Surgery for Vaginal Cancer

Types of surgery used for vaginal cancer

Several types of surgery can be done to treat vaginal cancer.

Local excision

This is sometimes called a wide excision. The surgeon takes out the cancer along with a nearby edge or rim of normal tissue. For vaginal intraepithelial neoplasia (VaIN), a local excision might be all that’s needed. For small stage I cancers, treatment might include a local excision along with surgery to check the lymph nodes (see below).

Vaginectomy

Vaginectomy is surgery to remove the vagina.

• Partial vaginectomy: Only part of the vagina is removed.
• Total vaginectomy: The entire vagina is removed.
• Radical vaginectomy: The vagina, along with the supporting tissues around it, are removed. This might be considered for people with vaginal cancer that cannot be treated with radiation or chemotherapy.

If a person has a uterus, it is often removed when a partial or total vaginectomy is done. This procedure is called a concurrent hysterectomy (see below).

Vaginal reconstruction

If all or most of the vagina must be removed, it might be possible for a surgeon to build a new vagina with tissue from another part of the body. It might be made from skin, a combination of muscle and skin from other areas of your body, or a clean piece of bowel. Your new vagina can allow you to have vaginal sex, but lubrication might be needed.

A reconstructed vagina needs special care. See How Cancer Surgery Can Affect Sex for Women to learn more.

Trachelectomy

Vaginal cancer most often starts in the upper part of the vagina near the cervix, so removing the cancer sometimes means also removing the cervix. If the cervix is removed but the uterus isn’t, the operation is called a trachelectomy. This is rarely done to treat vaginal cancer. See Surgery for Cervical Cancer for more about this procedure.

Hysterectomy

A hysterectomy (total hysterectomy) removes vaginal cancer, the uterus, and cervix with all or part of the vagina.

Types of hysterectomies

A bilateral salpingo-oophorectomy (BSO) removes the fallopian tubes and ovaries. When this is done along with a hysterectomy it is called a total abdominal hysterectomy bilateral salpingo-oophorectomy (TAHBSO).

A radical hysterectomy also removes the connective tissue that surrounds and supports the uterus. If you have a radical hysterectomy, you might need to have a catheter drain your bladder for a short time after surgery. This is because some of the nerves to the bladder can be damaged or removed.

Ways hysterectomies are done

There are a few ways hysterectomies can be done. Your doctor will talk to you about the approach that’s best for you before surgery.

• Abdominal hysterectomy: The uterus is removed through a 6- to 8-inch cut (incision) in the abdomen.
• Laparoscopic abdominal hysterectomy: The uterus is removed through 3 to 5 small cuts in the belly using a laparoscope, a thin, lighted tube with a camera on the end where small tools can be inserted and used.
• Robotic-assisted hysterectomy: The uterus is removed through the vagina or small cuts in the abdomen with a laparoscope. With a robotic approach, the surgeon sits at a control panel in the operating room, using robot arms to operate.
• Vaginal hysterectomy: The uterus is removed through the vagina.
• Laparoscopic vaginal hysterectomy: The uterus is removed through the vagina with the assistance of a laparoscope.

Surgery to remove lymph nodes (lymphadenectomy)

Surgery to remove lymph nodes is called lymphadenectomy or lymph node dissection.

Depending on where the cancer is in the vagina, lymph nodes in the groin area (inguinal lymph nodes) or inside the pelvis near the vagina (pelvic lymph nodes) might be taken out to check for cancer spread (metastasis). This is generally done for people with very early-stage vaginal cancer.

Possible side effects

If lymph nodes are removed, it can affect fluid drainage from the legs. If fluid builds up, it can cause lymphedema (swelling). This is more common if radiation or chemotherapy is given after surgery.

Support stockings or special compression devices might help reduce swelling. People with lymphedema need to be very careful to avoid an injury or infection in the affected leg or legs.

Pelvic exenteration

Pelvic exenteration is a major surgery that includes vaginectomy, removing the pelvic lymph nodes, and removing one or more of the following: the lower colon, rectum, bladder, uterus, and/or cervix. How much is removed depends on where the cancer has spread.

This surgery is not often needed for vaginal cancers but might be considered if the cancer comes back after other treatments or radiation can’t be used.

Anterior (front) pelvic exenteration

An anterior exenteration removes reproductive organs such as the vagina, cervix, and uterus and parts of the urinary system, such as the bladder.

If the bladder is removed, a new way to store and get rid of urine is needed. Surgeons can repurpose a short piece of intestine as a new bladder. This might be connected to the abdominal (belly) wall with a small opening called a urostomy. Urine can then be drained out through the belly either with a catheter or a small bag over the opening. Learn more in About Urostomies.

Posterior (back) pelvic exenteration

A posterior pelvic exenteration removes reproductive organs such as the vagina, cervix, and uterus and parts of the digestive system, such as the rectum or part of the colon.

If the rectum and part of the colon are removed, a new way to get rid of stool is needed. This is done by attaching the remaining intestine to the abdominal (belly) wall so that stool can pass through a small opening called a colostomy into a small plastic bag. Learn more in About Colostomies.

Recovery after pelvic exenteration

Recovery from total pelvic exenteration takes a long time. Most people don't begin to feel like themselves again for about 6 months after surgery. Some say it takes a year or two to adjust completely.

Nevertheless, they still can lead happy and productive lives. With practice, they can also have sexual desire, pleasure, and orgasms.

Coping with surgery for vaginal cancer

Vaginal cancer surgery can cause physical changes, which can affect your emotions, your identity, and the way you have sex.

Before surgery, it is important to ask the surgeon about the procedure, the possible side effects, and how it might impact your ability to have sex. Certain therapies, such as vaginal or pelvic floor therapy or the use of dilators, might help improve vaginal function after surgery.

Learn more in How Cancer Surgery Can Affect Sex for Women.