Vaginal Cancer: Surgery
Surgery is a common way to remove cancer tissue. A gynecologic oncologist can determine if a vaginal tumor can be safely removed with surgery.
Types of surgery for precancer and early stage cancer
Surgery to take out all the cancer is most often used for vaginal cancer that has not spread to other tissues. Cancer that's small and hasn’t spread is called early stage cancer. Your surgeon may use one of these types of surgery:
Laser surgery. A narrow beam of intense light is used like a knife. This allows the surgeon to remove tissue without causing a lot of blood loss. Laser surgery may be used to remove a small area of cancer on the surface of your vagina.
Wide local excision. This procedure removes cancer and some nearby healthy tissue. This method is used for precancer and very small tumors. Healthy tissue is removed from around the cancer to help prevent the cancer from growing back and to be sure that all the cancer has been removed.
Types of surgery for advanced cancer
In some cases, surgery may be done to remove part or all of your vagina. This is done for cancer that has spread (advanced cancer), or cancer that comes back after treatment. If the cancer has spread outside your vagina, your healthcare provider may also remove other reproductive organs. These may include your cervix, uterus, ovaries, and fallopian tubes. The healthcare provider may also remove lymph nodes or other nearby tissues. The types of surgery for advanced cancer include:
Vaginectomy. All or part of your vagina is removed. This is usually done at the same time as one of the procedures listed below.
Hysterectomy. This is the removal of the uterus. If cancer has spread, your surgeon may remove your uterus. For a total hysterectomy, the cervix and other tissue that supports the uterus are also removed. The procedure may be done through the vagina. This is called a vaginal hysterectomy. If it is done through a cut (incision) through the belly (abdomen), it’s called a total abdominal hysterectomy. In some cases, more tissue and other organs may need to be removed. This can be done through small incisions using a tool called a laparoscope or with the help of robotic technology. This procedure is called a laparoscopic hysterectomy or a robot-assisted laparoscopic hysterectomy.
Lymphadenectomy. This is surgery to remove nearby lymph nodes to see if they have cancer. Lymph nodes in your pelvis or groin may be removed. It depends on where the cancer is in the vagina.
Pelvic exenteration. This procedure is very rarely done. It is only done when no other treatment options will be helpful. Your healthcare provider may suggest it if cancer has spread beyond your vagina to nearby organs. This surgery removes your lower colon, rectum, bladder, cervix, vagina, ovaries, and nearby lymph nodes. Your surgeon makes artificial openings (stomas) for urine and stool to flow from your body into collection bags on your belly.
Risks of vaginal cancer surgery
All surgery has risks. The risks of vaginal surgery include:
Damage to internal organs
Bulging of organs under the incision (incisional hernia)
Long-term risks include:
Changes in your sex life. The types of changes depend on how much of your vagina is removed or rebuilt.
Lymphedema. If lymph nodes in the groin or pelvis are removed, it can lead to poor fluid drainage from the legs (lymphedema). The fluid builds up and causes severe leg swelling that doesn’t get better when you are lying down. It can be hard to treat.
Your risks depend on your overall health, what type of surgery you need, and other factors. Talk with your healthcare provider about which risks apply most to you. Also be sure you understand possible long-term changes that may be a result of surgery.
Getting ready for your surgery
Your healthcare team will talk with you about the surgery options that are best for you. You may want to bring a family member or close friend with you to appointments. Write down questions you want to ask about your surgery. Make sure to ask:
What type of surgery will be done?
What will be done during surgery?
What are the risks and possible side effects of the surgery?
How will your vagina work after surgery and what might your sex life be like?
Will you be able to get pregnant and carry a child after surgery?
When can you return to your normal activities?
Will the surgery leave scars and what will they look like?
Before surgery, tell your healthcare team if you are taking any medicines. This includes over-the-counter medicines, vitamins, herbs, and other supplements. This is to make sure you’re not taking medicines that could affect the surgery. After you have discussed all the details with the surgeon, you will sign a consent form that says that the healthcare provider can do the surgery.
You’ll also meet the anesthesiologist and can ask questions about the anesthesia and how it will affect you. Just before your surgery, an anesthesiologist or a nurse anesthetist will give you the anesthesia so that you fall asleep and don’t feel pain.
After your surgery
You may have to stay in the hospital for a few days, depending on the type of surgery you had. For the first few days after surgery, you are likely to have pain from the incision. Your pain can be controlled with medicine. Talk with your healthcare provider or nurse about your options for pain relief. Some people don’t want to take pain medicine, but doing so can help your healing. If you don’t control pain well, for example, you may not want to cough or turn over often, which you need to do as you recover from surgery.
You will likely have a urinary catheter for a few days. This a tube put through your urethra and into your bladder so that your urine goes into a bag outside your body.
You may have constipation from using some pain medicine, from not moving much, or from not eating much. Talk with your healthcare provider or nurse about getting more dietary fiber or the use of a stool softener.
You may feel tired or weak for a while. The amount of time it takes to recover from surgery is different for each person.
Recovering at home
When you get home, you may get back to light activity, but you may be told to avoid strenuous activity for a few weeks. Your healthcare team will tell you what kinds of activities are safe for you while you recover. Be sure you understand what you can't and can do.
After excision or a vaginectomy, you may have a procedure called skin grafting. This is done to repair or rebuild your vagina. Your surgeon removes skin from another part of your body, like your thigh or buttock.
You may also need another treatment after surgery, such as radiation. This is done to kill any cancer cells that may still remain. This helps to lessen the chances of the cancer coming back. Treatment after surgery is called adjuvant therapy.
When to call your healthcare provider
Let your healthcare provider know right away if you have any of these problems after surgery:
Fever of 100.4°F (38.0°C) or higher, or as directed by your healthcare provider
Redness, swelling, or fluid leaking from the incision or from your vagina
Blood in the urine or from the rectum
Know when to call your healthcare provider and how to reach them outside of office hours, such as at night or during weekends.
March 16, 2019
Radical Hysterectomy, Up To Date, Vaginectomy, Up To Date
Goodman, Howard, MD,Stump-Sutliff, Kim, RN, MSN, AOCNS