Surgery is the main treatment for vulvar cancer. 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. 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, reconstructive surgery is available using a skin graft or skin flaps. To do this, the surgeon may take a thin piece of skin (graft) 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.

Wide local excision takes out the cancer and a border (margin) of healthy cells, ideally at least 1 centimetre, 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).

A partial vulvectomy removes part of the vulva.

A radical vulvectomy removes the entire vulva, including the clitoris and, usually, the surrounding lymph nodes.

Pelvic exenteration is usually only used for recurrent vulvar cancer that has come back even after radiation therapy.

Pelvic exenteration is surgery to remove the lower colon, rectum and bladder. In women, the cervix, vulva, vagina, ovaries and nearby lymph nodes are also removed. 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)
• 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 vulva and vagina may also be needed after pelvic exenteration.

The lymph nodes (also called lymph glands) in the groin are usually the first place to which vulvar cancer spreads. Lymph nodes are part of the lymphatic system, and are found mainly in the groin, neck and armpits.

If the vulvar 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 millimetre, 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.

Radiation therapy is a commonly used treatment for vulvar cancer. In some women, radiation therapy may be combined with chemotherapy before surgery to help shrink the tumour.

You might have external radiation therapy to your pelvic area to treat vaginal cancer. Radiation therapy may also be recommended if the cancer has come back (recurrent cancer) or spread.

In women with vulvar cancer, chemotherapy is mainly used if the cancer has spread, or if the cancer returns after treatment (recurrent cancer). It may also be used with radiation therapy before surgery to help shrink the tumour.