Vulvar cancer Vulvar Cancer Dr Jérémie Zeitoun · Surgeon Paris 8th

What it is. Vulvectomy removes all or part of the vulva depending on tumour extent and lesion location. It can be partial (wide local excision) or total. It is the reference operation for vulvar cancer. The aim is to obtain healthy surgical margins.

When it is proposed. In the vast majority of invasive vulvar cancer cases, when surgery is feasible. The extent of the procedure is adapted to each situation, preserving function and appearance as much as possible.

How it works. The operation lasts 1 to 3 hours depending on associated procedures (with or without inguinal lymphadenectomy). It is performed under general anaesthesia. The hospital stay is generally 3 to 5 days at Clinique Hartmann.

And my ovaries? Vulvar surgery does not concern the uterus or the ovaries. You will not enter menopause from this operation.

A surgery that may be mutilating. Vulvectomy is an intervention that often significantly modifies vulvar anatomy. Depending on the extent of the procedure, the consequences on body image and intimate life can be significant. These aspects are addressed during the consultation, before any decision. In cases where the resection is particularly extensive, immediate flap reconstruction may be necessary to cover the skin defect — this possibility is anticipated and planned before the operation.

Healing complications. Vulvar healing is often difficult and prolonged — 4 to 8 weeks on average, sometimes longer. Healing defects (wound dehiscence, partial necrosis, local infection) are common and are among the most frequent complications after vulvectomy. Daily local care is necessary, and home nursing care is systematically organised on discharge.

What it is for. When cancer spreads, it first travels through the lymph nodes in the groin (inguinal nodes). The sentinel node is the first lymph node the cancer would reach if it were spreading. If this node is healthy, complete inguinal lymphadenectomy and its complications can be avoided.

How it is done. Most often by the isotopic method: a radioactive tracer is injected around the tumour the day before or the morning of the operation. This tracer travels to the inguinal sentinel node, detected in the operating theatre using a gamma probe. We remove it for pathological analysis. A blue dye may be used in addition depending on the centre.

If the sentinel node is not identified, a complete inguinal lymphadenectomy is performed.

Saint-Paul de Vence 2025 guidelines. Sentinel lymph node biopsy is now the reference for early-stage vulvar cancer (T1, depth >1 mm, <4 cm, no clinically suspicious nodes). It must be performed by a trained team. Validated by the GROINSS-V trials.

What it is. Inguinal lymphadenectomy involves removing the lymph nodes in the groin — on one side or both depending on tumour location. These lymph nodes are analysed to determine whether cancer cells have spread to them.

Why it matters. The result of node analysis determines whether complementary treatment is needed after the operation (radiotherapy). This information sometimes changes the treatment strategy.

Is it always performed? No — the decision depends on cancer type and stage. When sentinel lymph node biopsy is performed, its result guides the decision: if the node is healthy, lymphadenectomy can be avoided; if it is involved, lymphadenectomy is performed.

The main risk. Lymphoedema — swelling of the leg due to disruption of lymphatic circulation. This risk exists but is limited, especially when sentinel lymph node biopsy avoids extensive lymphadenectomy. Specialised physiotherapy helps prevent and treat it.

Radiotherapy. It may be recommended after surgery in case of insufficient surgical margins or lymph node involvement. In some locally advanced tumour situations not initially operable, concurrent radio-chemotherapy may be offered as first-line treatment.

Chemotherapy. It is more rarely used in vulvar cancer. It is reserved for advanced or metastatic forms, often in combination with radiotherapy. It does not concern early stages treated by surgery alone.

The decision is made at the multidisciplinary team meeting, after analysis of the surgical specimen, and is discussed with you during a dedicated consultation.

A reality to anticipate. Vulvar cancer can recur, most often within the first two years after treatment. Recurrence can be local (on the vulva), regional (inguinal nodes) or distant. This is why close surveillance after treatment is essential.

Treatment of recurrence. Each recurrence is discussed at the multidisciplinary team meeting. Depending on its location and extent, additional surgery may be offered — sometimes more extensive than the first operation. Radiotherapy and chemotherapy may also be indicated, alone or in combination.

The importance of follow-up. Regular clinical examination allows early detection of recurrence, when therapeutic options are more numerous. Any unusual sign between two consultations — pain, bleeding, swelling in the groin — should be reported quickly without waiting for the next scheduled appointment.

A cancer that mainly affects elderly women. The median age at diagnosis of vulvar cancer is 77 years in France. Surgery remains the reference treatment, but it must be adapted to the patient's general condition.

Geriatric assessment. For patients over 75 years or with significant comorbidities, an onco-geriatric consultation is systematically offered before the operation. This assessment — particularly the G8 score — helps measure the capacity to tolerate major surgery and to adapt the therapeutic plan if necessary.

Alternatives to surgery. When the general health condition does not allow surgical intervention, other options can be discussed at the multidisciplinary meeting: exclusive radiotherapy, concurrent radio-chemotherapy, or palliative treatment. Age alone is never a contraindication — it is the general condition that matters.