Your doctor will discuss with you the most appropriate type of surgery, depending on the stage of your cancer. Before your operation, make sure you have talked it over fully with your doctor. You will also be able to speak to a gynaecological nurse specialist who can give you information and support, particularly in the period before and after your operation.

All operations for cancer of the vulva will remove the area of the skin where the cancer is. This can range from removing the cancer and a small surrounding area of healthy tissue, to a radical vulvectomy in which the labia and sometimes the clitoris are removed.

The cancer will be removed using one of the following operations:

Wide local excision takes out the cancer and a border (margin) of healthy cells, usually at least 1cm, all around the cancer. Sometimes doctors use laser treatment to remove the abnormal cells instead of a blade (scalpel). A laser is a high-energy beam of light.

Radical local excision takes out the cancer and a larger area of normal tissue all around the cancer. The lymph nodes may be removed (known as lymph node dissection).

Partial vulvectomy removes part of the vulva.

Radical vulvectomy takes out the entire vulva including the inner and outer labia and the clitoris. Usually the surrounding lymph nodes are also removed.

Pelvic exenteration is done if the cancer has spread beyond the vulva to the organs nearby. These include: the lower bowel, the bladder and the cervix, the uterus and vagina. The surgeon removes any affected organs. Any surgery aims to completely remove the cancer while also preserving as much normal tissue as possible.

Usually only a small amount of unaffected skin is removed with the cancer, so it is often possible to stitch the remaining skin neatly together. However, if it is necessary to remove quite a lot of skin, you may need to have a skin graft, or skin flaps. To do this, the surgeon may take a thin piece of skin from another part of the body (usually the thigh or abdomen) and stitch it on to the operation site. It may be possible to move (rotate) flaps of skin in the vulval area to cover the wound.

A radical vulvectomy is a major operation on a physical, emotional and sexual level. Many hospitals that offer this kind of surgery also have specialist nurses who can support you and help you to talk through how you are feeling. Some of the issues that vulval surgery raises are discussed in the section 'How surgery may affect your sex life'.

The lymph nodes in the groin are usually the first place to which vulval cancer can spread. Lymph nodes are part of the lymphatic system, and are found mainly in the groin, neck and armpits. In order to plan treatment it helps doctors to know whether any cancer cells have spread from the vulva to the lymph nodes in the groins.

If the cancer is deeper than one millimeter, you may be advised to have the lymph nodes surgically removed from one or both groins. This is to check for cancer cells. The lymph nodes are usually removed through a separate cut (incision) in each groin. If the vulval cancer is at the very earliest stage you will not usually need to have any surgery to your lymph nodes.

A new method of checking whether the cancer has spread into the lymph nodes is currently being tried in research trials. It involves injecting a tiny amount of radioactive liquid around the area of the cancer before the operation and then scanning the nodes to see which one has first taken up the radioactive liquid. A blue dye is also injected into the area of the cancer during the operation, which stains the lymph nodes blue. The surgeon removes only the first one or two lymph nodes that the fluid goes into (known as the sentinel nodes). The nodes are then  be tested to see whether they contain cancer cells. It is hoped that this method of checking the lymph glands will cause less lymphoedema (see after surgery) than the other methods, but will be as effective at detecting the cancer.

You are usually admitted to hospital a day or so before your operation. When you arrive on the ward you will be shown around and the nurses will take your medical and personal details.

Make sure that you talk to your nurse or doctor about any questions or concerns that you have.

It often helps to write any questions down so that you don’t forget them, or have a close friend or relative with you when you talk to the doctor or nurse.

You will be seen on the ward by a member of the surgical team. They will take your full medical history before examining you and arranging for any further tests that may be necessary. Once the results of the tests are known, your doctor will discuss these and the operation with you. The type of operation you need will have been explained to you before your admission to hospital.

Preparation

You will be asked to wear special elastic stockings during and after the operation (until you are discharged home) to prevent blood clots forming in your legs. The doctor who will give you your anaesthetic (the anaesthetist) will come to see you to explain the anaesthetic details to you.