Radiotherapy for vulval cancer

Radiotherapy|  treats cancer by using high-energy rays, which destroy the cancer cells while doing as little harm as possible to normal cells.

Radiotherapy for cancer of the vulva can be given externally or internally, or as a combination of the two.

There are a number of ways that radiotherapy may be used to treat vulval cancer. It may be given before surgery|  to try to shrink the cancer and make a smaller operation possible. Radiotherapy may also be given after surgery if the cancer isn’t completely removed or if there is cancer in the lymph nodes.

Radiotherapy is most commonly used to treat vulval cancer that has come back or spread. If the cancer is advanced the main aim of radiotherapy may be to improve quality of life by shrinking the tumour and reducing symptoms. This is known as palliative radiotherapy .

Sometimes chemotherapy| is given with radiotherapy; this is called chemoradiation . Research is still going on to find out whether giving chemotherapy with radiotherapy is better than radiotherapy on its own.

We have a separate section on radiotherapy| , which gives detailed information about the treatment and its side effects.

Two types of radiotherapy are used to treat vulval cancer – external radiotherapy and internal radiotherapy (brachytherapy). Each woman’s treatment is designed individually. A course of treatment may be external radiotherapy only, or it may consist of two or more ‘phases’ of treatment. The first phase may be external x-ray treatment, and the second may involve internal radiotherapy, or more external treatment given to a smaller area.

Internal radiotherapy Back to top

Internal radiotherapy (also called interstitial radiotherapy, implant therapy, or brachytherapy) involves putting a radioactive material directly into the cancer. This gives a high dose of radiotherapy directly to the tumour from the inside.

There are several methods which can be used and practice varies from centre to centre. If you are going to have internal radiotherapy, your cancer specialist will be able to explain how this will be done at your particular centre.

These treatments are 'tailor-made', and the details of the treatment will be discussed with you beforehand.

External radiotherapy Back to top

In external radiotherapy high-energy x-rays are directed from a machine to the area of the cancer. External radiotherapy is normally given as a series of short, daily treatments in the hospital radiotherapy department. The treatments are usually given from Monday to Friday, with a rest at the weekend. The number of treatments will depend on the type and size of the cancer, but the whole course of treatment for vulval cancer will usually last a few weeks.

Each treatment takes around 10–15 minutes. Your doctor will discuss the treatment and possible side effects with you.

 

Before each session of radiotherapy the radiographer will position you carefully on the couch and make sure that you are comfortable. During your treatment you will be left alone in the room, but you will be able to talk to the radiographer, who will be watching you from the next room.

Radiotherapy is not painful, but you have to lie still for a few minutes while your treatment is being given. External radiotherapy won’t make you radioactive and it is perfectly safe for you to be around other people, including children, after your treatment.

Side effects

Radiotherapy to the vulva and groin causes general side effects such as diarrhoea and tiredness, and it can also cause other specific side effects. These side effects can be mild or troublesome, depending on the strength of the radiotherapy dose and the length of your treatment.

Your radiotherapy doctor (clinical oncologist) will tell you what to expect.

Skin reaction As the skin in the area of the vulva and groin is very sensitive, radiotherapy will cause soreness. Your specialist can prescribe cream to help soothe the soreness. Only use lukewarm water to wash the treatment area, and gently pat the area dry with a soft towel. Talcum powder or perfume may cause irritation, so avoid using these. Your radiographer or nurse can advise you on how to look after your skin during your treatment.

Inflammation of the bladder lining (cystitis) Radiotherapy to the groin may cause inflammation in the lining of the bladder, which can make you feel that you want to pass urine frequently.

You may also feel a burning sensation when you pass urine. Your doctor can prescribe medicines that can make passing urine less uncomfortable.

It helps to drink plenty of water and other fluids to make your urine more dilute.

Diarrhoea Radiotherapy may also irritate the bowel and cause diarrhoea| . If this is a problem let your doctor know, as medicines can be prescribed to help. It is important to drink plenty of water to replace the fluid lost through diarrhoea.

Tiredness Radiotherapy makes you tired, so try to get as much rest as you can, especially if you have to travel a long way for treatment each day. We have a section about coping with fatigue| , which you may find helpful.

The side effects listed above may continue for several weeks and then gradually disappear once your course of treatment is over. It is important to tell your doctor if side effects continue after this time.

Hair loss Radiotherapy for cancer of the vulva can make your pubic hair fall out| . It may grow back after treatment, but for some women this may be permanent.

Narrowing of the vagina While you're having radiotherapy, and for a few weeks after treatment, the vagina will become tender. This irritation can leave scarring, which makes the vagina narrower and less flexible. This may make having sex uncomfortable or difficult. You will be advised to use vaginal dilators with a lubricating jelly, to keep the vaginal walls open and supple. The dilators are usually made of plastic and can be given to you by your nurse or doctor, who will advise you how to use them.

Applying a hormone cream to your vagina may help. These are available on prescription from your doctor. Regular sex may also help to prevent the vagina from shrinking, but you may not feel ready for sex for some time.

We have a section on pelvic radiotherapy in women| , which has information on side effects and ideas about how to cope with them.

Swelling As the vulva is very sensitive to radiation it may be swollen for months or sometimes years after radiotherapy. The swelling can be reduced by gentle, upwards massage, which you can be taught to do by a specialist nurse or physiotherapist.

Changes to the skin The skin of the vulva may become permanently discoloured (reddened or darker).