Cancer surgery
Radical Vulvectomy and Groin Nodes Dissection for Vulval Cancer
Radical vulvectomy and groin lymph node surgery are specialist procedures used to treat some vulval cancers and determine whether cancer has spread beyond the vulva.
The extent of surgery depends on the size, position and depth of the cancer, as well as whether there is any evidence that the cancer has spread to the lymph nodes. In some women, only the cancer and a small margin of surrounding tissue need to be removed. In others, more extensive surgery involving the vulva and lymph nodes in one or both groins may be recommended.
At Gynae Solution, we understand that a diagnosis of vulval cancer can be deeply upsetting and that discussions about surgery can feel particularly difficult. We will explain your diagnosis, treatment options and expected outcomes clearly, giving you time to ask questions and understand why a particular approach has been recommended.
What is a radical vulvectomy?
A vulvectomy is an operation to remove part or all of the vulva.
The vulva is the external genital area, including the labia, clitoris and the tissues surrounding the vaginal and urethral openings.
A radical vulvectomy involves removing the vulval cancer together with a margin of healthy tissue around it. Depending on the location and extent of the cancer, this may involve removing a significant part of the vulva or, in selected circumstances, the entire vulva and deeper tissues.
The aim is to remove the cancer completely while preserving as much healthy tissue and function as safely possible.
Modern treatment is increasingly individualised. A radical vulvectomy is not automatically required simply because you have vulval cancer. Smaller, localised cancers may be treated with a wide local excision, while carefully selected patients may be suitable for sentinel lymph node assessment rather than complete groin lymph node dissection.
Why might I need surgery?
Surgery is the main treatment for many vulval cancers, particularly when the cancer can be completely removed.
The type of surgery recommended will depend on:
- The size of the tumour
- Where the tumour is located on the vulva
- How deeply the cancer has grown into the underlying tissue
- Whether there is more than one area of cancer
- Whether the cancer is close to important structures such as the clitoris, urethra or vagina
- Whether lymph nodes are involved or considered at risk
- Your general health and suitability for surgery
- Whether reconstruction may be required
The aim is to achieve complete removal of the cancer while avoiding unnecessary removal of healthy tissue wherever it is safe to do so.
Wide local excision versus radical vulvectomy
Not every vulval cancer requires a radical vulvectomy.
For a smaller, localised cancer, a wide local excision (WLE) may be sufficient. This removes the cancer together with an appropriate margin of healthy tissue around it while preserving as much of the vulva as possible.
A more extensive vulvectomy may be recommended when the cancer is larger, deeper, involves multiple areas or cannot be adequately removed with a more limited operation.
Your consultant will discuss exactly what needs to be removed and why before surgery.
What are groin lymph nodes?
The lymphatic system is part of your body's immune and drainage system. Lymph nodes in the groin are particularly important in vulval cancer because they can be one of the first places to which vulval cancer cells spread.
Checking the groin lymph nodes therefore provides important information about the stage of the cancer and whether additional treatment may be needed.
What is a groin lymph node dissection?
A groin lymph node dissection, also known as an inguinofemoral lymphadenectomy, involves removing lymph nodes from the groin.
Depending on the position and characteristics of the vulval cancer, lymph nodes may need to be assessed on one or both sides.
The lymph nodes are sent to a specialist laboratory where they are carefully examined for cancer cells.
The results help your multidisciplinary team understand whether the cancer has spread and decide whether further treatment, such as radiotherapy or other treatment, is appropriate.
What is a sentinel lymph node biopsy?
For some women with early vulval cancer, it may not be necessary to remove all the lymph nodes in the groin.
Instead, a sentinel lymph node biopsy may be appropriate.
The sentinel lymph node is the first lymph node, or group of nodes, to which lymphatic fluid from the tumour area is expected to drain. A tracer and/or dye is used to identify these nodes, which are then removed and examined for cancer cells.
If the sentinel nodes do not contain cancer, further groin lymph node surgery may not be necessary in appropriately selected patients.
This approach can significantly reduce the amount of lymphatic tissue removed and therefore reduce some of the complications associated with full groin node dissection, including lymphoedema and wound problems.
