Surgery is the main treatment for cancer of the vulva. It may be used either alone or in combination with radiotherapy and chemotherapy. Your doctor will talk to you about the most appropriate type of surgery.
There are several different operations for cancer of the vulva. Which operation you have usually depends on the stage of the cancer.
- Wide local excision takes out the cancer and a border (margin) of healthy cells, ideally at least 1 cm, all around the cancer.
- Radical local excision takes out the cancer and a larger area of normal tissue all around the cancer. The groin lymph nodes may also be removed (known as lymph node dissection).
- Partial vulvectomy removes part of the vulva.
- Radical vulvectomy removes the entire vulva, including the clitoris, and usually the surrounding lymph nodes.
- Pelvic exenteration is done if the cancer has spread beyond the vulva. The surgeon removes the affected organs, such as the lower bowel, or the bladder and the cervix, uterus and vagina.
Openings called stoma are made to bring the small or large intestine out onto the abdomen. This allows urine and faeces to flow from inside the body to a collection bag.
Common stoma include an ileostomy (formed from the lower half of the small bowel, called the ileum, which joins up with the colon), a colostomy (formed from the colon), and an ideal conduit (formed by isolating a small piece of ileum and implanting the tubes from the kidney (ureters) into it). For more information about adapting to life with a stoma, ask your treatment team or contact your local stoma association.
Plastic surgery to reconstruct the vagina may also be needed after pelvic exenteration.
The surgeon will aim to remove the cancer while preserving as much normal tissue as possible. However, it is important that a margin of healthy tissue around the cancer is removed, to reduce the risk of the cancer coming back (recurring) in this area.
Usually only a small amount of unaffected skin is removed with the cancer, so it is often possible to stitch the remaining skin neatly together. If it is necessary to remove a large area of skin, you may need a skin graft or skin flaps. To do this, the surgeon may take a thin piece of skin from another part of the body (usually the thigh or abdomen) and stitch it on to the operation site. It may be possible to move (rotate) flaps of skin in the vulval area to cover the wound. The graft or flaps will be done straight after the cancer is removed, as part of the same operation.
The lymph nodes (also called lymph glands) in the groin are usually the first place to which vulval cancer spreads. Lymph nodes are part of the lymphatic system, and are found mainly in the groin, neck and armpits.
If the vulval cancer is small, some surgeons perform a procedure called a sentinel lymph node biopsy. This involves giving an anaesthetic, then injecting a radioactive dye into the cancer. The aim of a sentinel node biopsy is to identify the first node to which the cancer might spread. If the cancer has spread to a lymph node, the node will take up the dye, allowing the surgeon to locate and remove it. This surgical technique is still being refined.
If the cancer is deeper than 1 mm, you will usually be advised to have the lymph glands from one or both sides of your groin removed. This is done to check whether any cancer cells have spread from the vulva. If your cancer is at the very earliest stage, surgery to your lymph nodes will probably not be needed.