Partial Vaginectomy

https://www.uptodate.com/contents/vaginectomy

I, too, had an abdominal (not laproscopic) radical hysterectomy that involved removing the upper third of my vagina. I can't tell from what you wrote about yourself if your path report revealed where your cancer originated or how it spread from there. My cancer was more advanced than yours and spread from the neck of the uterus both upwards into the fundus and downwards into the cervix, hence the need for the partial vaginectomy to give reasonable certainty of clear margins. I didn't know that was going to happen ahead of time, either.

Partial vaginectomy is a possibility as part of a radical hysterectomy, so your surgical consent likely covered your surgeon using his judgement as needed for having it done. They never know exactly what things wil look like until they are actually in there and need some leeway to avoid needing to wake you up for permission or taking you back for a second surgery. 

Perhaps your current onc could querry the onc who did the surgery about what he saw that made him procede with the partial vaginectomy. Understanding why might help you to be less angry about it if his reasoning makes sense like it did with me.

Actually, I've always been a bit perplexed as to what type of laparoscopic hysterectomy I had. The paperwork I reviewed and signed in Admitting before surgery said "radical" and so did the subsequent pathology report. The right and left parametriums were removed, which is typical of a radical hysterectomy, but there isn’t mention of a partial vaginectomy on the pathology report (cervix was clear of cancer). Ovaries, fallopian tubes and nearby lymph nodes were also removed.

So I assumed I had the radical hysterectomy, but since then I've seen the surgery listed as "total" in some other paperwork. I just had my six-month checkup a couple of weeks ago, but I'll try to remember to ask the doctor which surgery type I had when I see him next. Of course, by then it will have been five years since the surgery, so unless there's something visible during the physical exam I'm not sure he'd remember anything different than what's on the pathology report.

My Operative Report (OR) states what surgical procedure was done and why.  At the top of the OR, it states, "Operation: Exploratory laparatomy, Type II radical hysterectomy and bilateral salpingo-oophorectomy, and bilateral paraaortic and pelvic lymphadenectomy."  In the body of the OR it states, "The uterus consisted of a uterine corpus below which there was a bulbous swelling involving the upper cervix.  This patient had a consultation and endocervical curettage at another institution, with the curettage being negative.  However, the nature of the tumor was such that it was decided to go ahead and perform this wide excision (Type II radical hysterectomy)."

With respect to the vagina, the report states, "The vagina was then entered and circumscribed, and the specimen removed with a good margin.  The vaginal angles were suture transfixed with #0 Monocryl, and the vaginal vault closed with figure-of-eights of #2-0 Vicryl." 

Deb, does your OR give any more information about your gyn-onc's rationale for doing the partial vaginectomy? 

I knew I had to have at least a partial vaginectomy because I had a lesion in the upper vaginal wall. While I didn't hear about what would be don until the morning of the surgery I wasn't surprised. She also warned me of the possibility of bladder involvement and what that would mean. She tried very hard to leave enough vagina to "do whatever I wanted" which made me laugh. My husband and I had looked at each other and given the advanced nature of my cancer stated she could take the whole thing if she needed to.

I was facing almost stage IV so I honestly didn't care what female part needed to be remove--take them all at this point! Maybe when the urgency is less--you are looking at stage I, then preserving parts is more important. I feel for those women who have agonized over their treatments because of what it means to their sexual identity or their ability to have children. I could afford to be pragmatic and say "take what you must, when I wake up I'll find out".

Cheers,

Deb

Wow, I get why your angry and scared, your so brave and a real inspiration to uninformed newbies like me. Hang in there and make sure someone answers all your questions.

It is not at all surprising that you are angry, Deb. As Denise told me not long after I joined this group, we will grieve over the loss of who we used to be. It takes time to accept that and anger is also part of that grieving process. 

Like Deb (Dak82), I knew that I was going to have a partial vaginectomy because I too had a cancerous “nodule” on the upper part of my vagina (so stage IIIB). Like Deb, I was like, “Take whatever you want, not like I need it.” But I have no husband or significant other so that was not a priority to me. At one point my gyn onc was talking about the possibility that my cancer could have invaded my bowel and bladder and might need a total “re-plumbing” such as a colostomy, so compared to that, losing part of my vagina was not such a big deal. So I went into surgery with a much different frame of mind. I was just relieved things weren’t as bad as they could have been.

 Since “Deb 1” and I had more advanced stages of cancer, we were both expecting this so had time to come to terms with things. The fact that you found out about  the partial vaginectomy after surgery  would of course be a huge blow to you. Anyone would be upset and angry. Hugs to you, girl. You have every right to be upset about this and it will take time for you to come to terms with it. Even though we know we will "make it through" eventually, there is no denying that this s*** it hard to deal with. 

All your posts show me you have what it takes to push through your circumstances. I love being part of "Deb squared" and many of your posts make me laugh. We are all here for you.

Love and hugs,

Deb 1