Radiotherapy for vulval cancer
Radiotherapy treats cancer by using high-energy x-rays, which destroy the cancer cells while doing as little harm as possible to normal cells.
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 also 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.
Radiotherapy can be internal or external. Radiotherapy for cancer of the vulva is usually given externally. However, occasionally internal radiotherapy (brachytherapy - see below) is given on its own or in combination with external radiotherapy.
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-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.
Planning the radiotherapy
Before you have your radiotherapy, the treatment will need to be carefully planned. Usually you’ll be asked to attend the radiotherapy department and you’ll have a CT scan, which will take images of the area to be treated. These images are used to plan the precise area of treatment. You may need to attend one or more planning appointments before your treatment begins.
When you start your radiotherapy, before each session the radiographer will position you carefully on the couch and make sure that you’re comfortable. During your treatment you’ll be left alone in the room, but you’ll be able to talk to the radiographer, who will be watching you from the next room. Each treatment takes around 10-15 minutes. Your doctor will discuss the treatment and possible side effects with you.
Radiotherapy isn’t painful, but you will have to lie still for a few minutes while your treatment is being given. External radiotherapy won’t make you radioactive and it’s perfectly safe for you to be around other people, including children, after your treatment.
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 that can be used, and practice varies from centre to centre. As internal radiotherapy treatments are ‘tailor-made’, your cancer specialist will discuss the specific details of your treatment with you beforehand.
Side effects of radiotherapy
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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 more troublesome, depending on the strength of the radiotherapy dose and the length of your treatment.
If you have chemoradiation, side effects are likely to be more troublesome immediately after treatment. Although most of these side effects will gradually settle, occasionally some can persist longer term.
Your radiotherapy doctor (clinical oncologist) will tell you more about what to expect.
Because 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 and perfume should be avoided, as these can cause irritation. 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 to make passing urine more comfortable. It helps to drink plenty of water and other fluids to make your urine more dilute.
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’s important to drink plenty of water to replace the fluid lost through diarrhoea.
It’s common to feel tired during your radiotherapy treatment. It’s important to try to pace yourself and get as much rest as you need, especially if you have to travel a long way for treatment each day. Try to balance this with doing some gentle exercise, such as short walks, which will help.
We have a section about coping with fatigue that 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’s important to tell your doctor if your side effects continue after this time.
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, your vagina will be tender. The radiotherapy may cause some scarring, which makes the vagina narrower and less flexible. This may make having sex uncomfortable or difficult. You’ll 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 on how to use them. You won’t need to use vaginal dilators if you only have radiotherapy to one or both sides of your groin, rather than to your vulval area.
Applying a hormone cream to your vagina may also 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.
You may find it useful to read our information about sexuality and cancer of the vulva. We also have a sectiop on pelvic radiotherapy in women, which has information about side effects and ideas for how to cope with them.
Because 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 a specialist nurse or physiotherapist can teach you to do.
Changes to the skin
The skin of the vulva may become permanently discoloured (reddened or darker).