Which surgery for vulval cancer?
This page tells you about the different types of operations there are for vulval cancer. There is information about
- A quick guide to what's on this page
- How your surgeon decides which operation
- Removing the skin covering the vulva (for VIN)
- Removing the cancer
- Removing part of the vulva
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, you may have to have your womb, vagina, bladder, rectum or the lower part of your bowel removed. 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.
You can view and print the quick guides for all the pages in the Treating vulval cancer section.
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 grade of the cancer
- 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.
This operation is called a skinning vulvectomy. It means an operation to remove a wide area of skin that is affected by VIN. 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. Depending on the size of the area affected by VIN, you may be able to have the remaining skin stitched back together. But some women need to have reconstruction with a skin flap after this type of surgery. A skin flap is a piece of skin that is moved to another position (usually from very close by) while still attached to its own blood supply.
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. Your surgeon will not use a skin graft unless it is absolutely necessary.
In this section there are diagrams of a skinning vulvectomy showing the area of skin removed.
This is called a wide local excision. It means having the area containing the cancer removed, along with a border of healthy tissue around it. The important thing is to also remove a border of tissue that is free of cancer cells. This lowers the risk of the cancer coming back. With this operation, you may also have lymph nodes removed. There is a diagram of a wide local excision in this section that gives you an idea of the area that is removed.
Sometimes surgeons use a laser to destroy abnormal cells. A laser is a thin, high powered beam of light that your surgeon can use instead of a surgical blade (scalpel).
You may be able to have just the inner or outer labia removed. Or the labia may be removed from one side only. This is called a partial vulvectomy. What is possible will depend on where the cancer is, and on how easy it is for your surgeon to take a border of healthy tissue away as well as the cancer. This operation can be very similar to a wide local excision. There are diagrams of partial vulvectomy in this section that will give you an idea of the area that is removed.
Your surgeon will also remove the lymph nodes on one or both sides of your groin. The lymph nodes in the groin are usually the first place where cancer cells spread from the vulva. Removing them is called a lymph node dissection and makes it less likely that the cancer will come back. Whether you have the nodes taken from one or both sides will depend on the size and position of the cancer.
This operation used to be done by removing the vulva and the lymph nodes together, through one large incision (cut). 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. The diagram in this section will give you an idea of the area that is removed when you have the lymph nodes removed in what doctors call a 3 in 1 excision.
Having lymph nodes removed from your groin can affect fluid drainage in your legs. This can cause a build up of fluid called lymphoedema. So doctors want to find other ways to check the lymph nodes for cancer without removing them all. Doctors are looking at ways to check lymph nodes for cancer. These include sentinel lymph node mapping and ultrasound scanning with needle biopsy.
Sentinel node mapping means finding the lymph node that cancer cells are most likely to spread to. If this lymph node does not contain cancer, the other nodes nearby probably don't either. Ultrasound scans use sound waves to produce a picture of the lymph nodes in your groin. The doctor looks for changes in the size and appearance of the lymph nodes. They sometimes take a sample of cells (biopsy) from the lymph node during the scan. You can read more about these ways to check the lymph nodes in our section about vulval cancer research.
Sometimes advanced vulval cancer can spread from the vulva to other parts of your body, such a 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
- Womb – the body of the womb (uterus) or neck of the womb (cervix) or both
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. So there is more information 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.
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.
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 are going to be taken 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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