Find out about how your doctor decides which surgery you need, the different types and about how to get the support and help you need.
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.
Different surgery types
The different types of surgery depend on where the cancer is. These include:
Wide local excision
A wide local excision means surgery to remove a wide area of skin that is affected by VIN or cancer. The surgeon also removes a border of healthy tissue, called a margin.
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.
When the surgeon removes part of the vulva, this is also called a partial vulvectomy.
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.
Checking the 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.
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
- 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. 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.
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 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. You can also 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.