Vulvar Cancer Surgery: Removal and Recovery

Vulvar cancer surgery is planned to remove the cancer with a clear margin while preserving normal function and appearance as far as safely possible. The operation may be called a wide local excision, radical local excision, partial vulvectomy or modified radical vulvectomy. These names describe how much tissue is removed; they do not mean that every patient needs the whole vulva removed.

This page answers the questions patients and families most often have: “Will my whole vulva be removed?”, “Can the clitoris or vagina be preserved?”, “Will lymph nodes be removed?”, “How painful will recovery be?” and “Will I be able to urinate, walk and have sex normally?” The answers depend on the tumour’s size, depth and position, whether it is close to the clitoris, urine passage (urethra), vagina or anus, and whether there is concern about cancer in the groin lymph nodes.

In Hindi, vulvar cancer is often described as yoni ke bahari hisse ka cancer (योनि के बाहरी हिस्से का कैंसर), and the operation as removal of the affected outer genital skin.

What operation will I need for vulvar cancer?

The surgical name should be less important than a clear explanation of what will be removed in your case. Common terms include:

Wide local excision: removal of the tumour with a rim of normal-looking tissue around it.
Radical local excision: a deeper or wider excision designed to remove the full depth of invasive cancer and an appropriate tissue margin.
Partial vulvectomy: removal of part of the vulva containing the cancer.
Modified radical vulvectomy: removal of a larger affected part of the vulva, sometimes together with treatment of groin lymph nodes. In everyday language, this is an operation to remove the vulvar cancer and enough surrounding tissue for cancer control while avoiding unnecessary removal of uninvolved tissue.
Radical vulvectomy: removal of the entire vulva. This is now needed much less often because treatment is usually tailored to the tumour rather than automatically removing the whole vulva.

Different hospitals may use these terms slightly differently. Before consent, ask the surgeon to show exactly which tissue and which lymph nodes are expected to be removed.

Will my whole vulva need to be removed?

The aim is complete cancer removal without taking more normal tissue than is necessary. The plan considers:

the tumour’s size, depth, number and exact position
its distance from the clitoris, urethra, vagina and anus
whether it crosses or lies close to the midline
biopsy findings and the type of vulvar cancer
clinical examination and imaging of the groin nodes
previous vulvar treatment, skin conditions or scarring
the patient’s general health, function and priorities

A larger operation is not automatically a better cancer operation. The appropriate operation is the one most likely to achieve clear margins safely while protecting urinary, bowel and sexual function wherever possible.

Can the clitoris, vagina, urine passage or anus be preserved?

Often, uninvolved structures can be preserved, but the answer depends on how close the cancer is and whether a clear edge can be achieved safely. The surgeon should explain what is expected to remain, what might need partial removal and how the plan could change during the operation. Preserving a structure should not leave known cancer behind, but removal should not be wider than necessary.

A surgical margin is the edge of normal-looking tissue removed around the tumour. After surgery, a pathologist examines the specimen and reports whether cancer reaches or lies close to an edge. Surgeons plan an adequate margin, but there is no single number that can be applied safely to every part of the vulva. The distance may need to be balanced against nearby structures such as the clitoris, urethra and anus.

If the final pathology shows cancer at the cut edge or an unexpectedly close margin, the multidisciplinary team reviews the exact location and other risk factors. A further excision or radiotherapy may be discussed. The decision is individual rather than based on one measurement alone.

Will I need lymph nodes removed from my groin?

The inguinofemoral lymph nodes in the groin are a common first site of spread from invasive vulvar cancer. Very small, superficially invasive tumours may not need groin-node surgery. For other invasive cancers, assessing the nodes helps determine the stage and whether additional treatment is needed.

Node treatment may be needed on one side or both sides. Tumours close to the centre of the vulva can drain to both groins, while a clearly lateral tumour may sometimes be managed differently. The decision is based on the tumour’s position, clinical examination, imaging and the planned vulvar operation.

Can only the first few groin nodes be checked?

The sentinel lymph node is the first node, or first few nodes, to which lymph fluid from the tumour drains. A tracer is placed around the tumour area so the surgeon can identify and remove these nodes for detailed examination. If the sentinel nodes are free of cancer, many eligible patients can avoid removal of all groin nodes and reduce the risk of long-term leg swelling.

