Types of surgery for vaginal cancer

There are different types of surgery for vaginal cancer and vaginal intraepithelial neoplasia (VAIN) Open a glossary item . Some of these are major surgery.

The type of operation you have depends on the size and position of the cancer. Your surgeon and specialist nurse will explain the surgery that is best for you and the possible complications.

Surgery to remove just the area of cancer

Surgery to remove just the area of cancer is also called a wide local excision. You might have a wide local excision to:

treat VAIN
remove small stage 1 cancers from the lower part of the vagina.

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. Having a clear margin means there is less chance of the cancer coming back.

Your surgeon may also remove lymph nodes Open a glossary item from your groin.

To have this operation, you have a general anaesthetic Open a glossary item . Or you might have a spinal anaesthetic. This is an injection into your spine to numb the lower part of your body during surgery.

Diagram showing a wide local excision for vaginal cancer

Surgery to remove part or all of your vagina

The operation you have depends on how much of the vagina is affected by the cancer:

Surgery to remove just the upper part of the vagina is called a partial vaginectomy.
Surgery to remove the whole vagina is called a total vaginectomy.

For early stage cancers in the upper part of the vagina, your surgeon also removes:

your womb
your cervix
the lymph nodes on both sides of your pelvis

You might have had previous surgery to remove your womb or cervix. If this is the case, your surgeon just removes your vagina and pelvic lymph nodes.

Your surgeon may suggest you have a vaginal reconstruction after they remove your vagina. A reconstruction uses skin and muscle from other parts of your body to create a new vagina. This surgery is not suitable for everyone. Some people may decide they don't want to have this extra surgery.

Surgery to remove your womb, cervix and vagina

Your surgeon removes all or part 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.

Your surgeon may suggest taking out your ovaries if you have been through the menopause.

Diagram showing radical hysterectomy including removal of the vagina

Removing your vagina, womb, bladder, rectum and part of the bowel

This is for cancer that has spread outside your vagina to nearby lymph nodes and organs. Or you might have this surgery if the cancer comes back (recurs) 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)
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.

Diagram showing the organs removed with an operation called a total exenteration

These operations are very big and are difficult to cope with. It can be especially difficult if the surgeon removes your bladder and bowel along with your vagina and womb. It can take a long time to recover afterwards.

This type of surgery is more common 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 pee.

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 pee.

Having your rectum and part of your bowel removed

You will need a new opening for your poo (faeces) if the surgeon removes your back passage (rectum). Your surgeon makes an opening in your abdomen. They bring the healthy end of the bowel to the outside and stitch it in place. This is called a colostomy. You wear a bag over the colostomy to collect your faeces.

Some people have a temporary colostomy. It is closed a few months later when the bowel has fully healed. Some people have a permanent colostomy.

Removing the lymph nodes

During your operation your surgeon might remove some or all of the lymph nodes 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.

Diagram of the lymph nodes in the pelvis

Emotional effects

Vaginal surgery is difficult to cope with emotionally and physically. It is one of the most private parts of your body and plays a very big role in sexual life.

You might find it useful to talk to someone about the effect of surgery on your everyday life. Ask your healthcare team 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.