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 – the 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 onto 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.

Lymph nodes

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.

Side effects of surgery

• Pain. You will have some pain or discomfort. It is best to let your doctor or nurse know when you are feeling uncomfortable – don’t wait until the pain becomes severe.
• Lymph fluid build-up. If the lymph nodes in your groin have been removed, there is a risk of swelling of one or both of your legs. The lymph nodes normally help to remove lymph fluid from your legs. Removing the nodes can block the flow of lymph so that it collects in the tissues under your skin. This can make your legs swell and is called lymphoedema. The condition can develop a few months or even years after treatment. Many hospitals have a nurse or physiotherapist who specialises in treating lymphoedema. Swelling in your limbs may be reduced with gentle massage towards your heart, special compression garments and gentle exercise.
• Effect on your emotions and sex life.  Surgery can affect your emotions and sex life in a huge way.

Recovery after surgery

How quickly you recover after your operation will depend on the type of surgery you have had. If only a small amount of skin is removed, the wound will probably heal quickly. If your lymph nodes are removed or your surgery is more extensive, recovery will take longer.

You will be encouraged to start gently moving around as soon as possible after your operation. While you are in hospital, the nurse or a physiotherapist will help you do regular gentle leg exercises to prevent blood clots forming, as well as deep breathing exercises to prevent chest infection.

When you go home from hospital, you will need to take things easy for a while. If you have had major surgery, it is very important not to lift any heavy objects for at least 6–8 weeks. This will help the wound to heal. It is also advisable to wait about 8 weeks before going back to work, but you may need longer if you are healing slowly.

You can usually start driving after 6 weeks. However, your car insurance company may specify a longer time before you can drive again, so it is a good idea to contact them to check.

Whether you have radiotherapy will depend on the stage of your cancer, its size, whether it has spread to the lymph nodes and, if so, how many nodes are affected.

Some women with vulval cancer may be given chemotherapy.