Surgery is the most common treatment for vulvar cancer. The goal of surgery is to remove tumors or 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 important goal is to remove lymph nodes from the groin to check for the spread of cancer. Sometimes surgery requires removing surrounding tissue or organs. You should be treated by a gynecologic oncologist, a subspecialist with advanced training in the diagnosis, surgical treatment, and management of gynecologic cancers.
These are some of the most common types of surgery for vulvar cancer.
If you have a pre-cancerous lesion or early-stage vulvar cancer (Stage Ia), your surgeon may remove the cancer and some normal skin surrounding it. This surgery is called wide local excision.
For this surgery, the doctor 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 itself and whether the surgeon can remove enough normal tissue around the tumor. Also, your surgeon will consider the postoperative cosmetic result and the impact of surgery on your quality of life. The surgeon may also remove lymph nodes, where cancer cells can often be found, too. He or she removes lymph nodes from your groin to check for signs of cancer. You may receive chemotherapy and radiation therapy before or after this surgery. The surgeon will explain what he or she thinks is best for your situation.
This surgery is also called an inguinal node dissection. 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, the doctor may remove lymph nodes from both sides. Lymph nodes in the groin may be removed even in women with small tumors. Ask your health care provider whether you are a candidate for sentinel node evaluation. Sentinel node evaluation removes fewer lymph nodes to gain accurate staging information and reduces the potential side effects associated with more extensive lymph node removal.
If the cancer has spread outside your vulva to nearby organs, you may have a more involved surgery, removing one or more of the following: your vagina, cervix, uterus, lower colon, rectum, or bladder, depending on where the cancer has spread. This is called a pelvic exenteration and is not commonly done for vulvar cancer. In some cases, the surgeon removes your clitoris. Again, this depends on the location of the cancer.
This type of surgery uses a laser beam (a narrow beam of intense light) to cut out or kill pre-cancerous cells. Laser surgery is a noninvasive alternative to wide local excision as a treatment for pre-cancerous lesions (Stage 0 or carcinoma in situ). It is not used to treat invasive cancer.
What to expect after surgery
The side effects you have after surgery depend mainly on the extent of your surgery. If the doctor removes a large area of skin during surgery, you may need a skin graft from another part of your body. This helps the wound to heal. These are other possible side effects from vulvar surgery:
Discomfort or pain. It is likely you will 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 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.
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 a doctor or nurse about ways to cope with these side effects.