Surgery for vaginal cancer is not one standard procedure. Depending on the size, depth and location of the tumour, surgery may range from removing the tumour with a margin of healthy tissue to removing part or, in selected cases, a larger portion of the vagina. Lymph node assessment may also be required because the lymphatic drainage differs between cancers arising in the upper and lower parts of the vagina.
Dr. Priya Bhati specialises in gynaecologic cancer surgery and has expertise in managing complex gynaecologic cancers. Her official Amrita profile lists all gynaecologic cancer surgeries, laparoscopic gynae oncology surgery and robotic-assisted gynaecologic cancer surgery among her areas of expertise. At Amrita Hospital, vaginal cancer is managed within the Gynaecologic Oncology Division, with surgical, medical oncology, radiation oncology, radiology and pathology expertise available for treatment planning.
Vaginal cancer develops when malignant cells form in the tissues of the vagina.
It is a rare gynaecological cancer. Most primary vaginal cancers are squamous cell carcinomas, although adenocarcinoma and several less common tumour types can also occur.
Because vaginal cancer is uncommon, a vaginal growth, ulcer or abnormal bleeding does not automatically mean cancer. Several benign and precancerous conditions can produce similar symptoms.
A proper examination and biopsy are therefore important before deciding on treatment.
Once cancer has been confirmed, treatment needs to consider the exact location and extent of the disease.
The vagina is not simply one uniform area from a treatment perspective.
A tumour may develop in:
The location matters because it can affect the pattern of lymphatic drainage, the structures that may be close to the tumour and the type of treatment that can be considered.
For example, cancers arising in the upper vagina may drain toward the pelvic lymph nodes, while cancers in the lower vagina may involve the groin lymph nodes.
This is one reason vaginal cancer surgery needs careful anatomical planning.
Vaginal cancer can sometimes be found because of symptoms such as:
These symptoms can also occur with non-cancerous conditions.
If unusual vaginal bleeding, a persistent lump or an unexplained vaginal lesion does not settle, it should be evaluated rather than assumed to be a minor problem.
The first step is usually a detailed examination.
Your doctor may examine the vagina and cervix and look for:
If an abnormal area is identified, a biopsy may be required.
A biopsy removes a small sample of tissue so that a pathologist can examine it under a microscope.
The pathology report helps determine whether the lesion is:
Treatment should not be planned from appearance alone. The pathology diagnosis is an important part of deciding what comes next.
With vaginal cancer, the surgeon needs to know exactly where the tumour begins and how far it extends.
Important questions include:
These details can significantly change the treatment plan.
A small, localised tumour may be approached very differently from a tumour involving surrounding tissues.
For selected small and localised vaginal cancers, wide local excision may be considered.
The surgeon removes the tumour together with an appropriate margin of surrounding tissue.
The purpose is to remove the cancer completely while preserving as much healthy vaginal tissue and function as possible.
Whether this approach is suitable depends on the tumour's size, depth, location and ability to be removed with an adequate margin.
It is not appropriate for every vaginal cancer.
When a tumour involves a larger area of the vaginal wall, part of the vagina may need to be removed.
This is called a partial vaginectomy.
The amount of tissue removed depends on the location and extent of the cancer.
The surgical objective is to achieve appropriate cancer removal while considering the surrounding anatomy and the woman's postoperative function.
For selected cancers that are more extensive but still potentially treatable surgically, a radical vaginectomy may be considered.
This involves removing a larger portion of the vagina and surrounding tissues.
Depending on where the cancer is located, the operation may be combined with removal of nearby organs or lymph nodes.
Radical surgery is generally considered only when it is appropriate for the disease and when the expected benefit justifies the extent of the operation.
Lymph nodes can be an important part of vaginal cancer staging.
The appropriate lymph nodes depend partly on the location of the tumour.
For upper vaginal cancers, pelvic lymph nodes may need to be evaluated.
For cancers arising in the lower vagina, the groin or inguinal lymph nodes may be relevant.
Lymph node assessment can involve:
The decision depends on the cancer's location, size, depth and other staging information.
Cancer cells can sometimes travel from the primary tumour through the lymphatic system.
Finding cancer in lymph nodes can change the stage of disease and may influence whether radiation or other treatment is recommended.
This means that the operation may involve more than removing the visible vaginal tumour.
The surgical plan needs to consider where the cancer could potentially spread and how the disease should be staged.
No.
This is particularly important when discussing vaginal cancer.
Although surgery is an established treatment option, radiation therapy is also a major part of treatment and is commonly used for many vaginal cancers, especially when the disease is more extensive.
For early-stage disease, treatment may involve surgery, radiation therapy or a combination depending on the individual cancer.
For stage II, III and IVA disease, radiation-based treatment is commonly used, with surgery considered in selected cases.
