Which surgery for vulval cancer? | Cancer Research UK
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Which surgery for vulval cancer?

Different types of surgery can be used to treat vulval cancer. Which operation you have will depend on the stage of your cancer. Your surgeon will try to leave as much normal skin as possible, while making sure the cancer is completely taken away. Many women are cured of vulval cancer with surgery.

Types of vulval cancer surgery

With VIN the affected cells are only on the surface. So it is possible for the surgeon to take away only the skin and leave the healthy tissue underneath. For vulval cancer, the surgeon will probably have to remove part or all of your vulva. They may also remove the lymph nodes on one or both sides of your groin. There is more information about the different operations further down this page. There are also links to diagrams that show you what is removed in each type of surgery.

If the cancer has spread, your surgeon may have to remove your womb, vagina, bladder, rectum or the lower part of your bowel. These operations are rare. But for some women it is worth doing, because it may cure even an advanced cancer.

Getting information and support

A few people prefer not to know about their operation in advance. But for most women, it may help you to cope better if you understand exactly what is going to happen. If your surgeon doesn't tell you, ask what he or she is intending to do. Most hospitals will have a specialist nurse who can give you information and support. Do ask for an appointment with her if you are not offered one.

 

CR PDF Icon You can view and print the quick guides for all the pages in the Treating vulval cancer section.

 

 

How your surgeon decides which operation

Different types of surgery can be used to treat cancer of the vulva. Which operation you have will depend on the stage of your cancer. Your surgeon will take into account

  • The spread of the cancer – how large an area is affected and where the cancer is on your vulva
  • The depth of the cancer – the surgeon must remove all the cancer together with a border of healthy tissue round it
  • Whether the cancer is likely to have spread to the lymph nodes in your groin
  • Your personal wishes and feelings

Your surgeon will want to try to leave as much normal skin as possible, while making sure that the cancer is completely taken away. Making sure all the cancer is removed is the most important factor in trying to cure the cancer. Many women are cured of their vulval cancer with surgery.

Read more about the stages of vulval cancer.

 

Surgery to remove VIN

This operation is called a wide local excision. This means surgery to remove a wide area of skin that is affected by VIN. And the surgeon also removes a border of healthy tissue, called a margin. 

Look at a diagram of a wide local excision

Rarely, if the VIN is very widespread, your surgeon may need to do an operation called a skinning vulvectomy. This means removing the skin over a large area. Because the affected cells are only on the vulval surface, it is possible to take away only the skin and leave the healthy tissue underneath.

The surgeon may be able to stitch the remaining skin back together. Or you may need a skin flap (or less often a skin graft) to repair the area, but your surgeon will avoid doing this if at all possible.

A skin flap is an area of healthy skin with its blood supply, which is moved from close by to cover the area where skin has been removed.

Skin grafting is used less often than a skin flap. Grafting means your surgeon takes some healthy skin from another part of your body and stitches it over the site of the operation. The healthy skin is most often taken from your inner thigh – this is called the donor site. The donor site will heal on its own over a few weeks.

Look at diagrams of a skinning vulvectomy for VIN.

 

Removing the cancer

This operation is called a wide local excision. The surgeon removes the area containing the cancer, along with a border of healthy tissue around it. The border of healthy tissue is called the margin. The important thing is that the margin of healthy tissue does not contain cancer cells. This lowers the risk of the cancer coming back. With this operation, you may also have lymph nodes removed. 

Look at a diagram of a wide local excision.

When the surgeon removes part of the vulva, this is also called a partial vulvectomy. 

Look at diagrams of a partial vulvectomy

 

Removing the whole vulva

Surgery to remove the whole vulva is called vulvectomy or radical vulvectomy. The whole vulva is removed, including the inner and outer lips of the vagina. You may have the clitoris removed as well. 

Look at a diagram of a radical vulvectomy.

 

Checking the lymph nodes near the vulva (sentinel node biopsy)

If you have stage 1A vulval cancer you do not need any further tests to check for signs of cancer in your lymph nodes.

If your cancer is stage 1B or greater, your doctor will want to check your lymph nodes near the vulva to see if they contain cancer. Up until recently, the surgeon would remove all of the nearby lymph nodes to check for cancer spread. But this operation has side effects. So doctors are looking for other ways to check lymph nodes close to the vulva, so they do not need to remove lots of them. 

Your doctor may suggest you have a test to check your lymph nodes if your cancer is 

  • smaller than 4cm and 
  • you only have one area of cancer

This test is called a sentinel node biopsy. You have it at the same time as surgery to remove the cancer (wide local excision).    

For this test, the surgeon removes and checks the sentinel node (or nodes) for cancer. The sentinel node is the first node that fluid drains to from the vulva. This means it’s the first lymph node the cancer could spread to. If this node does not contain cancer, it’s likely that no further lymph nodes contain cancer cells. 

