Which surgery for vaginal cancer?
This page tells you about the different operations for vaginal cancer.
- A quick guide to what's on this page
- How your surgeon decides on your operation
- Laser surgery for VAIN
- Removing the cancer (wide local excision)
- Removing part or all of your vagina
Which surgery for vaginal cancer
Surgery for vaginal intraepithelial neoplasia may be laser surgery. And for small vaginal cancers it may be removing a small area of tissue. But some of the operations are major surgery. The different types of vaginal cancer operations include
- Wide local excision, which takes out the cancer and some of the healthy tissue around it
- Surgery to remove part or all of your vagina, along with surrounding tissues (partial or total vaginectomy)
- Surgery to remove your womb, cervix, the upper part of your vagina, lymph nodes and the surrounding tissues (radical hysterectomy)
- Surgery to remove your vagina, womb, bladder, rectum (back passage) and part of your bowel (pelvic exenteration)
Vaginal surgery can be one of the more difficult types of surgery to cope with emotionally and physically. The vagina is one of the most private parts of our bodies and plays a very big role in our sexual life. If your doctor has not fully explained these operations to you yet, reading about them here may come as a shock. It may help to get support from a family member, close friend, specialist nurse or one of the cancer support organisations.
You can view and print the quick guides for all the pages in the treating vaginal cancer section.
The amount of surgery you need will depend on the stage of your vaginal cancer. The tests you had will help your specialist to decide whether surgery is an option for you. But your doctor may not be able to tell you the exact stage of your cancer until after surgery. Our information on treatment by vaginal cancer stage gives a brief overview of possible treatments.
There are a number of different operations for cancer of the vagina. Some women with vaginal intraepithelial neoplasia (VAIN) may have laser surgery. For stage 1 vaginal cancer the surgeon may cut out the cancerous area and a surrounding border of healthy tissue. This is called wide local excision. These operations may be done using a spinal anaesthetic or general anaesthetic.
Some of the other operations for vaginal cancer are major surgery. They all need a general anaesthetic. So you will be asleep for the whole operation. The amount of tissue your surgeon needs to remove will depend on where the cancer is in your vagina. It will also depend on whether it has spread outside your vagina.
In vaginal intraepithelial neoplasia (VAIN) the cancer cells are only in the lining of the vagina. The surgeon uses a laser beam (a narrow beam of intense light) to destroy the areas of abnormal cells. This treatment can work well even for large areas of VAIN.
The name of the operation to remove the whole vagina is total vaginectomy.
An operation to remove the upper part of the vagina is a partial vaginectomy. The operation you need will depend on how much of the vagina is affected by the cancer.
If you need a total vaginectomy, a plastic surgeon may be able to make a new vagina (vaginal reconstruction). This uses skin and muscle from other parts of your body. Vaginal reconstruction means that you can have intercourse but you will need to use an artificial lubricant. The lining of the new vagina cannot make the mucus it would naturally make. This can take some time to get used to.
If the cancer has spread through the wall of your vagina and is starting to spread to surrounding tissues, you may have your vagina removed (vaginectomy) along with surgery to take out
- Your womb (uterus)
- All the tissues holding your womb in place
- All the lymph nodes around the womb
This is called a radical hysterectomy (or Wertheim's hysterectomy). The surgeon removes the surrounding tissues in case cancer cells have spread there before your surgery. Removing them helps to prevent the cancer from coming back in your bowel, bladder or nearby lymph nodes.
This is quite a big operation. You will be in hospital for about 3 to 10 days. And you will need to recover at home for at least another 6 weeks or so.
If you have had your menopause, your doctor may suggest taking out your ovaries as well. The cancer does not usually affect the ovaries, but some surgeons think it is worth doing because it removes the risk of cancer of the ovary in the future. You are no more at risk of cancer of the ovary than a woman who has not had cancer of the vagina, so this is a very personal decision. Some women agree with the surgeon that they may as well reduce any possible risk. Other women would rather not have their ovaries removed as well as their womb. There is no right or wrong way to feel about this. You may want to take some time to talk this over with your specialist, your specialist nurse, or a close family member or friend.
If you have not had your menopause, it may be possible to leave your ovaries. Removing them would put you into a premature menopause. If your ovaries do need to be removed, your doctor may suggest you take hormone replacement therapy (HRT) to prevent menopausal symptoms and bone thinning (osteoporosis).
If the cancer has spread outside your vagina to nearby lymph nodes and organs, you may need a very major operation to try to cure the cancer. This means having a radical hysterectomy plus possible removal of your
- Rectum (back passage) and
- Part of your bowel
If all these organs are removed, it is called a total pelvic exenteration. This is not a very common operation for patients with vaginal cancer.
These operations are very big and are difficult to cope with. It can be especially difficult if you have your bladder and bowel removed along with your vagina and womb. It can take a long time to recover afterwards. It is unlikely that you will begin to get over the changes to your body for at least 6 months. Some women say that it can take much longer to adjust completely.
This type of surgery is more often used for locally advanced cervical cancer. So, you can find detailed information about pelvic exenteration in the cervical cancer section. There is information about how to deal with these changes in the section about living with vaginal cancer.
Your surgeon may remove your bladder as part of a pelvic exenteration. Without your bladder, you will need to have some other way of collecting and storing urine. The most common way of doing this is to have an opening formed on the outside of the tummy (abdomen). This is called a urostomy. You need to wear a waterproof bag over the urostomy to collect your urine. You empty the bag as often as you would normally go to the toilet to pass urine.
If your back passage (rectum) is removed, you will need a new opening for your stools (faeces). Your surgeon makes an opening in your abdomen, brings the healthy end of the bowel to the outside and stitches it in place. This is called a colostomy. You have to wear a bag over it to collect your faeces. During this operation, your surgeon will also remove the lymph glands around the bowel, in case the cancer has spread there.
Occasionally, the surgeon may not know whether you need a permanent colostomy until you have the operation to remove the cancer. You may only need a temporary one. A temporary colostomy can be put back (or reversed) when the bowel has healed. It may not be clear how big the tumour is, or how much of the bowel is affected, until you have surgery. Your surgeon will explain this to you before the operation.
Your surgeon will not do a permanent colostomy unless it is absolutely necessary. You will be able to ask questions about why you need this type of operation before you sign the consent form. There is detailed information about colostomy in the bowel cancer section.
Vaginal surgery is probably one of the more difficult types of surgery for women to cope with emotionally and physically. It is one of the most private parts of our bodies and plays a very big role in our sexual life. If your doctor has not fully explained these operations to you yet, reading about them here may come as a shock.
You may find that you need to have someone you can talk to in depth about the effect that surgery will have on your everyday life, both emotionally and physically. You may want to have your partner or a good friend with you to support you during hospital appointments. For more information about where to get support, look at the vaginal cancer organisations list. You can find details of counselling organisations in this section.
If you want to find people to share experiences with on line, you could use CancerChat, our online forum. Or go through My Wavelength. This is a free service that aims to put people with similar medical conditions in touch with each other.
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