining the prognosis for vulvar cancer. An inguinal lymph node dissection is done for any vulvar tumour that is larger than 2 cm or has grown into the underlying tissue of the vulva by more than 1 mm.

An inguinal lymph node dissection is done through a separate cut (incision) near the crease between the leg and groin. It may be done at the same time as the original surgery to remove the cancer or at a different time.

A sentinel lymph node biopsy may be done to remove the sentinel lymph node to see if the cancer has spread there. If cancer is found in the sentinel node, a complete inguinal lymph node dissection may be done.

Depending on the location of the vulvar tumour, the surgeon may remove lymph nodes from one or both sides of the groin (called a bilateral inguinal lymph node dissection). If the tumour is at or near the middle of the vulva, a bilateral inguinal lymph node dissection will be done because the cancer can spread to lymph nodes on either side of the groin.

Find out more about lymph node dissection and sentinel lymph node biopsy.

A pelvic exenteration is a major operation. It is sometimes used to treat vulvar cancer that has already spread to other areas in the pelvis at the time of diagnosis or that has come back in the pelvis after treatment. It includes a vulvectomy, the removal of the lymph nodes in the groin and depending on how far the cancer has spread, the removal of one or more of the following:

• lower part of the colon
• rectum
• bladder
• uterus
• ovaries
• fallopian tubes
• cervix
• vagina

Find out more about pelvic exenteration.

Side effects can happen with any type of treatment for vulvar cancer, but everyone’s experience is different. Some people have many side effects. Other people have only a few side effects.

If you develop side effects, they can happen any time during, immediately after or a few days or weeks after surgery. Sometimes late side effects develop months or years after surgery. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.

Side effects of surgery will depend mainly on the type and site of surgery and your overall health. Surgery for vulvar cancer may cause these side effects:

• pain and discomfort
• poor wound healing
• nerve damage (symptoms include numbness, tingling and a mild shock-like sensation)
• change to appearance and function of the vulva (with more extensive surgery), such as the urine stream may go to one side
• infection
• lymphedema
• sexual problems including changes to sexual desire and sexual response

Tell your healthcare team if you have these side effects or others you think might be from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Find out more about surgery and side effects of surgery. To make the decisions that are right for you, ask your healthcare team questions about surgery.