However, sentinel lymph node surgery is not suitable for every patient. Whether it is appropriate depends on factors such as the size, location and characteristics of the tumour and whether there is more than one area of disease.
Why is it important to assess the lymph nodes?
Knowing whether the lymph nodes contain cancer is an important part of staging vulval cancer.
A lymph node that is free from cancer provides reassuring information about the extent of the disease. If cancer cells are found within the lymph nodes, this may indicate that the cancer has started to spread beyond the original tumour.
The lymph node results can therefore help your specialist team decide whether surgery alone is appropriate or whether additional treatment such as radiotherapy or other cancer treatment should be considered.
What happens before surgery?
Before your operation, you will have a detailed assessment of your cancer and your general health.
This may include:
- Review of your biopsy results
- Examination of the vulva and groins
- Imaging such as MRI, CT or PET-CT where appropriate
- Assessment of the lymph nodes
- Blood tests
- Anaesthetic assessment
- Discussion of the proposed operation and recovery
- Discussion of fertility, sexual function and other concerns where relevant
Your case may also be discussed by a multidisciplinary team (MDT) involving specialists in gynaecological oncology, radiology, pathology, oncology and other relevant disciplines.
This allows the treatment plan to be tailored to your individual cancer rather than applying the same operation to every patient.
What happens during radical vulvectomy?
The operation is performed under a general anaesthetic.
The surgeon removes the vulval cancer together with an appropriate margin of surrounding tissue. The exact operation will depend on where the tumour is situated.
Depending on the extent of the cancer, surgery may involve removal of part or all of the:
- Labia
- Clitoris
- Vulval skin
- Deeper vulval tissues
- Nearby tissues where necessary to achieve complete cancer removal
The aim is always to remove the cancer safely while preserving as much normal anatomy and function as possible.
If groin lymph node surgery is required, this may be performed during the same operation.
Can the vulva be reconstructed?
In some patients, reconstruction may be needed to close the surgical wound or restore the shape and function of the vulval area.
The way the wound is closed depends on how much tissue needs to be removed and where the defect is located.
This may involve using the remaining local skin and tissue. In more extensive surgery, a specialist reconstructive or plastic surgeon may be involved and tissue from another part of the body may sometimes be used.
Reconstruction is planned around your individual anatomy and cancer treatment.
What happens after surgery?
After the operation, you will be monitored closely while you recover from the anaesthetic and surgery.
You may have:
- A urinary catheter temporarily
- One or more surgical drains
- Dressings around the vulval or groin wounds
- Medication for pain relief
- Medication to reduce the risk of blood clots
- Support with mobility and wound care
The length of your hospital stay varies according to the extent of surgery and how quickly you recover.
Your surgical team will give you individual advice about wound care, washing, activity, driving, work and sexual activity.
Recovery after radical vulvectomy
Recovery from vulval cancer surgery can take time, particularly if you have had extensive vulval surgery and groin lymph node dissection.
You may experience swelling, bruising, tenderness or discomfort around the vulva and groins during the early stages of recovery.
Your wounds will need time to heal and you may need to temporarily modify activities that put pressure on the surgical area.
It is important not to rush your recovery. Your team will advise you when it is appropriate to gradually increase walking, exercise and other activities.
Emotional recovery is also important. Changes to the appearance or sensation of the vulva can affect body image, confidence, intimacy and sexual wellbeing. These are all legitimate concerns and can be discussed with your specialist team.
What are the risks of groin lymph node surgery?
As with any major operation, there are potential risks.
These can include:
- Bleeding
- Infection
- Blood clots
- Anaesthetic complications
- Wound healing problems
- Fluid collections or lymphocysts
- Swelling of the legs or genital area
- Numbness or altered sensation
- Lymphoedema
- Persistent discomfort
- Damage to nearby structures, although this is uncommon
Groin lymph node surgery can affect the normal drainage of lymphatic fluid from the legs. This can result in lymphoedema, which may develop soon after surgery or sometimes much later.
Your individual risk depends on the type and extent of surgery you have.
Lymphoedema after groin node dissection
Lymphoedema is swelling caused by a build-up of lymphatic fluid.
