What to Know About Surgery for Vaginal Cancer
Surgery removes cancer by cutting it out of your body. Sometimes the surgeon takes other tissue as well. For the surgery, you should see a gynecologic oncologist. This is a doctor who specializes in surgery for female pelvic cancers.
There are several kinds of surgery for vaginal cancer. The type you have depends on the following:
- your age
- general health
- the type and location of cancer you have
- the stage of the cancer
- your childbearing plans
Excision is the type of surgery most often used for vaginal cancer that has not spread. Cancer that hasn’t spread is called early stage cancer. With excision, 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 lets the surgeon 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. These procedures are generally done with general anesthesia. That means you will be asleep and free of pain during the surgery.
- Wide local excision. This surgical procedure removes cancer. It also removes some healthy tissue. It’s done for small lesions where it is possible to remove a margin of healthy tissue around the cancer. It's done to remove any cancer cells that might be in this normal-appearing area. These procedures are generally done with general anesthesia. That means you will be asleep and free of pain during the surgery.
Cancers that have spread are called advanced or invasive cancers. For these cancers 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. That 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. You will be asleep during the procedure.
- Total hysterectomy. If cancer has spread, your surgeon may remove your uterus, including your cervix. When the surgeon removes them through your vagina, it’s called a vaginal hysterectomy. Another way to remove the organs is with an abdominal hysterectomy. That is when the surgeon removes your organs through a cut in your abdomen. The cut is called an incision. In some cases, the surgeon can do this through small incisions. To do that, the surgeon will use an instrument called a laparoscope. This procedure is called laparoscopic hysterectomy.
- Lymph node dissection. Your surgeon may remove lymph nodes from your pelvis or groin to see if they contain cancer. This procedure is also called lymphadenectomy. Which lymph nodes are removed 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.
Following excision or a vaginectomy, you may have a procedure called skin grafting. This procedure repairs or reconstructs your vagina. To do it, the surgeon removes skin from another, usually hidden, part of your body. Or the surgeon obtains a flap of skin adjacent to the vagina or from your abdomen. You may also need another treatment, such as radiation, after surgery. This other treatment is to kill any remaining cancer cells and increase the chance of a cure. Treatment after surgery is called adjuvant therapy.
What to Expect After Surgery for Vaginal Cancer
After surgery, you should not place anything in your vagina. This includes not having intercourse for several months. Your doctor may perform follow-up exams and tests to make sure the surgery was successful. After surgery, you may have these side effects:
- Pain. You may have cramping or pain in the area you were operated on. This is normal and should not last long.
- Bleeding. It is normal to have vaginal bleeding for a few weeks after vaginal surgery.
Other side effects of surgery depend on the kind and extent of the surgery you have.
- If your surgeon partly or completely removes your vagina, you may decide to have it surgically repaired or rebuilt, using tissue from another part of your body. If your vagina is rebuilt or reconstructed, you will still be able to have sexual intercourse. But your reconstructed vagina will produce little or no natural lubricant during arousal. So, you will need to use lubricating gel before having intercourse. Also, the sensations you feel during intercourse may be different than they once were.
- If your surgeon removes your uterus along with the vagina, you will no longer be able to become pregnant.
- If your surgeon removes your ovaries, you may have the symptoms of sudden menopause. Those can include hot flashes, mood swings, and other changes.
- If your surgeon removes your bladder or colon, he or she will create a new way to get rid of urine or waste. Surgeons can now sometimes create this without having to use a bag outside the body for waste.
- If your surgeon removes your lymph nodes, you may have swelling in one or both of your legs.
Have a conversation with your doctor or nurse about ways to cope with any of the side effects or changes you experience.
