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What to Know About Surgery for Vulvar Cancer

Portrait of a female surgeon wearing a surgical mask

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. Sometimes surgery requires removing surrounding tissue or organs. Surgery is the most common treatment for vulvar cancer.

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

Local excision

If you have early-stage vulvar cancers (Stage I or II), your surgeon may remove the cancer and some normal skin surrounding it. This surgery is called wide local excision. Depending on the diagnosis, size, and location of the tumor, the doctor may remove the cancer and deeper layers of the vulva. This surgery is called radical local excision.

Vulvectomy

For this surgery, the doctor removes part or all 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 in your pelvic area and 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.

Lymphadenectomy

With this surgery, the surgeon removes the lymph node or nodes on the side of your body that has the tumor. In some cases, the doctor may remove lymph nodes from both sides of your groin. Lymph nodes in the groin may be removed even in women with small tumors.

Pelvic exenteration

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. Only rarely are all of these organs removed. In some cases, the surgeon removes your clitoris. Again, this depends on the location of the cancer.

Laser surgery

This type of surgery uses a laser beam (a narrow beam of intense light) to cut out or kill cancer cells. Laser surgery is used as a treatment for vulvar cancer that is not invasive (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.

  • 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. 

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