Surgery for Vaginal Cancer

Surgery is usually only used for small stage I or II vaginal cancers and for cancers that were not cured with radiation. The extent of the surgery depends on the size, location, and stage of the cancer.

Types of surgery used for 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 VAIN, a local excision may be all that's needed. For small stage I cancers, treatment may include a local excision along with surgery to check the lymph nodes (see below).

Vaginectomy

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.

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 only the cervix is removed (leaving the rest of uterus behind), the operation is called a trachelectomy. (See Surgery for Cervical Cancer for more about this procedure.) This is rarely done to treat vaginal cancer.

Hysterectomy

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).

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.

In some cases, the connective tissue that surrounds and supports the uterus is also removed. This is called a radical hysterectomy. If you have a radical hysterectomy, you may 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.

In either case, there are 2 main ways to remove the uterus:

  • Removing the uterus through the vagina is called a vaginal hysterectomy (or VH).
  • Removing the uterus through an incision (cut) in the abdomen (belly) is called an abdominal hysterectomy (or total abdominal hysterectomy; TAH).

For abdominal hysterectomy, sometimes special procedures are used to avoid making a large cut in the abdomen:

  • Laparoscopic hysterectomy: Often these surgeries are done through very small surgical incisions (cuts) on the abdomen. A laparoscope – a thin lighted tube with a camera that's put into one of the cuts – is used to see inside the abdomen and pelvis. Small instruments can be controlled through the tube or used in other small cuts to do the surgery. This allows surgeon to do the hysterectomy without making a large cut in the abdomen.
  • Robot-assisted surgery: Many surgeries are also done using a robotic interface. For this, the surgeon sits at a panel near the operating table and controls tools on robotic arms to perform the operation through small cuts in the abdomen/pelvis.

Your doctor will talk to you about the approach that's best for you before surgery is planned.

Vaginal reconstruction

If all or most of the vagina must be removed, it's possible to reconstruct (rebuild) a vagina with tissue from another part of the body. This allows a woman to have sex after surgery. A new vagina can be surgically created out of skin, intestinal tissue, or myocutaneous (muscle and skin) grafts.

A reconstructed vagina needs special care. See Sex and the Woman With Cancer to learn more.

Surgery to remove lymph nodes (lymphadenectomy)

Surgery to remove lymph nodes is called lymphadenectomy or lymph node dissection. For vaginal cancer, lymph nodes in the groin area or inside the pelvis near the vagina may be taken out to check for cancer spread.

Removing lymph nodes in the groin or pelvis can cause poor fluid drainage from the legs. The fluid builds up, leading to severe leg swelling that doesn’t get better at night when you're lying down. This is called lymphedema. This is more common if radiation is given after surgery. Chemotherapy after surgery is also linked to an increased risk.

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.

More information on preventing and managing this problem can be found in Lymphedema.

Pelvic exenteration

Pelvic exenteration is a major operation 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 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 piece of intestine is used to function as a new bladder. This may be connected to the abdominal (belly) wall with a small opening called a urostomy. Urine can then be drained out when the woman places a catheter into the urostomy. Or urine may drain continuously into a small plastic bag that sticks to the abdomen over the opening. More information can be found in Urostomy Guide.

If the rectum and part of the colon are removed, a new way to remove 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 that sticks to the abdomen. More details can be found in Colostomy Guide. Sometimes it’s possible to remove a piece of the colon and then reconnect it. In that case, no bags are needed.

Pelvic exenteration is rarely needed to treat vaginal cancer – radiation therapy is usually used first, and then less extensive surgery might be all that's needed. Still, this procedure might be used for vaginal cancers that have come back after treatment with radiation therapy. It's also sometimes needed to treat vaginal cancers when radiation therapy can't be used, for instance, if a woman has been treated with radiation for cervical cancer in the past. This because treating the same area with radiation more than once can cause severe problems.

More information about Surgery

For more general information about surgery as a treatment for cancer, see Cancer Surgery.

To learn about some of the side effects listed here and how to manage them, see Managing Cancer-related Side Effects.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master's-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Jain V, Sekhon R, Giri S, et al. Role of Radical Surgery in Early Stages of Vaginal Cancer-Our Experience. Int J Gynecol Cancer. 2016;26(6):1176-1181.

Saito T, Tabata T, Ikushima H, et al. Japan Society of Gynecologic Oncology guidelines 2015 for the treatment of vulvar cancer and vaginal cancer. Int J Clin Oncol. 2017 Nov 20.

Sinno A.K. Human papillomavirus genotype prevalence in invasive vaginal cancer from a registry-based population. Obstet. Gynecol. 2014;123(4):817–821. 

Last Medical Review: March 19, 2018 Last Revised: March 19, 2018

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