To find the sentinel lymph node, the doctor injects a dye or small amount of a weak radioactive chemical (called a tracer) into the area around the cancer. As the body drains tissue fluid into the lymph nodes in the normal way, the dye or radioactive tracer will show the route it takes. The first lymph node that the dye or tracer reaches is the sentinel node. 

The surgeon removes this and sends it to the lab to be examined for cancer cells. If it doesn't contain cancer cells, there is a good chance that the cancer has not spread. So you  will not need surgery to remove the rest of the lymph nodes.  But, if there are cancer cells in one or more sentinel nodes, you will need further treatment. You may have surgery to remove all the remaining lymph nodes. Or you may have radiotherapy.

Sentinel node biopsy is still a new test. You may have it as part of a clinical trial. A study called the GROINSS-VII study is looking at this at the moment.

Read more about the GROINSS-VII study.

 

Removing the lymph nodes near the vulva

The lymph nodes in the groin are usually the first place where cancer cells spread from the vulva. An operation to remove the lymph nodes is called a lymph node dissection or a lymphadenectomy. This surgery can make it less likely that the cancer will come back.

Your surgeon may remove the lymph nodes on one or both sides of your groin. This will depend on the size and position of the cancer. 

Surgery to remove lymph nodes from your groin can affect fluid drainage in your legs. This can cause a build up of fluid called lymphoedema. 

This operation used to be done by removing the vulva and the lymph nodes together, through one large cut (incision). Nowadays it is more usual to make separate smaller incisions in the groins to remove the lymph nodes. Using several smaller incisions means that it is easier for you to recover and you are less likely to have problems after the surgery. 

Look at a diagram showing what doctors call a 3 in 1 incision for a woman having her vulva removed. 

 

Removing vulval cancer that has spread

Sometimes advanced vulval cancer can spread from the vulva to other parts of your body, such as the bowel, bladder or womb. If this has happened to you, you may need to have a very big operation called a pelvic exenteration. This will include a radical vulvectomy. Your surgeon will also remove one or more of the following

  • Lymph nodes in the pelvis or groin
  • The lower part of your bowel
  • Back passage
  • Bladder
  • Womb – the body of the womb (uterus) or neck of the womb (cervix) or both
  • Vagina

These operations are rare for vulval cancer. Your surgeon will only consider this if you are fit enough to make a good recovery. But for some women it is worth doing, because it may cure even an advanced cancer.

This type of surgery is more often done for advanced cervical cancer. Read more about pelvic exenteration in the cervical cancer section. If you go to this page, please remember to use your back button to get back to this section. The other information about cervical cancer will not apply to you if you have vulval cancer.

 

Other treatments along with surgery

Some women need to have treatment alongside their surgery. Doctors call this adjuvant treatment. Your specialist may suggest you have radiotherapy after your surgery. This may be to the remaining vulval tissue, to lymph nodes in your groin, or both. The aim of this treatment is to try and kill off any remaining cancer cells to lower the risk of the cancer coming back in the future.

Your doctors may want you to have treatment before your operation. Doctors call this neo-adjuvant treatment. The treatment may shrink the cancer and make it easier to remove. It may mean that you can have a smaller operation. 

Radiotherapy is the most commonly used adjuvant treatment. But your doctor may suggest chemotherapy at the same time. Some chemotherapy drugs are known to help radiotherapy to work.

Read more about radiotherapy for vulval cancer and chemotherapy for vulval cancer.

 

Getting information and support

You won't need to be told that this is a cancer affecting a deeply personal and private part of your body. A few people prefer not to know about their operation in advance. But for most women, it may help you to cope better if you understand exactly what is going to happen.

It is particularly important to understand what tissues the surgeon is going to be take away. Some of these operations may mean removing the clitoris. Whether it does in your case will depend on exactly where your cancer is. It will be less of a shock if you know about this in advance. If your surgeon doesn't tell you, ask what he or she is intending to do. Some surgeons don't offer this kind of information in detail because they are aware some people don't want to know. They may wait for you to ask. You can even ask the surgeon to sketch out a diagram if that will help you.

There should be information available for you to take home with you. Ask your surgeon or specialist nurse for a booklet or printed web pages that you can read through yourself. This will help you to work out what questions you need to ask next time you go to the hospital. Or you can talk to your GP, who will be in contact with the surgeon and should be able to tell you what will happen.

Most hospitals carrying out this type of treatment will have a clinical nurse specialist supporting women having treatment for gynaecological problems. This nurse is there to answer your questions or just talk about how you are feeling. If the nurse specialist isn't introduced to you when you first go to the hospital after your diagnosis, do ask. You can make an appointment to see her.

There is a UK support organisation for women having vulval cancer treatment. It is run by women who have been through what you are going through. Talking to another women who's already been there may be a big help. They are called VACO and are listed in our vulval cancer organisations page.

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Updated: 26 May 2016