Surgery for vulvar cancer

Surgery is a medical procedure to examine, remove or repair tissue. Surgery, as a treatment for cancer, means removing the tumour or cancerous tissue from your body. This usually means cutting into the body, but surgery to remove cancer can also be done in different ways, such as using extreme cold (called cryosurgery) or lasers.

Most people with vulvar cancer have surgery. The type of surgery you have depends mainly on the size and location of the tumour, the stage of the cancer and whether the cancer is linked to human papillomavirus (HPV) infection.

When planning surgery, your healthcare team will also consider other factors, such as your overall health.

Surgery may be the only treatment you have or it may be used along with other cancer treatments. 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.

A wide local excision removes the vulvar tumour or other abnormal areas, along with 1 to 2 cm of healthy tissue around it (called the surgical margin). This helps lower the risk of the cancer coming back. A wide local excision 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 wide local excision is also known as a simple partial vulvectomy.

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

A simple vulvectomy removes the whole vulva including the skin and the tissue right under the skin. Most of the deep tissue is left in place.

A radical vulvectomy removes the deeper tissues under the vulvar skin. There are 2 types of radical vulvectomy:

• A partial radical vulvectomy removes part of the vulva and the deeper tissues under the tumour. It may or may not remove the clitoris. It’s the most common type of vulvectomy used to treat vulvar cancer.
• A complete radical vulvectomy removes the whole vulva (including the clitoris), the deeper tissues under the vulvar skin and nearby lymph nodes. This surgery is rare. It can cause significant disfigurement and loss of sexual function.

You may need a vulvar reconstruction depending on the extent of your surgery. If you have a vulvectomy that removes a small amount of vulvar skin, the doctor usually can close the surgical wound by stitching the remaining skin together. But you may need skin from another part of the body (called a skin graft or skin flap) to cover up the wound if you have a large area of skin removed.

Reconstruction may be done at the same time as the vulvectomy or at a later time by a reconstructive surgeon.

Vulvar cancer can spread to the inguinofemoral lymph nodes, which are in the groin. The groin is the area in the fold or depression where the thigh meets the belly (abdomen). Lymph node surgery helps your doctor stage the cancer, plan treatment and determine a prognosis.

An inguinofemoral lymph node dissection removes the inguinal (closer to the skin) and femoral (deeper under the skin) lymph nodes. It’s 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 inguinofemoral lymph node dissection is also called an inguinofemoral lymphadenectomy.

If the tumour is at or near the middle of the vulva, the doctor may remove lymph nodes from both sides of the groin (called a bilateral inguinofemoral lymph node dissection) to prevent cancer spreading to either side.

A sentinel lymph node biopsy (SLNB) is done when the tumour is small and shows no clear signs of spreading to the lymph node. An SLNB removes a sentinel lymph node to see if it contains cancer cells. A sentinel lymph node is the first lymph node in a chain or group of lymph nodes that cancer is most likely to spread to. If cancer is found in the sentinel node, an inguinofemoral lymph node dissection may be done to remove more lymph nodes from the area. You may also be offered radiation therapy.

Find out more about a lymph node dissection and a sentinel lymph node biopsy (SLNB).

Pelvic exenteration is a major operation. It’s sometimes used to treat advanced vulvar cancer that has already spread to other areas in the pelvis when first diagnosed or that has come back in the pelvis after treatment (called local recurrence).

Pelvic exenteration includes a vulvectomy and removing the lymph nodes in the groin. It also removes one or more of the following organs, depending on how far the cancer has spread:

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

This operation is rare because of its long-term side effects. You usually need to have an examination under anesthesia (EUA) and some imaging tests first before deciding whether this operation is suitable for you. Find out more about pelvic exenteration.

Laser surgery uses a powerful, narrow beam of light (called a laser beam) to destroy precancerous cells.

Laser surgery is sometimes used to treat VIN.

Side effects of surgery will depend mainly on the type of surgery you have and your overall health. Tell your healthcare team if you have side effects that you think are from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

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 the appearance or function of the vulva (with more extensive surgery)
• 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.