Types of surgery for vaginal cancer
There are different types of surgery for vaginal cancer. Your doctor will talk to you about your operation and the possible complications.
How your surgeon decides on your operation
The type of surgery you need depends on the stage of your vaginal cancer. The stage tells you how big the cancer is and how far it has spread. It also depends on where the cancer is in your vagina.
Your surgeon might not be able to tell you the exact stage of your cancer until after surgery.
There are a number of different operations for vaginal cancer and 
(VAIN). Some of the operations for vaginal cancer are major surgery.
Laser surgery for vaginal intraepithelial neoplasia (VAIN)
Vaginal intraepithelial neoplasia (VAIN) means that there are abnormal cells in the inner lining of the vagina. VAIN is not cancer.
Women with severe abnormal cells usually have treatment to prevent the cells from developing into cancer. One of the possible treatments is laser surgery.
The doctor 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 doctor usually uses a local anaesthetic to numb the area in the vagina before treating it.
A wide local excision
You might have an operation called a wide local excision to treat or for small stage 1 cancers that are in the lower part of the vagina.
A wide local excision means that the surgeon removes the cancer and a border of healthy cells from all around the abnormal area.
If the border is completely free of cancer cells, it’s called a clear margin. This is important because having a clear margin means there is less chance of the cancer coming back.
Your doctor may also remove lymph nodes from your groin.
To have this operation, your surgeon might use a or you might have a spinal anaesthetic. This is an injection into your spine to numb the lower part of your body during surgery.
Removing part or all of your vagina
An operation to remove the upper part of the vagina is a partial vaginectomy. A total vaginectomy is an operation to remove the whole vagina. The operation you have depends on how much of the vagina is affected by the cancer.
For early stage cancers that are in the upper part of the vagina, you usually have all or part of the vagina removed. Your doctor also removes your womb and cervix, and the lymph nodes on both sides of your pelvis. If you have had your womb or cervix removed previously you just have the vagina and pelvic lymph nodes removed.
Your doctor may suggest you have a vaginal reconstruction after having your vagina removed. A reconstruction uses skin and muscle from other parts of your body to create a new vagina. This surgery is not suitable for everyone. Also, some people may decide they don't want to have this extra surgery.
Removing your womb, cervix and vagina
Your surgeon removes all of your vagina. They also remove:
- your womb (uterus)
- the cervix
- all the tissues holding your womb in place
- all the lymph nodes around the womb
This is called a radical hysterectomy. The surgeon removes the surrounding tissues in case cancer cells have spread there.
You will be in hospital for about 3 to 10 days. You need to recover at home for at least another 6 weeks or so.
Removing the ovaries
Your doctor may suggest taking out your ovaries if you have been through the . Vaginal cancer doesn’t usually affect the ovaries. But some surgeons think it’s worth doing because it removes the risk of cancer of the ovary in the future.
Some women agree with the surgeon to reduce any possible risk. Others would rather not have their ovaries removed as well as the womb. There is no right or wrong way to feel about this. You may want to take some time to talk about this with your specialist, cancer nurse, or a close family member or friend.
Removing your vagina, womb, bladder, rectum and part of the bowel
You need a major operation if the cancer has spread outside your vagina to nearby lymph nodes and organs. Or you might have this surgery if the cancer has come back (recurred) and you previously had radiotherapy.
Your surgeon removes:
- your vagina
- your womb (uterus)
- the cervix
- all the tissues holding your womb in place
- all the lymph nodes around the womb
Depending on where the cancer is your surgeon might also need to remove your:
- bladder
- rectum (back passage)
- another part of the bowel
If your surgeon removes all these organs, it is called a total pelvic exenteration. This is not a very common operation for 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 could take about 6 months to get over the changes to your body. Some women say that it can take much longer to adjust completely.
This type of surgery is more often used for cervical cancer. You can find more information about pelvic exenteration in the cervical cancer section.
Having your bladder removed
Without your bladder, you need another 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 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.
There is more information about having a urostomy in the bladder cancer section.
You might have a different type of operation called a continent urinary diversion, which means you don’t need to wear a bag. Instead you put a thin tube into the urostomy several times a day to drain the urine.
Having your rectum and part of your bowel removed
You will need a new opening for your poo (faeces) if your back passage (rectum) is removed. 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 wear a bag over the colostomy to collect your faeces.
During this operation, your surgeon will also remove the lymph nodes around the bowel. This is in case the cancer has spread there.
The surgeon may not know whether you need a permanent colostomy until you have the operation to remove the cancer. You might only need a temporary one.
You have the temporary colostomy put back (or reversed) when the bowel has healed. It may not be clear how big the cancer is, or how much of the bowel is affected until you have surgery. Your surgeon will explain this 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 more information about having a colostomy in the bowel cancer section.
Removing the lymph nodes
During your operation your surgeon might remove some or all of the around your vagina. These are from your lower tummy (pelvis) or groin.
A pathologist checks the lymph nodes to see if they contain cancer cells. Knowing whether cancer is present helps your doctor work out the stage. They can then decide which further treatment following surgery is best for you.
Emotional effects
Vaginal surgery is probably one of the more difficult types of surgery to cope with emotionally and physically. It is one of the most private parts of a woman's body and plays a very big role in sexual life.
You might find it useful to talk to someone about the effect that surgery is having on your everyday life. Ask your doctor or nurse what support is available in your area. You could ask about counselling if you think this might help.
Vaginal cancer is rare. So it can be difficult to find people at the same hospital going through a similar experience to you. You could contact other national organisations and charities or join an online discussion group.
