Surgery for Vaginal Cancer
Surgery is usually only used for small stage I tumors and for cancers that were not cured by radiation. Surgery is not often used to treat squamous cell cancers of the vagina, but it is used for sarcomas and melanomas.
The extent of the surgery depends on the size and stage of the cancer.
In this procedure, the surgeon removes the cancer along with a surrounding rim of normal tissue. This is sometimes called a wide excision. For VAIN, a local excision may be all that is needed. For small stage I cancers, treatment may include a radical wide local excision along with a procedure to evaluate the lymph nodes.
Vaginectomy is surgery to remove the vagina. If only part of the vagina is removed, it’s called a partial vaginectomy. If the entire vagina is removed, it’s called a total vaginectomy. A radical vaginectomy is removal of the vagina along with the supporting tissues around it.
Vaginal cancer is most often found in the upper part of the vagina (near the cervix), so removing the cancer sometimes means also removing the cervix. If only the cervix is removed (leaving the rest of uterus behind), the operation is called a trachelectomy. This operation is rarely used to treat vaginal cancer.
Sometimes to remove a vaginal cancer, the uterus and cervix must be removed, as well as all or part of the vagina. This operation is called a hysterectomy or total hysterectomy (TH). In operations done for cancer, the connective tissue that surrounds and supports the uterus is often removed as well. In that case, the operation is called a radical hysterectomy. In either case, there are 2 major ways to remove the uterus.
- Removing the uterus through the vagina it is called a vaginal hysterectomy (or VH).
- Removing the uterus through an incision in the abdomen, it is called an abdominal hysterectomy (or total abdominal hysterectomy; TAH).
Often these surgeries are done with the help of a laparoscope – a thin lighted tube that is inserted into the abdomen. Many surgeries are also done using a robotic interface. For this the surgeon sits at a panel near the operating table and controls robotic arms to perform the operation through several small incisions in the patient’s abdomen/pelvis.
The approach that is best for you and your cancer will be discussed with you before surgery. The fallopian tubes and ovaries are often removed in the same operation. This procedure is known as a bilateral salpingo-oophorectomy (or BSO). You may see the abbreviation TAHBSO, which stands for total abdominal hysterectomy bilateral salpingo-oophorectomy.
If a radical hysterectomy is done as part of your treatment, you may need to have a catheter to drain your bladder for a time after surgery. This is because some of the nerves to the bladder can be damaged or removed.
If all or most of the vagina must be removed, it is possible to reconstruct (rebuild) a vagina with tissue from another part of the body, which will allow a woman to have sexual intercourse. A new vagina can be surgically created out of skin, intestinal tissue, or myocutaneous (muscle and skin) grafts.
A reconstructed vagina produces little or no natural lubricant when a woman becomes sexually excited. A woman should prepare for intercourse by using a lubricant inside the vagina. If the vagina was rebuilt using muscle and skin from the leg, touching the new vagina may make a woman feel as though her thigh is being stroked. This is because the walls of the vagina are still attached to their original nerve supply. Over time, these feelings become less distracting and may even become sexually stimulating. (For more information about vaginal reconstruction, see Sexuality for the Woman With Cancer.)
Surgery to remove lymph nodes (lymphadenectomy)
Surgery to remove lymph nodes is called lymphadenectomy or sometimes is called lymph node dissection. For vaginal cancer, lymph nodes from the groin area or from inside the pelvis near the vagina may be removed to check for cancer spread.
Removing lymph nodes in the groin or pelvis can result in poor fluid drainage from the legs. The fluid builds up, leading to leg swelling that is severe and doesn’t go down at night when you are lying down. This is called lymphedema. This is more common if radiation is given after surgery. Support stockings or special compression devices may help reduce swelling. Women with lymphedema need to be very careful to avoid infection in the affected leg or legs. They can do this by taking these precautions:
- Protect the leg and foot from sharp objects and care for any cuts, scratches, or burns right away
- Avoid sunburn of the affected leg(s) and avoid cutting or tearing the cuticles of the toenails
- Report any redness, swelling, or other signs of infection to the nurse or doctor without delay
More information about lymphedema can be found in Understanding Lymphedema – (For Cancers Other Than Breast Cancer).
Pelvic exenteration is an extensive operation that includes vaginectomy and removing the pelvic lymph nodes, as well as of one or more of the following structures: the lower colon, rectum, bladder, uterus, and cervix. How much has to be removed depends on how far the cancer has spread.
If the bladder is removed, a new way to store and get rid of urine is needed. Usually a short segment of intestine is used to function as a new bladder. This may be connected to the abdominal wall so that urine is drained periodically when the woman places a catheter into a small opening (called a urostomy). Or urine may drain continuously into a small plastic bag attached to the front of the abdomen over the opening. More information about urostomy can be found in Urostomy: A Guide.
If the rectum and part of the colon are removed, a new way to eliminate solid waste is needed. This is done by attaching the remaining intestine to the abdominal wall so that stool can pass through a small opening (called a colostomy) into a small plastic bag worn on the front of the abdomen. (More information about colostomy can be found in Colostomy: A Guide.) Sometimes it’s possible to remove a piece of the colon and then reconnect it. In that case, no bags or external appliances are needed.
Pelvic exenteration is rarely needed to treat vaginal cancer – radiation therapy is usually used first, and then less extensive surgery may be all that is needed to control cancer that comes back. Still, this procedure might be used for vaginal cancers that have come back after treatment with radiation therapy. It is also sometimes needed to treat vaginal cancers when radiation therapy cannot be used, for example, if a woman has been treated with radiation for cervical cancer in the past. That is because treating the same area with radiation more than once can cause severe complications.
For more information on surgery, see A Guide to Cancer Surgery.
Last Medical Review: June 17, 2014 Last Revised: February 16, 2016