Surgery is usually only used for small stage I tumors and for cancers that were not cured by radiation. Surgery is also used for sarcomas and melanomas.

The extent of the surgery depends on the size and stage of the cancer.

Local excision

In this procedure, the surgeon removes the cancer along with a surrounding rim of normal tissue. This 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

Vaginectomy is surgery to remove the vagina. If only part of the vagina is removed, it is called a partial vaginectomy. If the entire vagina is removed, it is called a total vaginectomy. A radical vaginectomy is when the vagina is removed along with the supporting tissues around it.

Hysterectomy

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 uterus and cervix. If only the cervix is removed (leaving the uterus behind), it is called a trachelectomy. When both the uterus and cervix are removed, the 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. There are 2 major ways to remove the uterus. If it is removed through the vagina it is called a vaginal hysterectomy (or VH). If the uterus is removed through an incision in the abdomen, it is called an abdominal hysterectomy (or total abdominal hysterectomy -- TAH). 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.

Vaginal reconstruction

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 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 lubricating gel 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 the impact of vaginal reconstruction, see our document, "Sexuality and Women: For the Woman Who Has Cancer and Her Partner.")

Lymphadenectomy

Lymphadenectomy is the removal of lymph nodes. It is sometimes 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. This is called lymphedema. 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.

Pelvic exenteration

A pelvic exenteration combines a radical hysterectomy and vaginectomy with removal of some of the organs in the pelvis. It can include removing the bladder, rectum, and/or part of the colon. 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.

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. 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 -- less extensive surgery is usually able to control the cancer. This procedure may 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. This occurs when women were 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.

Last Medical Review: 12/30/2008
Last Revised: 09/14/2009