Sentinel-node biopsy is generally considered for carefully selected patients with a single vulvar tumour smaller than 4 cm, no suspicious groin nodes on examination or imaging, and no other feature that makes the technique unsuitable. It is not simply a smaller version of groin dissection, and it should be performed by a team experienced in vulvar cancer and sentinel-node mapping.

When do more groin lymph nodes need to be removed?

An inguinofemoral lymph-node dissection removes a group of superficial and deeper nodes from one or both groins. It may be recommended when the tumour is not suitable for sentinel-node biopsy, when nodes appear involved, or when sentinel-node results show disease that requires further treatment.

For some patients with a positive sentinel node, radiotherapy may be considered instead of further node surgery, depending on the size of the deposit and other findings. A positive node result should therefore be reviewed by the multidisciplinary team rather than treated as an automatic one-size-fits-all decision.

Does Stage III always mean removing the whole vulva?

No. Stage III vulvar cancer includes several different situations. It may refer to cancer in groin lymph nodes or to tumour extending into nearby structures. Treatment can involve surgery followed by radiotherapy or chemoradiotherapy, or primary chemoradiotherapy when surgery would be excessively extensive or would not be the best route to cancer control.

A patient with a removable vulvar tumour and limited nodal disease may have a different plan from a patient whose tumour involves the urethra, vagina, anus or fixed groin nodes. The team should explain which feature makes the cancer Stage III and how that feature changes treatment.

Will I need reconstruction or plastic surgery?

After a wider excision or vulvectomy, the wound may close directly or may need tissue moved from a nearby area as a flap. Reconstruction can help close the wound without excessive tension, protect exposed structures and preserve function and appearance. It may be planned with a plastic or reconstructive surgeon.

Needing a flap does not mean the cancer operation has failed or is unusually severe. It is one method of creating a safer closure after the tissue required for cancer treatment has been removed.

How painful is vulvar cancer surgery?

Pain is expected after surgery, but it should be actively treated. The amount varies from a small local excision to a larger vulvectomy with groin-node surgery or reconstruction. Pain relief may include regular tablets, stronger medicine initially and measures that reduce pressure on the wound. Tell the team if pain prevents sleep, walking, urination or wound care.

Risks vary with the extent and location of surgery and whether groin nodes are treated. Possible complications include:

bleeding, infection or blood clots
wound separation or delayed healing
fluid collections called seromas or lymphoceles
leg or genital swelling caused by lymphoedema
numbness, altered sensation or persistent discomfort
changes in urination, bowel function or sexual function, depending on the operation
changes in body image and emotional wellbeing

Smoking, diabetes, nutrition, previous radiotherapy and the extent of surgery can affect healing. Ask about the risks that apply to the proposed operation rather than relying on a general list.

What will the wound be like, and will I need a catheter or drains?

Recovery varies widely. A focused local excision may allow a shorter stay and quicker recovery than a modified radical vulvectomy with groin-node surgery or reconstruction. Some patients need a urinary catheter, wound drain or groin drain for a period. The team should provide instructions on washing, drying, dressings, pain relief, movement and blood-clot prevention.

Loose clothing and careful wound hygiene can make early recovery more comfortable. Activity usually increases gradually. The time needed before driving, work, exercise or sexual activity depends on wound healing and the operation performed; use the surgeon’s advice rather than a fixed timetable.

Contact the treating team promptly for fever, increasing redness or swelling, unpleasant-smelling discharge, worsening pain, heavy bleeding, difficulty passing urine, chest pain, shortness of breath or new one-sided leg swelling. These symptoms should not wait for a routine appointment.

Will I need radiation or chemotherapy after surgery?

Some patients need surgery alone. Additional radiotherapy, sometimes with chemotherapy, may be advised when pathology shows involved lymph nodes, a margin that cannot be safely cleared, or other features associated with a higher risk of recurrence. The radiation field may include the vulva, groins or pelvis depending on the findings.

The final recommendation is usually made after the operation report and pathology have been reviewed at a multidisciplinary meeting. Ask which pathology finding is driving the recommendation and what benefit and side effects are expected.

Will I be able to urinate and walk normally?

Many patients return to normal urination and walking, but the early recovery and longer-term effects depend on where the tumour is and how much tissue is removed. A catheter may be used temporarily while swelling settles or the wound heals. If surgery is close to the urine passage, the surgeon should explain whether its shape or function may change.

