What surgery options are available for vaginal cancer?
Primary vaginal cancer is a rare form of cancer that starts in the vagina. Primary vaginal cancer is treated with either surgery, radiation, chemotherapy, or a combination of these treatments depending on individual factors. Over 100 women are diagnosed with vaginal cancer in Australia each year. It is more common in women over 60 years.
Types of surgery for vaginal cancer
Surgery may be performed to remove the affected areas of the vagina. The primary aim of surgery for vaginal cancer is to remove all cancerous tissue. During surgery the extent of the disease may be determined. The type of surgery for vaginal cancer includes:
Partial vaginectomy - Surgery to remove only the affected part of the vagina.
Total vaginectomy - Surgery to remove the whole vagina.
Radical vaginectomy - Surgery to remove the vagina and surrounding tissue.
Reconstructive surgery - In some cases, a surgeon can complete a vaginal reconstruction where skin grafts and muscle from other parts of the body are used to reconstruct the vagina. This specialist operation needs to be conducted by a plastic (reconstructive) surgeon.
Total Hysterectomy – Depending on the disease stage, some people also need to have their uterus and cervix removed.
Lymph node dissection - Sometimes the lymph nodes in the pelvis may also be removed and it would be important to know that information. If the cancer is located within the upper vagina, the pelvic lymph nodes may be removed. When the cancer is located within the lower vagina, lymph nodes in the groin may be removed. The lymph nodes are examined by a pathologist under a microscope to see if they contain cancer cells.
Stages of vaginal cancer
In stage 1, the cancer is located only in the vagina and has not grown through the vaginal wall.
In Stage 2, the cancer has grown through the wall of the vaginal but has not reached the pelvis.
In stage 3, cancer has spread to the wall of the pelvis, or to the lymph nodes in the pelvis.
Stage 4 is divided into stage 4A and stage 4B:
- Stage 4A: Cancer has spread to one or more of the following including the bladder, rectum, or beyond the pelvis that has the bladder, uterus, ovaries and cervix. The lymph nodes may or may not be involved.
- Stage 4B: Cancer has spread to a distant part of the body that is not near the vagina, such as the lungs.
When provided a cancer stage, a patient may also receive results of their grade of cancer. Low-grade cancer cells are slow growing and therefore less likely to spread. High-grade cells are more aggressive and are likely to spread quickly.
Treatment based on cancer stage
If the vaginal cancer is small and still confined within the vagina, surgery can be used to treat the cancer alone. A partial, total or radical vaginectomy are treatment options in Stage 1 vaginal cancer.
Stage 2, 3 and 4A vaginal cancer are treated in a similar way.
Radiotherapy is the main treatment. Patients usually have both internal radiotherapy and external radiotherapy. External beam radiotherapy directs radiation at a cancer from a machine outside of the body. Internal radiotherapy uses an implant that is placed inside the vagina to provide a radioactive source.
Chemotherapy is usually only given in combination with radiation therapy to enhance the effects of the radiation treatment. This is particularly if the vaginal cancer is advanced or returns after initial treatment.
Treatment for Stage 4B is not usually curable. Surgery is not recommended as it’s not possible to remove all the cancer that has spread throughout the body. Radiotherapy may be prescribed to help relieve symptoms such as pain, swelling or bleeding.
After the treatment is complete, patients will need regular follow-up.
For more information on diagnosing & treating vaginal cancer, visit the Vaginal Cancer page.
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