Surgery is almost always the best to option to treat vulvar cancer. Chemotherapy and/or radiation therapy might be prescribed for women with large vulvar cancers in order to shrink them before surgery, making the surgery more successful.
There are several operations to treat vulvar cancer:
Removal of the cancer and a margin of healthy tissue (excision)
This procedure, also be called a wide local excision or radical excision, involves cutting out the cancer and at least 3/4 inch (2 centimeters) of the normal tissue all the way around it. This helps ensure that all of the cancerous cells have been removed.
Removal of a portion of the vulva (partial vulvectomy)
During a partial vulvectomy, a portion of the vulva is removed, along with its underlying tissues.
Removal of the entire vulva (radical vulvectomy)
Radical vulvectomy involves removal of the entire vulva, including the clitoris and underlying tissues.
Extensive surgery for advanced cancer
When the cancer spreads beyond the vulva and involves nearby organs, it may be necessary to remove all of the vulva and the involved organs in a procedure called pelvic exenteration. If the cancer has spread further, it may be necessary to remove the lower colon, rectum, bladder, cervix, uterus, vagina, ovaries and nearby lymph nodes. When the bladder, rectum or colon is removed, it can be necessary to create an artificial opening in your body (stoma) for your waste to be removed in a bag (ostomy).
Depending on the extent of your surgery, reconstructive surgery may be recommended. This is something to discuss with your treatment team if you have undergone a partial or radical vulvectomy.
Surgery to remove nearby lymph nodes
Sometimes vulvar cancer spreads to lymph nodes in the groin, so some or many may need to be removed. This can cause a condition called lymphedema, which results in the swelling of the legs due to fluid retention.
A relatively new procedure called sentinel lymph node biopsy (SLNB) can reduce the need to remove so many lymph nodes, reducing the occurrence or severity of lymphedema. This procedure involves identifying the lymph node where the cancer is most likely to spread first. That lymph node for testing and if cancer cells are not found in that lymph node, then it is unlikely that cancer cells have spread to other lymph nodes.
Side Effects of Surgery
Some discomfort is common after surgery. It often can be controlled with medicine. Tell your treatment team if you are experiencing pain. Other possible side effects are:
- Nausea and vomiting
- Infection, fever
- Wound problem
- Fullness due to fluid in the abdomen
- Shortness of breath due to fluid around the lungs
- Swelling caused by lymphedema, usually in the legs
- Blood clots
- Difficulty urinating or constipation
Most of these side effects are temporary. Be sure to talk with your treatment team members about any side effects you experience. They can help you find ways to manage them.