Treatment for vulval cancer
Surgery is the main treatment for cancer of the vulva. Many women are cured of their vulval cancer with surgery. It may be used alone or in combination with radiotherapy and chemotherapy.
The aim of surgery is to completely take away the cancer. Making sure that all the cancer is removed is the most important factor in trying to cure the cancer. At the same time your surgeon will try, as far as possible, to preserve the appearance and function of the vulva and nearby tissues.
Radiotherapy may sometimes be given to shrink the cancer before surgery. It can also be given after surgery to make sure any remaining cells are destroyed. Radiotherapy and chemotherapy can also be used together (chemoradiation). If the cancer has spread to other parts of the body, chemotherapy may be used on its own.
Planning your treatment
Back to top
In most hospitals a team of specialists will talk to you about the treatment they feel is best for your situation. This multidisciplinary team (MDT) will include:
a gynaecological oncologist (a surgeon who specialises in gynaecological cancers)
a plastic surgeon (a doctor who specialises in reconstructive surgery)
a medical oncologist (a doctor who specialises in treating cancer with chemotherapy)
a clinical oncologist (a doctor who specialises in treating cancer with radiotherapy and chemotherapy)
a radiologist (a doctor who specialises in reading scans)
a gynaecology-oncology specialist nurse, who will be your main contact and will make sure you get help and support throughout your treatment.
The MDT may also include other healthcare professionals, such as a dietitian, physiotherapist, occupational therapist, psychologist or counsellor.
The team will take a number of factors into account when advising you on the best course of action, including your age, general health, the type and size of the tumour, and whether the cancer has begun to spread.
If two treatments are equally effective for your type and stage of cancer, your doctors may offer you a choice of treatments. Sometimes people find it hard to make a decision. If you’re asked to make a choice, make sure that you have enough information about the different options, what’s involved and the possible side effects, so that you can decide on the right treatment for you.
Remember to ask questions about any aspects that you don’t understand or feel worried about. It may help to discuss the benefits and disadvantages of each option with your cancer specialist or nurse specialist.
If you have any questions about your treatment, don’t be afraid to ask your doctor or nurse. It often helps to make a list of questions and take a relative or close friend with you.
Before you have any treatment, your doctor will explain its aims. They will usually ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you’re asked to sign the form you should be given full information about:
the type and extent of the treatment
its advantages and disadvantages
any significant risks or side effects
any other treatments that may be available.
If you don’t understand what you’ve been told, let the staff know straight away so they can explain again. Some cancer treatments are complex, so it’s not unusual for people to need explanations repeated.
It’s a good idea to have a relative or friend with you when the treatment is explained, to help you remember the discussion. You may also find it useful to write a list of questions before your appointment.
People sometimes feel that hospital staff are too busy to answer their questions, but it’s important for you to know how the treatment is likely to affect you. The staff should be willing to make time for your questions.
You can always ask for more time if you feel that you can’t make a decision when your treatment is first explained to you.
You are also free to choose not to have the treatment. The staff can explain what may happen if you don’t have it. It’s essential to tell a doctor or the nurse in charge, so they can record your decision in your medical notes. You don’t have to give a reason for not wanting treatment, but it can help to let the staff know your concerns so they can give you the best advice.
The benefits and disadvantages of treatment
Back to top
Many people are frightened at the idea of having cancer treatments, particularly because of the possible side effects. However, these can usually be controlled with medicines.
Treatment can be given for different reasons, and the potential benefits will vary depending on your individual situation. In people with early-stage vulval cancer, surgery is often done with the aim of curing the cancer. Occasionally additional treatments are also given to reduce the risk of it coming back.
If the cancer is at a more advanced stage, then usually more than one type of treatment is needed. The treatment may only be able to control the cancer, improving symptoms and quality of life. However, for some people in this situation the treatment will have no effect upon the cancer and they will get the side effects without any of the benefit.
If you’ve been offered treatment that aims to cure your cancer, deciding whether to accept it may not be difficult. However, if a cure is not possible and the purpose of treatment is to control the cancer for a period of time, it may be more difficult to decide whether to go ahead.
Making decisions about treatment in these circumstances is always difficult, and you may need to discuss in detail with your doctor whether you wish to have treatment. If you choose not to have it, you can still be given supportive (palliative) care, with medicines to control any symptoms.
Your multidisciplinary team uses national treatment guidelines to decide on the most suitable treatment for you. Even so, you may want another medical opinion. If you feel it will be helpful, you can ask either your specialist or GP to refer you to another specialist for a second opinion. Getting a second opinion may delay the start of your treatment, so you and your doctor need to be confident that it will give you useful information.
If you do go for a second opinion it may be a good idea to take a relative or friend with you, and have a list of questions ready so that you can make sure your concerns are covered during the discussion.