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 advanced training in the diagnosis, surgical treatment, and management of gynecologic cancers.

Types of vulvar surgery

These are some of the most common types of surgery for vulvar cancer.

Local excision

If you have a pre-cancerous 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.

Laser surgery

This type of surgery uses a laser beam to cut out or kill pre-cancerous cells. Laser surgery is sometimes a noninvasive option to wide local excision as a treatment for pre-cancerous lesions or Stage 0 (carcinoma in situ). It isn’t used to treat invasive cancer.

Vulvectomy

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 whether 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. This often isn’t needed. Also, your surgeon will think about the postoperative cosmetic result and the impact of surgery on your quality of life. You may need a skin graft if a lot of tissue is removed. Talk to 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.

Pelvic exenteration

If the cancer has spread outside your vulva to nearby organs, you may have 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 isn’t done in most cases for vulvar cancer.  

Risks of vulvar cancer surgery

All surgery has risks. The risks of vulvar surgery include:

• Heavy bleeding

• Healing problems

• Infection

• Blood clots

• Chronic leg swelling. This is called lymphedema.

• Changes in sexual pleasure and desire

• Urinary infections

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 over-the-counter medicines, vitamins, 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. 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.

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’re likely to 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 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. Other side effects can include the following:

• Discomfort or pain. You’ll likely have some temporary pain after surgery. Also, if you wear tight jeans or slacks, 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 away.

• 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.