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Surgery for vaginal cancer
Surgery is sometimes used to treat vaginal cancer. The type of surgery you have depends mainly on the size of the tumour, stage of the cancer, where the tumour is and whether you have had radiation to the pelvis. When planning surgery, your healthcare team will also consider other factors, such as your age, overall health and personal preferences.
Surgery may be done for different reasons. You may have surgery to:
- completely remove the tumour
- restore the structure of the vagina
- control the spread of the cancer
- reduce pain or ease symptoms (called palliative surgery)
The following types of surgery are used to treat vaginal cancer. You may also have other treatments before or after surgery.
Wide local excision
A wide local incision removes the tumour and a wide area of tissue around it. This surgery may be done to remove a small stage I vaginal carcinoma, especially if the tumour is located in the lower part of the vagina. It may also be done for melanoma of the vagina. It may be an option for younger women who wish to preserve their fertility.
A vaginectomy removes part of the vagina (upper or lower vaginectomy) or all of the vagina (total vaginectomy). When all of the vagina and the supporting tissues around it are removed, it is called a radical vaginectomy. A vaginectomy may be a treatment option for stage I and stage II vaginal carcinoma and melanoma of the vagina.
A hysterectomy removes the uterus. The following types of hysterectomies may be done to treat stage I vaginal carcinoma that is close to the cervix or vaginal sarcoma.
Total hysterectomy removes the cervix and uterus.
Radical hysterectomy removes the cervix, uterus, some of the structures and tissues near the cervix and upper vagina and nearby lymph nodes. Surgery to remove these lymph nodes is called a lymph node dissection or lymphadenectomy (LND).
A hysterectomy may be done through the abdomen (called abdominal hysterectomy). Less often, hysterectomy may be done through the vagina (called vaginal hysterectomy). Some doctors may also do a hysterectomy by laparoscopic or robotic surgery. Laparoscopic and robotic surgeries use a thin, tube-like instrument with a light and lens (called a laparoscope) to look at organs inside the body. The surgeon makes small incisions, or cuts, in the abdomen and then passes the laparoscope and surgical tools through those cuts to remove tissue.
Find out more about hysterectomies.
Lymph node dissection
Surgery to remove lymph nodes is called a lymph node dissection or lymphadenectomy. It is often done at the same time as a hysterectomy. The surgeon may remove lymph nodes in the pelvis and the groin so they can be checked to see if they have cancer cells in them.
Find out more about lymph node dissections.
A pelvic exenteration removes the cervix, uterus, vagina, ovaries, fallopian tubes and nearby lymph nodes. The bladder, rectum or both may be removed. In some cases, the vulva is also removed.
This surgery is sometimes done to treat vaginal cancer that recurs, or comes back, within the pelvis (called local recurrence) after it is has been treated with radiation therapy. It is the most common surgery for vaginal sarcoma.
Find out more about pelvic exenterations.
Reconstructive surgery may be done to repair or reconstruct the vagina following a vaginectomy or pelvic exenteration. Vaginal reconstruction helps restore the structure and function of the vagina. The vagina may be reconstructed at the same time as the vaginectomy or pelvic exenteration.
The vagina can be created out of skin, pieces of intestinal tissue or muscle and skin grafts. Skin can be taken from the buttock or inner thigh, flaps of muscle can be taken from the wall of the abdomen and flaps of muscle and skin can be taken from the inner thighs.
The surgeon shapes the flaps and skin and sews them into the area where the vagina was. Once it heals, the newly created vagina (called a neovagina) is much the same size and shape as the woman’s original vagina.
Not all women choose to have vaginal reconstruction. It will be needed if you want to continue to have sexual intercourse. Some women also feel that having reconstruction is important for their body image and quality of life.
A reconstructed vagina does not make the natural lubricants that a normal vagina does. These natural lubricants help keep the vagina clean and also help moisten the vagina during sex. After surgery, the woman will be taught how to manage vaginal dryness.
Women are encouraged to continue regular intercourse after their surgery or to use a vaginal dilator to maintain the shape and function of the neovagina.
Side effects can happen with any type of treatment for vaginal cancer, but everyone’s experience is different. Some women have many side effects. Other women have only a few side effects.
If you develop side effects, they can happen any time during, immediately after or a few days or weeks after surgery. Sometimes late side effects develop months or years after surgery. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.
Side effects of surgery will depend mainly on the type of surgery and your overall health.
Surgery for vaginal cancer may cause these side effects:
- bladder problems, including losing the feeling of having to urinate or not being able to empty the bladder completely
- lymphedema in the legs
- treatment-induced menopause
- sexual problems, including vaginal dryness and painful intercourse
- bowel obstruction
Tell your healthcare team if you have these side effects or others you think might be from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.