Therefore, seeing a gynaecologic oncologist does not necessarily mean that surgery will be recommended.
The first goal is to determine what treatment is appropriate for the cancer.
Radiation therapy can be particularly important when:
Radiation may be given externally, internally through brachytherapy, or using a combination of techniques.
The choice depends on the location and extent of the tumour.
In some patients, treatment involves more than one modality.
For example, surgery may be followed by radiation when the pathology indicates a higher risk of local recurrence or when the surgical margins are close or involved.
Conversely, radiation may be used before or instead of surgery in selected situations.
The treatment sequence is determined by the cancer's stage, pathology and anatomical location.
This is why vaginal cancer treatment should be planned by specialists who regularly manage gynaecologic cancers.
If surgery requires removal of a significant portion of the vagina, reconstruction may sometimes be considered.
Reconstructive procedures can help restore vaginal anatomy after extensive surgery.
Depending on the operation, reconstruction may involve tissue from another part of the body or other surgical techniques.
Whether reconstruction is appropriate depends on:
Reconstruction is not required for every vaginal cancer operation.
If extensive surgery is being considered, reconstruction and its expected effect on recovery and sexual function should be discussed before treatment.
There is no single surgical technique that is suitable for every vaginal cancer.
Your treatment plan may be influenced by:
A small superficial lesion may be easier to remove locally than a large tumour.
Upper and lower vaginal cancers have different relationships with surrounding structures and lymphatic drainage.
A tumour that has grown deeper into the vaginal wall may require a more extensive operation or a different treatment approach.
If the cancer extends beyond the vagina, surgery may become more complex or radiation may become a more important component of treatment.
Previous hysterectomy, pelvic surgery or radiation can affect anatomy and surgical planning.
Medical conditions and previous treatments also influence whether major surgery is appropriate.
Some women develop a vaginal tumour after they have previously undergone hysterectomy.
A lesion may occur at or near the vaginal cuff, which is the upper end of the vagina where the cervix and uterus were previously attached.
This situation requires careful assessment.
The surgeon needs to establish:
The surgical plan can therefore be different from that for a woman with an intact uterus.
When vaginal cancer has spread beyond the area that can be safely removed, surgery may not be the first treatment.
Radiation therapy, including external-beam radiation and brachytherapy, may form an important part of treatment.
Chemotherapy may also be used in combination with radiation in selected cases.
In highly selected situations involving extensive local disease or recurrence, very major surgery such as pelvic exenteration may be considered.
Pelvic exenteration is an extensive operation that can involve removal of multiple pelvic organs.
It is not a routine treatment for vaginal cancer. It is reserved for carefully selected patients after detailed assessment of the disease and other available treatment options.
Vaginal cancer can sometimes return after initial treatment.
Recurrence may occur locally or at another site.
Treatment depends on:
For selected local recurrences, surgery may be considered.
In some cases, radiation or other cancer treatment may be more appropriate.
Previous radiation can make further treatment particularly complex, which is why recurrent vaginal cancer benefits from specialist multidisciplinary assessment.
Before a surgical decision is made, your medical team may review:
Imaging can help determine the size and extent of the tumour and whether nearby structures or lymph nodes appear involved.
The pathology report is equally important because different tumour types can behave differently and may require different treatment approaches.
Vaginal cancer is rare.
Because the diagnosis can influence a major treatment decision, pathology needs to be interpreted in the appropriate clinical context.
If there is uncertainty about the diagnosis or tumour type, your treating team may recommend specialist pathology review.
This can be particularly relevant when the biopsy findings are unusual or when the tumour does not clearly fit the most common vaginal cancer types.
After surgery, the removed tissue is examined by a pathologist.
The final report may provide information about:
Your treatment team then reviews the findings and determines whether additional treatment is needed.
Depending on the results, further radiation therapy or other cancer treatment may be considered.
Follow-up is also important after treatment.
Recovery depends heavily on the type of operation.
A small local excision is very different from a partial or radical vaginectomy.
After surgery, your medical team may monitor:
The recovery period can be longer after extensive surgery.
Your doctor will explain when you can resume normal activities, exercise and sexual intercourse.
This is a subject many women may hesitate to discuss.
Treatment for vaginal cancer can affect sexual function, particularly when surgery involves significant removal of vaginal tissue or when radiation therapy is required.
Possible concerns can include:
These issues deserve medical attention.
Depending on your treatment, your care team may discuss vaginal care, dilator use when appropriate, pelvic floor rehabilitation and other measures that can support recovery.
Fertility considerations depend on the woman's age, the location of the tumour and the treatment required.
Vaginal cancer treatment does not always involve removal of the uterus or ovaries. However, extensive surgery or radiation involving the pelvis can affect reproductive function.
If having children in the future is important to you, raise this issue before treatment begins.
