Surgery is the most common treatment for cancer of the vulva, as well as precancerous lesions. If the cancer has spread past the vulva, radiation therapy and chemotherapy may also be performed. At Penn, our gynecologic specialists continue their efforts to devise and enhance new and even better options for complex gynecologic surgery. Reconstructive surgery may be an option for people who have extensive vulvar surgery.
Surgery for vulvar cancer
We offer several surgical options to treat vulvar cancer. The type of procedure that’s appropriate for you depends on the location and stage of your cancer or precancer.
Laser surgery for precancerous lesions of the vulva
During laser surgery for precancerous lesions of the vulva, a focused laser beam destroys the layer of skin containing abnormal cells. Laser surgery is used as a treatment for pre-invasive vulvar cancer. It is not used to treat invasive cancer.
Radical excision for vulvar cancer
Invasive lesions will be removed by wide margins (radical excision), and lymph nodes in the groin will be evaluated.
In many cases, a sentinel lymph node biopsy will be performed in conjunction with the radical excision. During a sentinel lymph node biopsy, the first (sentinel) lymph node to which cancer cells are most likely to spread is identified, surgically removed and examined to determine whether cancer is present. A few hours before surgery, a radiocolloid or radioactive tracer (or in some cases, dye) is injected into the lesion. A gamma probe is then used to locate high-risk nodes to be removed, rather than removing all lymph nodes. This results in a smaller surgery and reduced risk of lymphedema. A pathologist then checks the lymph node for the presence of cancer cells.
A negative result suggests that cancer has not spread to nearby lymph nodes or other organs. A positive result means cancer is present in the sentinel lymph node and may be present in other nearby (or regional) lymph nodes or organs. By getting this fuller picture of your vulvar cancer, we can better develop a treatment plan that's right for you.
In some cases, a lymphadenectomy is performed instead of a sentinel lymph node biopsy. During a lymphadenectomy, some or all of the lymph nodes in the tumor area are removed during radical excision and examined by a pathologist for the presence of cancer.
Pelvic exenteration for vulvar cancer
Pelvic exenteration is a radical surgery that removes all organs from the pelvic region. It is not commonly performed by Penn Medicine gynecologic oncologists, but may be used to treat cancer that has spread to surrounding reproductive and pelvic organs.
Vulvectomy for vulvar cancer
Vulvectomy is the surgical removal of all or part of the vulva. There are three types of vulvectomy:
- Simple vulvectomy is the removal of the entire vulva.
- Skinning vulvectomy is a rare operation in which the top layer of skin affected by the cancer is removed.
- Radical vulvectomy is a rare operation that can be complete or partial. A partial vulvectomy involves the removal of the vulva, including the deep tissue. In a radical vulvectomy, surgeons remove the entire vulva, deep tissue and the clitoris. This surgery is only performed in extensive cancer cases.