Surgery for Vaginal Cancer

Usually, surgery is only used for very early-stage 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. Surgery may be the only treatment needed for a very small vaginal 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 vaginal intraepithelial neoplasia (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 vaginectomyremoves the vagina along with the supporting tissues around it. This type of surgery may be considered for patients with vaginal cancer that cannot be treated with radiation or chemotherapy.

A gynecologic or reconstructive surgeon can repair the vagina or create a new vagina with grafts of tissue from other parts of the body (see Vaginal reconstruction below). It still might be possible to have sexual intercourse after this type of surgery, but a lubrication aid may be needed.

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 bilateralsalpingo-oophorectomy (or BSO). You may see the abbreviation TAHBSO, which stands for total abdominalhysterectomy 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 totalabdominal hysterectomy; TAH).

For an 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, is put through one of the cuts 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 lets the surgeon avoid making a large cut in the abdomen.
• Robot-assisted surgery: Many surgeries use a robotic interface. For this, the surgeon sits at a panel near the operating table and controls tools on robotic arms to operate 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, itmight be possible to reconstruct (rebuild) a vagina with tissue from another part of the body. This would allow a person 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 (inguinal lymph nodes) or inside the pelvis near the vagina (pelvic lymph nodes) may be taken out to check for cancer spread (metastasis). This is generally done for patients with very early-stage vaginal cancer.

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. This is called lymphedema. This is a more common development 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. People 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 a catheter is put 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 get rid of 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 bagwould be 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, it may be used if you have been treated with radiation for cervical cancer in the past. This is because treating the same area with radiation more than once can cause severe problems.

Coping with surgery for vaginal cancer

Many people experience a range of feelings after vaginal surgery, such as loss, sadness, or anxiety. Some people may feel that they have lost their identity. Others have questions about whether sexual intercourse can continue after surgery.

Before surgery, it is important to ask the surgeon about the procedure, the possible side effects, and when sexual intercourse can begin again. Talk with the health care team about finding additional information or support in coping with this surgery.