The feasibility of fertility preservation depends on the exact diagnosis and planned treatment.
A specialist can explain what may be possible without compromising cancer treatment.
Certain types of human papillomavirus, or HPV, are associated with vaginal cancer.
However, having HPV does not mean that you have vaginal cancer.
HPV infection is common, and most infections do not lead to cancer.
Women with persistent high-risk HPV infection may develop precancerous changes, and vaginal intraepithelial neoplasia, or VaIN, can sometimes precede invasive vaginal cancer.
This is why abnormal vaginal lesions need appropriate evaluation rather than being assumed to be harmless.
VaIN refers to abnormal or precancerous changes in the vaginal lining.
It is different from invasive vaginal cancer.
Treatment for VaIN can include observation in selected low-grade cases, laser treatment, local excision, vaginectomy or other treatments depending on the grade and extent of the lesion.
A biopsy is important when an invasive component needs to be ruled out before treatment.
If you have been told that you have VaIN, VIN or an abnormal vaginal lesion, a gynaecologic oncology consultation can help clarify what the diagnosis means and whether treatment is necessary.
Vaginal cancer is uncommon and can involve difficult surgical decisions.
A gynaecologic oncologist has specialist training in cancers of the female reproductive system and their surgical management.
This can be particularly relevant when:
Dr. Priya Bhati completed her MCh in Gynaecologic Oncology from Christian Medical College, Vellore, after postgraduate training in Obstetrics and Gynaecology and clinical experience at PGIMER Chandigarh and CMC Vellore. She currently serves as an Associate Professor in Gynaecologic Oncology at Amrita Hospital, Kochi.
Her listed expertise includes all gynaecologic cancer surgeries, laparoscopic gynaecologic oncology surgery and robotic-assisted gynaecologic cancer surgery.
Vaginal cancer treatment may require input from several specialists.
At Amrita Hospital, the Gynaecologic Oncology Division manages vaginal cancer within a multidisciplinary cancer programme. The department lists medical oncology, radiation oncology, radiology and onco-pathology among the specialties involved in treatment planning.
This is particularly relevant for vaginal cancer because surgery is only one possible component of treatment.
The team can consider whether surgery, radiation, chemotherapy or a combination of treatments is appropriate for the individual diagnosis.
If you have already been diagnosed with vaginal cancer, bring:
If you have received a treatment recommendation elsewhere, bring that information as well.
A complete set of records makes it easier to understand the diagnosis and discuss treatment options.
Before agreeing to surgery, consider asking:
These questions can help you understand not only the operation itself but also how it fits into the complete treatment plan.
A diagnosis of vaginal cancer can be particularly unsettling because the condition is uncommon and treatment decisions can vary considerably from one patient to another.
The right approach depends on the tumour's location, size, depth, pathology and spread.
For some women, surgery may offer an appropriate way to remove a localised tumour. For others, radiation-based treatment may be more suitable. Some patients may require a combination of treatments.
Dr. Priya Bhati provides specialist gynaecologic oncology care in Kochi, with expertise in complex cancer surgery and minimally invasive gynaecologic oncology procedures.
If you have been diagnosed with vaginal cancer, have an abnormal vaginal biopsy or have been advised to undergo surgery, a specialist consultation can help clarify the diagnosis and discuss the treatment options relevant to your situation.
1. Is vaginal cancer curable?
Some vaginal cancers, particularly cancers diagnosed at an earlier stage, can be treated with the aim of controlling or eliminating the cancer. The outlook depends on factors such as stage, tumour type, size, location and spread.
2. Is surgery always needed for vaginal cancer?
No. Surgery is one treatment option. Radiation therapy is also an important treatment for vaginal cancer and is commonly used for more advanced local disease.
3. What surgery is used for vaginal cancer?
Depending on the tumour, surgery can include wide local excision, partial or total vaginectomy, lymph node surgery and, in selected advanced or recurrent cases, more extensive procedures.
4. What is a vaginectomy?
A vaginectomy is an operation to remove part or all of the vagina. The extent of removal depends on the location and size of the cancer.
5. Can a small vaginal cancer be removed without removing the whole vagina?
In selected small and localised cancers, wide local excision or a more limited surgical procedure may be possible.
6. Will I need my uterus removed?
Not necessarily. Whether the uterus needs to be removed depends on the location and extent of the vaginal cancer and the type of surgery required.
7. Will I need lymph node surgery?
Some women require lymph node assessment. The appropriate lymph nodes depend partly on where the vaginal tumour is located. Upper vaginal tumours may involve pelvic nodes, while lower vaginal tumours may involve the groin nodes.
8. Can vaginal cancer be treated with radiation instead of surgery?
Yes. Radiation is an established treatment for vaginal cancer and is commonly used for many stage II, III and IVA cancers.
