Vulvar Cancer: Surgery
Surgery is the most common treatment for vulvar cancer. The goal of surgery is to
remove tumors or areas of cancer (cancerous lesions) from the vulva while trying to
leave as much normal tissue as possible. This allows your sexual, bowel, and bladder
functions to stay intact. Another goal is to remove lymph nodes from the groin to
check for the spread of cancer. Sometimes surgery requires removing surrounding tissue
or nearby organs. You should be treated by a gynecologic oncologist. This is a specialist
with extra training tp diagnose, do surgery on, and manage gynecologic cancers.
Types of vulvar surgery
These are some of the most common types of surgery for vulvar cancer.
If you have a precancerous sore (lesion) or early-stage vulvar cancer (Stage 0 or
carcinoma in situ), your surgeon may remove the cancer and some normal skin around
it. This surgery is sometimes called wide local excision.
This type of surgery uses a laser beam to cut out or kill precancerous cells. Laser
surgery is sometimes a less invasive option to wide local excision as a treatment
for precancerous lesions or Stage 0 (carcinoma in situ). It isn’t used to treat invasive
For this surgery, your healthcare provider removes part (partial vulvectomy) or all
(total vulvectomy) of your vulva. The extent of surgery depends on the size of the
tumor, where it is located on the vulva, and how much of the vulva is involved. It
also depends on the traits of the tumor and if the surgeon can remove enough normal
tissue around the tumor. In some cases, the surgeon removes your clitoris. This depends on
the location of the cancer. In most cases, your surgeon can try to save the clitoris.
. Your surgeon will also think about how the area will look after surgery and how
surgery will affect your quality of life. You may need a skin graft or skin flap if
a lot of tissue is removed. Talk with your healthcare provider about this so you know
where the grafted skin and tissues will come from and how it will be done.
Lymph node surgery
This surgery may be called an inguinal node dissection. Vulvar cancer often spreads
to lymph nodes in the groin. The surgeon may remove lymph nodes from your groin to
check for signs of cancer. With this surgery, the surgeon removes the lymph nodes
in the groin area on the side of your body that has the tumor. In some cases, your
healthcare provider may remove lymph nodes from both sides. They may even remove lymph
nodes in women with small tumors. Ask your healthcare provider if you’re a candidate
for sentinel node evaluation. This involves finding the lymph nodes that drain the
area that contains the cancer. This allows your healthcare provider to remove fewer
lymph nodes for accurate staging information. This reduces the chance of side effects
due to more extensive lymph node removal.
If the cancer has spread outside your vulva to nearby organs, you may need a more
involved surgery. You may have your vagina, cervix, uterus, lower colon, rectum, or
bladder removed. The surgery you have depends on where the cancer has spread. This
is called a pelvic exenteration. It is rarely done for most cases of vulvar cancer.
Risks of vulvar cancer surgery
All surgery has risks. The risks of vulvar surgery include:
Your risks depend on your overall health, what type of surgery you need, and other
factors. Talk with your healthcare provider about which risks apply most to you.
Getting ready for your surgery
Your healthcare team will talk with you about the surgery options that are best for
you. You may want to bring a family member or close friend with you to appointments.
Write down questions you want to ask about your surgery. Make sure to ask about:
What type of surgery will be done
What will be done during surgery
The risks and side effects of the surgery
If there will be changes in how your body works after surgery
When you can return to your normal activities
If the surgery will leave scars and what they will look like
If surgery will affect your sex life
Before surgery, tell your healthcare team if you’re taking any medicines. This includes
prescription medicines, over-the-counter medicines, vitamins, herbs, and other supplements.
This is to make sure you’re not taking medicines that could affect the surgery. After
you’ve talked about all the details with the surgeon, you’ll sign a consent form that
says that the healthcare provider can do the surgery.
You’ll also meet the anesthesiologist or nurse anesthetist. You can ask questions
about the anesthesia and how it will affect you. Just before your surgery, an anesthesiologist
or a nurse anesthetist will give you certain medicines so that you fall asleep and
don’t feel pain. In some cases the surgery can be done under a spinal anesthesia.
What to expect after surgery
You may have to stay in the hospital for a few days. This depends on the type of surgery
you had. For the first few days after surgery, you’ll likely have pain from the incision.
Your pain can be controlled with medicine. Talk with your healthcare provider or nurse
about your options for pain relief. Some people don’t want to take pain medicine.
But doing so can help your healing. If you don’t control pain well, you may not want
to cough or turn over often. You need to do this as you recover from surgery.
You’ll likely have a urinary catheter for a few days. This a tube put through your
urethra and into your bladder so that your urine goes into a bag outside your body.
In some cases, you may go home with the catheter.
You may feel tired or weak for a while. The amount of time it takes to recover from
surgery is different for each person.
The side effects you have after surgery depend mainly on the extent of your surgery.
If your healthcare provider removes a large area of skin during surgery, you may need
a skin graft or skin flap from another part of your body. This helps the vulvar wound
to heal. But it also gives you another wound at the site the skin was removed for
the graft or flap. Other side effects can include the following:
Discomfort or pain. You’ll likely have some short-term (temporary) pain after surgery. Also, if you wear
tight jeans or pants, you may feel some discomfort in the genital area. This is because
some padding of vulvar tissue is now missing.
Wound infection. The location and type of surgery increases the risk for wound infection. If you have
a fever, worsening redness or pain, or discharge, tell your healthcare provider right
Sexual changes. Depending on how much tissue is removed during surgery, you may have some numbness
or trouble reaching orgasm. These changes may or may not be temporary.
Genital or leg swelling. This is a side effect of lymph node removal. The fewer lymph nodes removed, the less
likely you will have this side effect.
Talk with your healthcare provider about ways to cope with these side effects.