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Doctors use excision most often as the surgery for vaginal cancer that has not spread to other tissues (early stage cancer). Excision means your surgeon cuts out precancerous or cancerous lesions. Your surgeon may use one of the following approaches for precancerous and early stage cancers:
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 a lot of blood loss. Your surgeon may use laser surgery to remove a lesion on the surface of your vagina. This procedure is not used for invasive vaginal cancer, 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. Doctors use this method for small lesions where it is possible to remove a margin of healthy tissue around the cancer to help prevent the cancer from returning.
For cancers that have spread (called advanced or invasive cancer), or cancers that return, you may need surgery to remove part or all of your vagina. If the cancer has spread outside your vagina, your doctor may also remove other reproductive organs. These may include your uterus, ovaries, and fallopian tubes. The doctor may also remove lymph nodes or other nearby structures. Doctors use general anesthesia for these procedures, which means you will be asleep and free from pain during the surgery. Following are procedures surgeons use to treat vaginal cancer that has already spread to other tissues:
Vaginectomy. This involves removing all or part of your vagina and is usually done at the same time as one of the procedures listed below. An anesthesiologist will give you general anesthesia (sleep medicine), so you will be asleep during the procedure.
Hysterectomy. If cancer has spread, your surgeon may remove your uterus, including your cervix. When your surgeon performs this procedure through your vagina, it is called a vaginal hysterectomy. It is called a total abdominal hysterectomy when your surgeon removes your organs through a cut, called an incision, in your abdomen (belly). The surgeon may recommend a radical hysterectomy to remove healthy tissue that is next to the cancer. In some cases, your surgeon can do this through small incisions, using an instrument called a laparoscope or with the help of robotic technology. This procedure is called a laparoscopic hysterectomy or a robot-assisted 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 on the location of your vaginal cancer.
Pelvic exenteration. This procedure is very rare. It is only done when no other treatment options are available. Gynecologic oncologists are specialists who are trained and experienced in doing this complicated procedure. Your doctor may suggest it if cancer has spread beyond your vagina to other organs. This surgery removes your lower colon, rectum, bladder, cervix, vagina, ovaries, and nearby lymph nodes. Your surgeon makes artificial openings (called stoma) for urine and stool to flow from your body into collection bags.
Following excision or a vaginectomy, you may have a procedure called skin grafting to repair or reconstruct your vagina. Your surgeon removes skin from another, usually hidden, part of your body, like your thigh or buttock. You may also need another treatment, such as radiation, after surgery to kill any remaining cancer cells and to increase your chance of a cure. Treatment after surgery is called adjuvant therapy.
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