9. What is brachytherapy?
Brachytherapy is a form of internal radiation therapy in which a radiation source is placed close to the cancer. It may be used as part of vaginal cancer treatment depending on the tumour.
10. Can surgery and radiation both be required?
Yes. Depending on the cancer and surgical pathology, radiation may be recommended after surgery. Some patients may also receive combined treatment as part of their initial cancer management.
11. What if my vaginal cancer has come back?
Recurrent vaginal cancer needs a fresh assessment. Depending on where the recurrence is located and what treatment you previously received, options can include surgery, radiation or other cancer treatment.
12. Can vaginal cancer occur after a hysterectomy?
Yes. A vaginal cancer can develop after a previous hysterectomy, including near the vaginal cuff. Treatment depends on the exact location and extent of the tumour.
13. Can vaginal cancer affect sexual function?
It can. Surgery and radiation may affect vaginal anatomy, comfort and sexual function. These concerns should be discussed before treatment so that appropriate measures can be planned.
14. Can the vagina be reconstructed after cancer surgery?
In selected women undergoing extensive surgery, vaginal reconstruction may be considered. Whether it is appropriate depends on the amount of tissue removed and the overall treatment plan.
15. Can vaginal cancer affect fertility?
It can, depending on the treatment required. Surgery that involves the uterus or ovaries and pelvic radiation can affect reproductive function.
16. Is vaginal cancer related to HPV?
Certain high-risk HPV types are associated with vaginal cancer. However, having HPV does not mean that a woman has cancer.
17. What is VaIN?
VaIN stands for vaginal intraepithelial neoplasia. It describes abnormal or precancerous changes in the vaginal lining and is different from invasive vaginal cancer.
18. What happens if my biopsy says VaIN?
Treatment depends on the grade, size and distribution of the lesion. Options can include observation for selected low-grade lesions, laser treatment, local excision or other treatments.
19. What should I bring for my first consultation?
Bring your biopsy and pathology reports, scan reports and images, previous treatment records and any relevant operation or radiation records.
20. Why should I see a gynaecologic oncologist for vaginal cancer?
Vaginal cancer is uncommon and treatment can involve complex decisions about surgery, lymph nodes, radiation and reconstruction. A gynaecologic oncologist specialises in cancers of the female reproductive system and their surgical management.
21. Where can I get vaginal cancer treatment in Kochi?
Dr. Priya Bhati provides specialist gynaecologic oncology care in Kochi. Vaginal cancer is also managed through the Gynaecologic Oncology Division at Amrita Hospital, where multidisciplinary cancer treatment includes surgical, medical oncology, radiation oncology, radiology and pathology expertise.
MBBS, M. Ch. (Gynaecologic Oncology), MD (Obs & Gynae)
Senior Consultant - Gynae Oncologist and Robotic Surgeon, Department of Gynecologic Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala
Dr. Priya Bhati is a Senior Consultant Gynae Oncologist and Robotic Surgeon at Amrita Institute of Medical Sciences, Kochi. She specialises in the treatment of gynaecological cancers and complex gynaecological conditions, with expertise in cancer surgery, robotic-assisted surgery and laparoscopic surgery. With years of experience at leading institutions such as CMC Vellore and PGIMER Chandigarh, she brings extensive surgical experience along with a caring and patient-focused approach.
Dr. Priya has completed her M.B.B.S. from Kasturba Medical College, Mangalore, M.D. in Obstetrics & Gynecology from Goa Medical College, and M.Ch. in Gynaecologic Oncology from Christian Medical College, Vellore. She treats women with different types of gynaecological cancers and also performs complex benign gynaecological surgeries and advanced procedures such as CRS and HIPEC.
She believes that every patient deserves to understand her condition and treatment clearly. Along with treating gynaecological cancers, Dr. Priya also focuses on prevention and early detection, including HPV vaccination and preventive gynaecologic care. Her goal is to provide personalised treatment while making patients and their families feel informed, comfortable and supported throughout their care.
I was very scared when I came to know about my cancer. Dr. Priya Bhati explained everything clearly and told me what we should do next. I am really thankful for her support.
Dr. Bhati is very patient and listens to all your doubts. She explained my reports in simple words and did not make me feel rushed. I felt much better after talking to her.
We met Dr. Priya Bhati for my mother’s treatment. She explained the surgery properly and answered all our questions. We felt that she really understood our concerns.
I was worried about having surgery, but Dr. Bhati explained the procedure and what to expect. She was very calm and supportive. I am happy that we consulted her.
Dr. Bhati gave us enough time during the consultation and explained the treatment options clearly. She also listened to what we wanted to know. Very good doctor and a very positive experience.
After my diagnosis, I was confused about what to do next. Dr. Bhati went through my reports and explained everything step by step. Her guidance gave me confidence to start my treatment.