Vaginal Cancer: Surgery 

Surgery to treat vaginal cancer may be a choice for very small tumors or after other treatment, such as radiation, is not successful. A gynecologic oncologist is a specialist who will help decide if a vaginal tumor can be safely removed with surgery or if other treatments are more appropriate.

Types of surgery for precancer and early-stage vaginal cancer

• Precancer. If precancer cells are found in the vagina, they'll be treated to keep them from becoming cancer cells over time. Laser surgery might be used. To do this, 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. It can be repeated if precancer cells come back later. Laser surgery rarely causes problems or side effects. But if the precancer is large, one of the surgeries covered below might be needed to be sure all the precancer cells are removed.

• Early-stage vaginal cancer. Surgery to take out all the cancer may be the only treatment needed for early-stage vaginal cancer. This is cancer that's small and hasn’t spread beyond the vagina where it first started. Then a procedure called wide local excision might be possible. This surgery is used to take out all of the cancer, along with an edge (margin) of healthy tissue around it. Depending on where the cancer is in the vagina, one of the surgeries covered below may be needed.

Types of surgery for more advanced vaginal cancers

In some cases, surgery may be done to remove part or all of your vagina. This is done for bigger tumors, cancer that has spread in the vagina, and cancer that comes back after treatment. Depending on the size of the tumor and where it is in the vagina, surgery might be needed to treat early cancers and precancers.

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. In rare cases, nearby organs, such as the bladder or rectum are also removed.

Nearby lymph nodes or other nearby tissues might be taken out, too.

The types of surgery used to treat more advanced vaginal cancer include:

• Vaginectomy. All or part of your vagina is removed. This is often done at the same time as one of the surgeries listed below.

• Hysterectomy. This is the removal of the uterus. If the cancer has spread, a total hysterectomy might be needed. This means the cervix and other tissue that supports the uterus are also removed. In some cases, more tissue or other organs may need to be removed, such as the ovaries and fallopian tubes. This surgery may be done in different ways:

  • Vaginal hysterectomy. This is done through the vagina.

  • Total abdominal hysterectomy. This is done through a cut (incision) in the belly (abdomen).

  • Laparoscopic hysterectomy. This surgery is done through small incisions using a tool called a laparoscope.

  • Robot-assisted laparoscopic hysterectomy. This method uses robotic technology.

• Lymphadenectomy. This is surgery to remove nearby lymph nodes to see if they have cancer cells in them. Lymph nodes in your pelvis or groin may be removed. It depends on where the cancer is in the vagina.

• Pelvic exenteration. This major surgery is very rarely needed for vaginal cancer. It's done when no other treatment choices will help. It might be suggested if the cancer has spread beyond your vagina to nearby organs, but is still only in the pelvic area. Your lower colon, rectum, bladder, cervix, vagina, ovaries, and nearby lymph nodes are taken out. Your surgeon makes artificial openings (called stomas) for urine and stool to flow from your body into bags that stick on your belly.

Risks of vaginal cancer surgery

All surgery has risks. The risks of vaginal surgery include:

• Excess bleeding

• Infection

• Damage to internal organs

• Bulging of organs under the incision (incisional hernia)

Long-term risks include:

• Changes in your sex life. These 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. The fluid builds up and causes severe leg swelling that doesn’t get better, even when you are lying down. This is called lymphedema. 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 choices 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? Will lymph nodes or other organs be removed?

• Will vaginal reconstruction be needed? If so, how will it be done?

• 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?

• Are there any choices other than surgery?

Before surgery, tell your healthcare team if you are taking any medicines. This includes over-the-counter and prescription medicines, vitamins, herbs, and other supplements. Also tell them if you use marijuana, CBD, or any illegal drugs. This is to make sure you’re not taking anything that could affect the surgery. After you have discussed all the details with the surgeon, you will sign a consent form that says you agree to have the surgery.

You’ll also meet the anesthesiologist or nurse anesthetist and can ask questions. Anesthesia is the medicine you'll be given to make you sleep and not feel pain during surgery. Ask how it will affect you. Just before your surgery, an anesthesiologist or a nurse anesthetist will give you the anesthesia. 

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 will have pain from the incision. Your pain can be controlled with medicine. Talk with your healthcare provider or nurse about your choices 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 instance, you may not want to cough, turn over often, or get out of bed, which you need to do as you recover from surgery.

You may have a urinary catheter for a few days. This a soft tube put through your urethra and into your bladder. It drains your urine into a bag outside your body. It gives your bladder time to recover.

You may have constipation from using some pain medicine, not moving much, or from not eating much. Talk with your healthcare provider or nurse about getting more dietary fiber or using a stool softener.

You may feel tired or weak for a while. This is normal. 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 not do any 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.

Follow-up care

After excision or a vaginectomy, you may need vaginal reconstruction. This is done to repair or rebuild your vagina. The grafted tissue or new vagina can be made with skin and muscle from another part of your body or intestinal tissue. 

You may also need more treatment after surgery, most often radiation. This is done to kill any cancer cells that may be left in your body. It helps to lower the chance that the cancer will come back.

When to call your healthcare provider

Talk with your healthcare provider about problems you should watch for. Call right away if you have any of the following:

• Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider

• Chills

• Fast, irregular heartbeat or new chest pain

• Abnormal or increased bleeding

• Redness, swelling, or fluid leaking from the incision or from your vagina

• Incision opens up or the edges pull apart

• Trouble passing urine or changes in how your urine looks or smells

• Blood in your urine or from your rectum

• Nausea or vomiting

• Trouble moving your bowels or excessive diarrhea

• Pain, redness, swelling, or warmth in an arm or leg

Know what problems to watch for and when you need to call your healthcare provider. Also be sure you know how to reach them outside of office hours, such as at night or on holidays or weekends.