- Radical local excision
- Radical vulvectomy
- + / – groin node dissection or sentinel lymph node biopsy (SLN)
Once the stage of your vulvar cancer has been established, Dr. Tan will recommend a treatment strategy.
The choice of treatment depends largely on the stage of the disease at the time of diagnosis, but other factors can play a part in choosing the best treatment plan, such as your age, your general health, your individual circumstances, and your preferences.
The cancer and a margin of normal-appearing skin (usually about ½ inch) around it are excised (cut out). This is sometimes called radical local excision.
A radical vulvectomy can be complete or partial. When part of the vulva, including the deep tissue, is removed, the operation is called a partial radical vulvectomy. In a complete radical vulvectomy, the entire vulva and deep tissues, including the clitoris, are removed.
Sometimes these procedures remove a large area of skin from the vulva, requiring skin grafts from other parts of the vulva or other parts of the body to cover the wound. However most of the time the surgical wounds resulting from these procedures can be closed, without grafts and still provide a very satisfactory appearance.
Because vulvar cancer often spreads to lymph nodes in the groin, these may need to be removed. This procedure is called an inguinal lymph node dissection. Usually only lymph nodes on the same side as the cancer are removed. If the cancer is in or near the middle, then both sides may have to be done.
In the past, the incision (cut in the skin) that was used to remove the cancer in the vulva was made larger to remove the lymph nodes. Now we prefer to remove the lymph nodes through a separate incision located about 1 to 2 cm (less than ½ to 1 inch) below and parallel to the groin crease. The incision is made fairly deep, down through membranes that cover the major inguinal vein and artery. This will expose most of the lymph nodes, which are then removed.
After the surgery, a suction drain is placed into the incision and the wound is closed. The drain remains in place until the flow of fluid has mostly diminished.
The total procedure is usually takes 2 to 3 hours. The incision on the vulva is highly individual but the incision for the groin node dissection is along the groin crease.
Surgery always carries risks
General risks include infections in the lung and bladder, blood clot in the legs that can go to the lungs. There are ways that we can decrease those risks by using antibiotics before surgery, using blood thinning medication and leg compressors to prevent clots.
Specific risks to of surgery for vulval cancer:
- Wound healing – Especially in older patients with diabetes, in smokers or in obese patients the risk of wound infection and wound breakdown is significant
- Lymph oedema – Lymphatic fluid usually drains from the legs via the lymph glands into the groin and from there into pelvis and the aorta back into the blood circulation. When lymph glands had to be removed, some fluid may accumulate in the legs
- Deviation of the urinary stream – you may spray or not pee straight if part of the urethra is removed.
When you wake up from anaesthesia there will be a drip to give you the necessary fluids, and a catheter will drain urine from your bladder. An oxygen mask will supply oxygen to the respiratory system.
A drain may collect body fluid from the groins. The drain will be removed when the lymphatic fluid production from the groins slows down.
You need to stay in hospital for 6 to 8 days.