When a woman is diagnosed with vulvar cancer, surgery is the most common first step to remove all the cancerous tissue. Some normal tissue is also removed to help keep the cancer from coming back. Lymph node tissue from the groin may also be removed during surgery. Lymph nodes are small glands that make a colorless fluid and act as filters for the body. They keep bacteria and other matter from getting into the blood stream.
The type of surgery done depends on the location of the cancer and how involved it is. Your doctor will talk with you about what kind of surgery you need.
On the day of your surgery
When you arrive for your surgery, please go to the Admitting Department in the main lobby of Brigham and Women's Hospital (75 Francis Street). You should arrive two hours before your scheduled surgery.
A receptionist will greet you and direct you to an admitting interviewer who will ask you for all necessary information for admission, verify your insurance, collect a deposit (if necessary), and have you sign a consent form for admission to the hospital.
You will be escorted to the Pre-Operative Surgical Area. Depending on the time of your surgery, you will either stay with the nurse or wait to be called for your surgery. Your family and friends will be directed to the Surgical Liaison Area, which provides information and a comfortable central location for family members to wait while surgery is underway.
You will be taken to an area where you will change into a hospital gown and be helped on to a stretcher. Next, you will meet the anesthesia team, who will place an intravenous needle in a vein. This will be used to administer medication to relieve anxiety and make you drowsy. You will then be moved into the operating room, which is staffed with physicians, nurses and technicians who involved with your care during surgery.
After your surgery
After surgery, you will be monitored closely. You will wake up in the recovery room where nurses will be checking your blood pressure and pulse frequently. Although you will feel like sleeping, occasionally you will be asked to cough and take deep breaths to keep your lungs clear. You will probably be receiving oxygen by facemask. If you feel cool, the nurse will give you extra blankets.
The nurses want to make you as comfortable as possible, so let them know how you are feeling. You will still have an intravenous (IV) tube in your arm or hand. If it feels uncomfortable, please tell your nurse. You may have a Foley catheter, which was put in during surgery to drain urine from your bladder. Surgical patients usually have plastic boots on their legs to assist blood circulation. If you wish to know about any equipment or procedures, the staff will be happy to explain it to you.
Once you have sufficiently recovered from surgery, you will be transferred to your hospital room. Once in your room, you may have visitors.
Recovery after surgery: The first day
After surgery, you will probably feel weak and tired. You may find it difficult to do things for yourself. Your nurse will coordinate your care. This care will include pain control, personal care and discharge planning. Other members of the health care team will also help organize your care and will address your discharge needs.
The nurses will assess your ability to take fluids and foods. When you are taking enough fluids, your IV fluids will be stopped. On the night of surgery, your nurse will assist you with walking and personal care. On your first day after surgery, your urinary catheter will usually be removed. Your nurse will assist you in becoming independent with your personal care and walking.
After surgery, it is important that you take frequent deep breaths and cough every 15-20 minutes. Coughing, deep breathing and getting out of bed will speed your recovery. Deep breathing opens the tubes going to your lungs and helps to clear the lungs of sputum (spit).
Symptom management after surgery
It is normal to have pain or discomfort from your incision site immediately after surgery. Every patient experiences different levels of pain. Your comfort level will be monitored by your nurse. The nurse will ask you to rate your pain using a scale of one to 10. One is the lowest level of pain and 10 is the highest. Your nurse will make sure you are as comfortable as possible. It is important to communicate your needs. For the initial 12-24 hours after surgery, you may receive your pain medication by vein or injection. When you are ready (typically the first or second day after surgery) your pain medication will be in pill form. Again, you can use the one-to-10 pain scale to describe your level of pain, and the nurse can give you the amount of medication that you need.
Wound care and hygiene
- Your nurse will apply ice to the surgical area for the first 24 hours after surgery. Sitting is discouraged while in the hospital; standing or lying is preferred.
- Twenty-four hours after surgery, you will begin wound care. It is important to keep the incision clean and dry. You will need to clean the surgical area two to three times a day. This can be done by taking a sitz bath or, if you have a hand-held showerhead, letting the water run over the vulva or surgical area. The nurse in the hospital will give you equipment to use at home for a sitz bath and show you how to use it. You should also blow dry the area after the bath or shower. The hair dryer should be set on cool air and gently waved over the surgical area. You should continue with the wound care until instructed to stop by your doctor.
- After urinating or moving your bowels, the vulva area should be cleaned. This can be done by pouring warm water over the vulva while sitting on the toilet. You may find using a plastic squeeze bottle is helpful. This can be purchased at any drug store. Once clean, the area should be gently dried by using a patting motion and a hair dryer set on cool temperature.
- Check the area of your incision every day for redness, swelling, drainage or wound opening. If you have any concerns with how the incision looks, call your doctor's office.
- Prolonged sitting should be avoided. It will cause pressure on the area of surgery and interfere with circulation and healing.
- If you had lymph node tissue removed, you may have a drain in each groin. These drains are placed during surgery and will prevent a build up of fluid under the incision. It is normal to have drainage from this area because of the surgery. The drains are attached to a collecting bulb. The drainage from these tubes will be blood-tinged at first, gradually becoming light yellow.
- The drains will remain in place for one to two weeks. When the drainage is less than two tablespoons in 24 hours, the physician will remove the drains during an office visit. You may shower, making certain that the area of the drain and incision is dried carefully.
- The nurse will instruct you on how to care for the drains and empty the collecting device. A teaching sheet will be given to you prior to discharge. This sheet will tell you how to care for the drains and how to empty them.
- You will probably go home with staples or steri-strips (thin white Band-Aids) if you had groin nodes removed. They will help your incision heal. Staples are metal clips that are used in addition to sutures to help close the incision. Your incision may be slightly red around the stitches or staples. This is normal. The staples are removed 10-14 days after surgery. You should call to schedule an appointment with the nurse to have them removed.
- After removing the staples, steri-strips may be applied. The steri-strips can be removed at your doctor's discretion. You may shower with the staples or steri-strips in place. When the steri-strips begin to curl up, you may peel them off. With time, the color of your incision will fade and become less noticeable. This will take 6-12 months. You will also have stitches in the vulva area that will dissolve. It can take six to eight weeks for these stitches to dissolve.
- Wear loose-fitting clothing that will not rub or irritate the incision area.
- Do not put anything into the vagina. This includes tampons, douching or having sexual intercourse. Your doctor will advise you when this area is healed well enough. This is usually in about eight weeks.
- Your doctor will write you a prescription for pain medication when you go home. After surgery, discomfort may be mild to moderate. Take your pain medication before the pain becomes severe. This will give you better pain control. If you find that you are having a lot of discomfort as your activity increases, try taking your pain medication one-half hour before that activity. If your pain is not relieved by medication, please call your physician. Pain medication may cause constipation. To prevent constipation, when you are taking pain medication drink more fluids, eat more high fiber foods and use a stool softener such as Colace. It is also okay to take an over-the-counter laxative such as Milk of Magnesia if constipation is a problem
- Take all of the medications you were on before the operation, unless any of those medications have been changed or stopped. If you have any questions about what medicine to take or not to take, please call your surgeon. Your primary care physician is another resource to help answer such questions.
Call if you experience any of the following:
- Temperature greater than 100.5;
- Redness, swelling, tenderness or drainage from your wound;
- Pain that is not relieved by your pain medication;
- A foul odor from your vagina;
- Prolonged constipation or diarrhea even though you have eaten foods and taken medication to relieve it;
- Cough with phlegm; or
- Burning with urination.