Before and after surgery for vulval cancer

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1 Before and after surgery for vulval cancer This information is an extract from the booklet Understanding cancer of the vulva. You may find the full booklet helpful. We can send you a copy free see page 8. Contents Before your operation After your operation Going home Follow-up Before your operation If you smoke, try to give up or cut down before your operation. This will help reduce your risk of chest problems, such as a chest infection, and will help your wound to heal after the operation. Your GP can give you information, help and support if you want to give up smoking. You may also find it helpful to read our booklet Giving up smoking. You ll usually be admitted to hospital the day before your operation. However, women who have very small early-stage cancers may not need to be admitted the day before their surgery. They may go into hospital, have their surgery and go home on the same day or the following day. A member of the surgical team will discuss the operation with you. You ll also be visited on the ward by the doctor who will give you your anaesthetic (the anaesthetist). You ll be given special elastic stockings (TED stockings) to wear during and after the operation to prevent blood clots forming in your legs. Make sure that you talk to your nurse or doctor about any questions or concerns that you have about the operation. Macmillan and Cancerbackup have merged. Together we provide free, high quality information for all. Questions about cancer? Ask Macmillan Page 1 of 8

2 After your operation There are different types of surgery for vulval cancer. The type of care you receive after your operation, and the speed of your recovery, will depend on the type of surgery you have. We can send you information about the different operations. Lymph nodes Urethra Outer lips Clitoris Inner lips Vagina Perineum Anus The vulva If the cancer is very small and only a small amount of skin is removed, your wound is likely to heal quickly. If your lymph nodes are removed, and particularly if you have more major surgery (such as a radical vulvectomy, where the entire vulva is removed), healing and recovery will take longer. All the tissue that was removed from your vulva will be carefully checked after the operation. If your lymph nodes were removed they will also be examined for signs of cancer. It takes a few days to a week to get the results of these checks. Once your surgeon has the results they ll talk them over with you. This will usually happen during your stay in hospital or at your first outpatient visit after your operation. Page 2 of 8 Questions about cancer? Ask Macmillan

3 Drips and drains When you go back to the ward after your operation you ll be given fluids into a vein in your hand or arm. This is called a drip or intravenous infusion. The drip is usually taken out once you re eating and drinking normally again. You may also be given antibiotics through the drip to stop you getting any infections. You ll usually have a tube (catheter) put in while you re under the anaesthetic, to drain urine from your bladder. The catheter will be taken out after a few days. If your lymph nodes have been removed, you ll have a tube called a wound drain going into your groin. This is to drain any fluid that may collect there. The drain is connected to a small suction bottle. It will be removed from your groin when most of the excess fluid has been drained off usually this is within about seven days. Dressings You may not have any dressings on the vulval wound, as the area is likely to be kept clean by being gently rinsed with fluid. This is usually done three times a day until you go home. If you do have a dressing, it will be removed after a few days and changed regularly to keep the area clean and help the skin to heal. Stitches are usually dissolvable and will disappear as the wound heals. If you have any wounds in your groin area, they will be covered with dressings, which will need to be changed regularly. When the skin has healed you ll be able to go home. Once you re at home, you won t need to put dressings on the area, but it s important to keep it clean and dry. The nurses on the ward will show you the best way to do this before you go home. If necessary, they will arrange for a district nurse to visit you at home to help with rinsing the area and keeping it clean. If you ve had a skin graft, you may need dressings on the area the skin was taken from (the donor site). Usually these dressings stay in place until new skin has formed. Your nurse will explain more about this to you. Questions about cancer? Ask Macmillan Page 3 of 8

4 Pain You ll have some pain and discomfort after your operation, which will be controlled with painkilling drugs. Depending on the extent of your surgery you may need a strong painkiller, such as morphine, for the first day or two after your operation. Morphine may be given to you as tablets, as injections into a muscle (given by the nurses), or through a special pump known as a patient-controlled analgesia pump (PCA pump). If you have a PCA pump it will be attached to a fine tube (cannula), which is placed in a vein in your arm. You can control the pump yourself using a handset that you press when you need more of the painkiller. It s fine to press the handset whenever you have pain, as the pump is designed so that you can t give yourself too much painkiller. You will be shown how to use this type of pump. Some women who have more extensive surgery may have a different method of pain relief called an epidural infusion. A fine tube is inserted through your back into the area just outside the membranes around your spinal cord, called the epidural space. A local anaesthetic and other painkilling drugs are given by infusion (drip) into this space using an electronic pump. The anaesthetic drugs work by numbing the nerves in the operation area and reducing pain. It s important to let the nurses know if your painkillers don t seem to be working so that they can either increase the dose or arrange for you to have a different painkiller. Bowels You may not have bowel movements for a few days after your operation. This is normal and may be due to the combined effects of the operation, painkillers and changes to your diet and activity levels. You may be prescribed laxatives to prevent constipation. If opening your bowels is painful or difficult, let your doctors know so they can prescribe extra laxatives to help. Rest and activity The nurses will encourage you to start moving about as soon as possible after your operation. This is important for your recovery, as it helps to prevent problems such as chest infections and blood clots. You ll also be given injections of a blood-thinning medicine to prevent blood clots. The injections are usually given under the skin (subcutaneously) in the tummy (abdomen). If you have to stay in bed, the Page 4 of 8 Questions about cancer? Ask Macmillan

