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Surgery for vaginal cancer
Surgery is a common treatment for vaginal cancer. Surgery is used to:
- potentially cure the cancer by completely removing it
- treat advanced cancer to control the spread of the cancer, reduce pain or ease symptoms and improve quality of life (palliative treatment)
The type of surgery done depends mainly on the size of the tumour, stage of the cancer, location of the tumour, history of prior pelvic radiation and the woman’s overall health. Side effects of surgery depend on the type of surgical procedure.
Wide local incision
A wide local incision is the complete removal of the tumour and a surrounding border of normal healthy tissue. This procedure may be done to remove a small stage I tumour, 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 and sexual function.
A vaginectomy is removal of part of the vagina (upper or lower vaginectomy) or all of the vagina (total vaginectomy). When the vagina and supporting tissues around it are removed (to obtain tumour-free margins), it is called a radical vaginectomy. A vaginectomy may be a treatment option for stage I and stage II vaginal cancer.
A hysterectomy is done when the cervix and uterus must be removed (called a total hysterectomy). The surgery is called a radical hysterectomy if connective tissue that surrounds and supports the uterus is removed as well. Hysterectomy may be used to treat stage I vaginal cancer located near the cervix.
A lymphadenectomy is a surgical procedure that removes lymph nodes. The lymph nodes from inside the pelvis and sometimes the groin may be removed to check for spread of the cancer.
A pelvic exenteration is the removal of the vaginal tumour, pelvic lymph nodes and one or more of the following: lower colon, rectum, bladder, uterus, cervix. Pelvic exenteration is not usually used for vaginal cancer because radiation therapy can often control the cancer with fewer complications. As such, this procedure is often reserved for local cancer recurrence after pelvic radiation therapy. If it is done, the extent of the surgery depends on how far the cancer has spread.
Reconstructive surgery may be done to repair or reconstruct the vagina following a vaginectomy or pelvic exenteration. Vaginal reconstruction restores the structure and function of the vagina.