Walking usually starts gently after surgery because movement helps recovery and lowers blood-clot risk. Groin-node treatment can increase the risk of leg or genital swelling called lymphoedema. This happens because fluid from the legs and genital area normally drains through the groin lymph nodes; removing or treating these nodes can slow that drainage. The risk is generally lower when only sentinel nodes are removed than after a full groin-node dissection. Report new swelling, heaviness, redness or pain so it can be assessed and managed early.

Can I have sex after vulvar cancer surgery?

Many patients can return to sexual activity after healing, but comfort, sensation and appearance may change. The effect depends on the tumour’s position, whether the clitoris or vaginal entrance is involved, reconstruction, radiotherapy and emotional recovery. Ask when the wound is sufficiently healed and what can help with dryness, tightness or pain. Many women find these questions hard to raise, so it can help to write them down when preparing for a specialist appointment.

There is no requirement to resume sex by a particular date. The patient’s comfort and choice come first. A partner can help by avoiding pressure, listening and attending a consultation if invited. Persistent pain, bleeding or fear deserves support from the cancer team.

How long will recovery take?

There is no single recovery time. A small local excision and a modified radical vulvectomy with groin-node surgery are very different operations. Hospital stay and return to work, driving or exercise depend on wound healing, drains, reconstruction, other health conditions and whether complications occur.

Before leaving hospital, ask what help will be needed at home, when the wound will be checked and which activities should wait. A family member may initially help with meals, medicines, washing, short walks, appointments and watching for warning signs.

How can my family care for me at home?

Family members can help most by following the discharge plan rather than inspecting or treating the wound without guidance. Keep medicines and contact numbers organised, support regular food and fluids, encourage the recommended gentle movement and protect the patient’s privacy and independence.

Questions to ask before surgery

What is the exact name of my operation, and what tissue will be removed?
Is the goal a wide local excision, partial vulvectomy or modified radical vulvectomy?
How close is the tumour to the clitoris, urethra, vagina or anus?
Do I need sentinel-node biopsy or a full groin-node dissection?
Will nodes be treated on one side or both sides?
Might I need reconstruction, a catheter or drains?
How could the operation affect urination, sexual function and lymphoedema risk?
What pathology results could lead to more surgery or radiotherapy?
Who should I contact if there is a wound problem after discharge?

When should I get a second opinion before surgery?

Vulvar cancer is uncommon, and the balance between cancer clearance and preservation of function can be complex. A specialist review is especially useful when the tumour is close to the clitoris, urethra or anus; when groin nodes look abnormal; when reconstruction may be needed; or when surgery and chemoradiotherapy are both possible options.

Bring the biopsy report, examination notes, imaging reports and image files, details of previous vulvar procedures and a current medicine list. You can also read the main vulvar cancer guide, review vulvar cancer warning signs, or request a gynaecological-cancer second opinion.

Frequently asked questions

Is a vulvectomy the same as removing the vagina?

No. The vulva is the external genital area; the vagina is the internal canal. A vulvectomy removes part or all of the vulva. If a tumour involves nearby vaginal tissue, the surgeon will explain any additional removal separately.

Will the whole vulva be removed?

Usually not. Modern surgery is tailored to the tumour. Many patients can be treated with a wide or radical local excision or partial vulvectomy. More extensive removal is considered only when needed for safe cancer clearance.

Can I avoid having all groin lymph nodes removed?

Some patients with a single tumour smaller than 4 cm and clinically normal groin nodes may be eligible for sentinel-node biopsy. Eligibility depends on all clinical findings and specialist assessment.

Does a clear margin guarantee the cancer will not return?

No. A clear margin lowers concern about cancer left at the surgical edge, but recurrence risk also depends on tumour biology, lymph nodes, stage and underlying vulvar disease. Follow-up remains important.

Can sexual function be affected?

It can be, depending on the tumour’s location and the tissue removed. Physical healing, sensation, dryness, pain, body image and anxiety may all play a role. Ask what changes are expected and what specialist support is available.

Medical references

This information is for general education. The appropriate operation and lymph-node plan can only be decided after examination, biopsy review and staging assessment.

Book a consultation to discuss a vulvar cancer diagnosis, surgical plan or second opinion.