5 nurses will encourage you to do regular leg movements and deep-breathing exercises. A nurse or a physiotherapist can help you do the exercises. If you ve had lymph nodes removed from your groin, you ll be encouraged to put your feet up when you re sitting down. This helps fluid to drain in your legs. Changes to your vulva There may be numbness or altered sensation around the operation site after surgery. This is due to the effects of the surgery on the nerves close by. It often improves over a period of months. Some types of vulval surgery can change the appearance of your genital area. How you approach looking at the vulval area after your operation will be very personal to you. If you ve never looked at your vulva before, the idea of doing so may seem strange. You may not want to look at the area at all, or you may want a nurse with you when you look for the first time. A nurse can explain what s happened to the area and offer support and advice. You may prefer to look alone or with a partner, relative or friend. Whoever you choose, make sure it s someone that you trust and can talk to about your feelings. Don t force yourself to do things before you feel ready. If you decide to look at the area where you had surgery remember that you may feel shocked, even if you were well prepared. This is understandable. Our cancer support specialists on can give you details of organisations you can talk to about your feelings. How you might feel It s common to feel upset and tearful after the operation. This can be a natural reaction to the diagnosis of cancer, the effects of the operation and being away from home and family. You may find these feelings pass after a few days, or you may continue to feel this way after you go home. Let your doctor or specialist nurse know if you aren t feeling better or if you begin to feel depressed, as you may need extra help and support. Some hospitals have local support groups for women who have gynaecological cancers. If you think you d find a support group helpful, let your clinical nurse specialist know. They will be able to tell you if there s one in your hospital or the local area. Questions about cancer? Ask Macmillan Page 5 of 8

6 You could also join an online support group. Visit our social networking site at macmillan.org.uk/community There you can chat with other people who have vulval cancer, or just read through the posts or blogs other people have written. Going home When you go home you ll need to take things easy for a few weeks. How long it takes you to recover will depend on the extent of your surgery. If you ve had major surgery, it s very important not to lift any heavy objects for at least 6 8 weeks. This will help the skin to heal completely. It s advisable to wait about eight weeks before going back to work, but you may need longer if you heal more slowly. You can usually start driving after six weeks, but you should check with your specialist and car insurance provider first, as they may want you to wait longer before you drive again. If your operation involved removing only a small amount of skin, your recovery will be much quicker. Your doctor will advise you on what to expect and the precautions you should take. Here are some other helpful tips to consider: Avoid wearing tight clothing and using any lotions, perfumes and talcum powders in the area where you had your operation. Avoid doing a lot of walking until the skin has healed. Frequent baths with warm water can soothe the wound and help healing, but avoid using scented bath oils and bubble bath. Some women find that a sitz bath (a type of bath that fits over the toilet and allows you to soak just your buttocks and genital area) is easier to use. If you can t get a sitz bath locally, you can buy one online. If passing urine makes your wound sting, try pouring a small jug of warm or tepid water over the wound while you re still sitting on the toilet. A hairdryer on a cool setting can be a more comfortable way of drying the vulval skin than a towel. Wear loose-fitting skirts. Page 6 of 8 Questions about cancer? Ask Macmillan

7 Follow-up If you can avoid wearing underwear, this may help to keep you more comfortable. However, it won t be possible to avoid wearing underwear if you have to keep pads in place. If you become constipated, ask your doctor to prescribe you some laxatives. Before you leave hospital, the staff can arrange for a district nurse to visit you at home. They can also organise other support services if you need them. Sex It s safe to start having sex again once your wound has completely healed, which usually takes about 6 8 weeks. However, many women need longer than this to feel physically or emotionally ready for sex. A few women may develop some tightening and scar tissue at the entrance to the vagina, which can make sex more difficult. If this happens it s important to discuss it with your doctor or nurse. They will be able to give you advice and support. Most women feel shocked and upset by the idea of having surgery to the vulva. When these strong feelings are combined with the trauma of surgery and all the emotions that go with having a cancer diagnosis, it s understandable that your sex life will be affected. We have more information about sex and sexuality after treatment for vulval cancer. You ll have an appointment with your surgeon in the outpatient clinic 4 6 weeks after surgery. They will check how well your skin is healing and discuss any problems with you. If you have any problems or worries before this follow-up appointment, contact your hospital doctor or the nurses on your ward for advice. After all your treatment has finished, you ll be asked to go back to the hospital for regular check-ups. How frequent these are and which tests you ll have will depend on your individual situation. Questions about cancer? Ask Macmillan Page 7 of 8

8 More information and support Cancer is the toughest fight most of us will ever face. But you don t have to go through it alone. The Macmillan team is with you every step of the way, from the nurses and therapists helping you through treatment to the campaigners improving cancer care. We are Macmillan Cancer Support. To order a copy of Understanding cancer of the vulva or any of the other booklets mentioned in this information, visit be.macmillan.org.uk or call We make every effort to ensure that the information we provide is accurate but it should not be relied upon to reflect the current state of medical research, which is constantly changing. If you are concerned about your health, you should consult your doctor. Macmillan cannot accept liability for any loss or damage resulting from any inaccuracy in this information or third party information such as information on websites to which we link. Macmillan Cancer Support Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ REVISED IN MARCH 2012 Planned review in 2014 Page 8 of 8 Questions about cancer? Ask Macmillan