Removing lymph nodes from the groin can alter the normal drainage pathways from the legs and pelvic area. Some patients develop swelling in one or both legs, the groin or the genital area following surgery.
There are ways of managing lymphoedema, including specialist assessment, compression garments, exercise, skin care and lymphatic therapy where appropriate.
Where sentinel lymph node surgery is suitable, avoiding a full groin node dissection can reduce the risk of lymphatic complications.
What happens to the lymph nodes after surgery?
The removed lymph nodes are sent to a specialist pathologist for detailed examination.
The pathology report may determine:
- Whether cancer cells are present
- How many lymph nodes contain cancer
- The characteristics of any cancer found
- Whether the cancer has spread beyond the original vulval tumour
These findings are combined with the results from your vulval surgery and imaging to establish the stage of your cancer.
Your specialist team will then explain what the results mean for you and whether any additional treatment is recommended.
Will I need radiotherapy or other treatment?
Not everyone requires additional treatment after surgery.
If the cancer has been completely removed and there are no concerning features, surgery may be all that is required.
If the cancer has involved lymph nodes, the margins are affected or there are other features associated with a higher risk of recurrence, radiotherapy or other treatment may be recommended.
The decision is individual and will be discussed by your multidisciplinary team.
Will surgery affect my sex life?
This is an important consideration and one that is sometimes overlooked.
Vulval surgery can change the appearance and sensation of the vulva. Depending on what needs to be removed, it may affect sexual sensation, comfort or confidence.
Healing can also take time, and it is completely normal to need time before you feel ready to resume sexual activity.
Your specialist team can discuss these issues with you before and after treatment. If you are experiencing difficulties with intimacy, pain or changes in sexual function, support is available.
Can vulval cancer surgery affect my fertility?
Fertility is not usually affected by removal of the vulva itself because the womb and ovaries are not normally removed as part of a vulvectomy.
However, every patient's circumstances are different. If additional treatment is required, or if the cancer involves other parts of the reproductive system, there may be implications for fertility.
If preserving fertility is important to you, this should be discussed with your specialist team before treatment begins.
When should I seek help after surgery?
You should contact your surgical team promptly if you develop:
- Increasing redness, swelling or pain around the wound
- Pus or an unpleasant-smelling discharge
- A fever or feeling significantly unwell
- Heavy bleeding
- Sudden or increasing swelling in a leg
- Calf pain or tenderness
- Shortness of breath or chest pain
- A wound that is opening or not healing as expected
Your hospital team will give you specific instructions about who to contact following your operation.
Why specialist vulval cancer surgery matters
Vulval cancer surgery requires careful consideration of both cancer control and quality of life.
The aim is not simply to remove as much tissue as possible. It is to achieve safe and effective cancer treatment while preserving healthy tissue and function wherever this can be done without compromising cancer control.
At Gynae Solution, Mr Jafaru Abu provides specialist care in gynaecological oncology, with treatment planned around each patient's diagnosis, circumstances and priorities.
From your initial consultation and investigations through surgery, pathology results and follow-up, you will have the opportunity to understand what is happening at every stage.
Book a consultation
If you have been diagnosed with vulval cancer, have been advised that you may need a vulvectomy or groin lymph node surgery, or would like a specialist opinion about your treatment options, a consultation can provide an opportunity to discuss your diagnosis in detail.
At Gynae Solution, we are here to provide expert, compassionate care and help you understand the options available to you.
Common questions
How soon can I be seen?
Daily appointments are available at The Park Hospital. Call the secretary on 0115 966 2049, or send an enquiry below and we will reply within 24 hours on business days.
Do I need a GP referral?
Referrals from GPs are welcome, and you can also enquire directly. If you are using private medical insurance, check with your insurer whether a referral is required for your policy. See GP referrals and fees and insurance.
What does a consultation cost?
A new consultation is £250 and a follow-up consultation is £150. The cost of any tests, procedures or surgery is quoted individually after your consultation. See fees and insurance.
Enquiries
Send us a message
Enquiries from patients and referring clinicians are both welcome. We endeavour to answer all enquiries within 24 hours on business days. If your case is urgent, please say so in your message or call the secretary directly.