What to Know About Surgery for Vaginal Cancer

Excision is the type of surgery most often used for vaginal cancer that has not spread (called early stage cancer). Excision means the surgeon cuts out cancerous cells. The surgeon may use one of these approaches to do this.

  • Laser surgery. For this, your surgeon uses a narrow beam of intense light as a knife. This allows him or her to remove tissue without causing blood loss. Your surgeon may use laser to remove a lesion on the surface of your vagina. It is not used for invasive vaginal cancer. This is partly because the technique makes it impossible to tell whether all the cancer has been removed.

  • Wide local excision. This surgical procedure removes cancer, along with some healthy tissue. It is done for small lesions where it is possible to remove this margin of healthy tissue around the cancer.

For cancers that have spread (called advanced or invasive) or cancers that return, you may need surgery to remove part or all of your vagina. If the cancer has spread outside the vagina, the doctor may also remove other reproductive organs. This may include your uterus, ovaries, and fallopian tubes. Also, your doctor may remove lymph nodes or other nearby structures. Lymph nodes are bean-shaped structures involved in fighting infection. These procedures are done with general anesthesia, which means you will be asleep and free of pain during the surgery. These are procedures for vaginal cancer that has spread.

  • Vaginectomy. This involves removing all or part of your vagina. Your doctor will give you general anesthesia so you will be asleep during the procedure.

  • Total hysterectomy. If cancer has spread, your surgeon may remove your uterus, including your cervix. This procedure is called a vaginal hysterectomy when the surgeon removes your organs through your vagina. It is called abdominal hysterectomy when the surgeon removes your organs through a cut, called an incision, in your abdomen. In some cases, the surgeon can do this through small incisions, using an instrument called a laparoscope. This procedure is called laparoscopic hysterectomy.

  • Lymph node dissection. Your surgeon may remove lymph nodes to see if they contain cancer. This procedure is also called lymphadenectomy. Which lymph nodes are removed--whether in your pelvis or groin--depends upon the location of the vaginal cancer.

  • Pelvic exenteration. This procedure is very rare. Your doctor may suggest it if cancer has spread beyond your vagina to other organs. This surgery removes the lower colon, rectum, bladder, cervix, vagina, ovaries, and nearby lymph nodes. Artificial openings (stoma) are made for urine and stool to flow from the body into a collection bag.

Following excision or a vaginectomy, you may have a procedure called skin grafting to repair or reconstruct your vagina. For it, the surgeon removes skin from another, usually hidden, part of your body. You may also need another treatment, such as radiation, after surgery to kill any remaining cancer cells and increase the chance of a cure. Treatment after surgery is called adjuvant therapy.

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