Surgery for vaginal cancer

Surgery is a medical procedure to examine, remove or repair tissue. As a treatment for cancer, it means removing the tumour or cancerous tissue from your body.

Surgery is sometimes used to treat vaginal cancer. The type of surgery you have depends mainly on the size and location of the tumour, the stage of vaginal cancer, and whether you've already 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 the only treatment you have, or it may be combined with other cancer treatments. You may have surgery to:

• completely remove the tumour
• find out if cancer has spread to the lymph nodes
• 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.

A wide local excision removes the tumour and some normal tissue around it. This surgery may be done to remove a small stage 1 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. A wide local excision may be an option if you are young and want to preserve your fertility.

A vaginectomy removes part or all of the vagina. It is called an upper or lower vaginectomy depending on which part of the vagina is removed. It is called a total vaginectomy when all of the vagina is removed. A vaginectomy may be a treatment option for stage 1 and stage 2 vaginal carcinoma and melanoma of the vagina.

When all of the vagina and the supporting tissues around it are removed, it is called a radical vaginectomy. This is usually done as part of a pelvic exenteration, and may be used to treat vaginal cancer that has come back after radiation therapy.

A hysterectomy removes the uterus. The following types of hysterectomies may be done to treat stage 1 or 2 vaginal cancer that is close to the cervix.

A total hysterectomy removes the uterus and cervix.

A radical hysterectomy removes the uterus, cervix, and some of the structures and tissues near the cervix and upper vagina. Lymph nodes are often removed (called a lymph node dissection or lymphadenectomy) during the same surgery.

A hysterectomy may be done through the abdomen (called abdominal hysterectomy). It is less often done through the vagina (called a vaginal hysterectomy).

Find out more about hysterectomies.

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 removes lymph nodes in the pelvis or groin or both to check if cancer has spread to these areas.

Find out more about lymph node dissections.

A pelvic exenteration removes the cervix, uterus, vagina, ovaries, fallopian tubes and nearby lymph nodes. The bladder or rectum or both may be removed. In some cases, the vulva is also removed. The goal of a pelvic exenteration is to completely remove the cancer.

This surgery is sometimes done to treat vaginal cancer that comes back within the pelvis (called local recurrence) after it 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 or later on.

The vagina can be created out of skin, pieces of intestinal tissue, or muscle and skin grafts. Skin can be taken from the buttock, 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 to reconstruct the vagina.

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 original vagina.

Not everyone chooses to have vaginal reconstruction. It will be needed if you want to continue to have vaginal sex. Some people 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, your healthcare team can help you manage vaginal dryness.

People who have had reconstructive surgery are encouraged to continue regular vaginal sex after surgery if they were having it before. They can also use a vaginal dilator (a plastic rod used to open and stretch the vagina) to maintain the shape and function of the neovagina.

Side effects of surgery will depend mainly on the type of surgery and your overall health. Tell your healthcare team if you have side effects that you think are from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Surgery for vaginal cancer may cause these side effects:

• bladder problems, including losing the feeling of having to urinate (pee) or not being able to empty the bladder completely
• lymphedema in the legs
• treatment-induced menopause
• sexual problems, including vaginal dryness and painful vaginal sex
• a bowel obstruction

Find out more about surgery and side effects of surgery. To make the decisions that are right for you, ask your healthcare team questions about surgery.