Surgery for vulvar cancer

Surgery for vulvar cancer aims to remove the tumor tissue, as well as the seemingly healthy margins. It can be hard to tell whether there are cancer cells present in this surrounding healthy-looking tissue during the operation. By expanding the amount of tissue that is removed, the chances of removing all tumor cells increase significantly. In some cases, we will need to remove the inner and outer labia, or even the clitoris or a part of the urethra. This will likely not affect your ability to hold urine.

Your surgeons may have to remove lymph nodes from your groin, because vulvar cancer can spread through these nodes. We may perform a sentinel node biopsy (the removal and analysis of the lymph node in closest reach of the tumor) or all lymph nodes in the groin.

If necessary, your surgeon will work together with a plastic surgeon who can help close the surgical wound after the procedure, or if part of your urethra needs to be removed.

Surgery for vulvar cancer - what to expect?

You will come in for a preoperative screening before your surgery. You will receive general anesthesia or an epidural which will numb the lower half of your body.

Surgery for vulvar cancer aims to remove as much tissue as possible. Depending on the size of your tumor, your surgeon may have to remove the inner and outer labia as well, or even the clitoris. If needed, your surgeon will remove the lymph nodes in the groin through two additional incisions.

Despite removing large margins surrounding the tumor, your surgeon will try and conserve as much healthy tissue as possible in order to minimize any problems after surgery.

Effectiveness

Your tumor will be removed after surgery. All tissue that has been removed, including the margins and lymph nodes, will be checked for the presence of cancer cells.

This helps us establish the progression and stage of the illness, to determine whether you will need further treatment. You will have to come in for follow-up screenings for the rest of your life.

Preoperative screening

Before your surgery, you will be invited to meet with your anesthesiologist at the outpatient clinic for a consultation and a brief examination to assess your overall shape and any potential particularities we will need to keep in mind. The consultation assistant will measure your heart rate and blood pressure and will inquire about your height and weight. If needed, we can take those measurements during the appointment.

This preoperative screening will take approximately 20 minutes and will form the base of your anesthesia. Your anesthesiologist will listen to your lungs and heart and inspect your mouth and throat in preparation of the breathing tube that will be placed during surgery. Your anesthesiologist will also ask you:

whether you have been under anesthesia before
whether you have any other conditions
whether you have taken cancer medicine before
whether you have had radiation treatment before
whether you have any allergies
whether you smoke
whether you drink alcohol
what kind of medication you take

Please inform your anesthesiologist of the type of medication and dose you take, and how often you take it. Your physician may want to run more tests before your surgery, such as: electrocardiogram (ECG), lung x-rays, a lung function test, or a blood test.

General or local anesthesia

Before your surgery you will be given general anesthesia, local anesthesia, or a combination of the two. General anesthesia means that you will be completely unconscious during surgery, whereas local anesthesia means that a part of your body will be numb and motionless.

General anesthesia

General anesthesia completely sedates your body. You will be given a cocktail of sleeping medicine, pain killers, and sometimes a muscle relaxant through IV. You will be unconscious within 30 seconds. You will be ventilated during the entire process.

If you are having major surgery, we will place a respiration tube in your throat. For smaller surgeries, a small cap in the back of the throat will suffice. We will closely monitor your heart rate, blood pressure, breathing, and temperature through our monitoring devices.

Local anesthesia

If you are given local anesthesia, you will be conscious during your surgery. Local anesthetics are usually administered through an epidural in the spine, and will temporarily numb all body parts underneath. We may place a tube to give you IV pain medication during and after surgery.

Your anesthesiologist will keep a close eye on your blood pressure, heart rate, breathing, and temperature in order to adapt the anesthesia if needed.

Most people undergoing major surgery will be given a mixture of general and local anesthetics.

Side-effects and complications

Many women experience pain after surgery. It may take several weeks before the surgical wound has healed. You may need to rely on a catheter to collect the urine through your urethra or the abdomen. Lymph node removal may cause fluid build-up in the legs (lymphedema). Compression stockings can alleviate some of the symptoms.

The surgery may affect your sex life, especially if the clitoris has to be removed. Your vagina may be tighter, you may experience dryness, and the lymphedema in your lower abdomen or upper legs may cause pain during sex. If this is the case for you, we can offer support and guidance.

After your surgery

This surgery is extensive and can have great effects on your body and mind. It will take some time before you are fully recovered and able to pick up your day to day activities again. You may experience fatigue for months following the procedure.