Read about what radiotherapy is and when you have it for vulval cancer.
When you have radiotherapy
Radiotherapy uses high energy waves to treat cancer. When you have it for vulval cancer depends on where the cancer is, how big it is and whether it has spread.
You might have it with surgery, with or without chemotherapy.
Doctors call this neoadjuvant treatment. The aim of having it before surgery is to shrink your cancer so you can have a smaller operation. Or it may make surgery possible when it wasn't before.
You may have chemotherapy during your course of radiotherapy. Doctors know that some chemotherapy drugs can help radiotherapy to work. Your doctor may call this chemoradiotherapy or concurrent therapy.
Doctors sometimes use radiotherapy to try to stop cancer from coming back in the lymph nodes after you have had surgery. This is called adjuvant treatment. You are most likely to have this if:
- two or more of the lymph nodes that were removed contain cancer cells
- one of your lymph nodes was larger than 5mm in size
- the cancer has broken through the capsule that surrounds the lymph node
In these cases there is quite a high chance of the cancer coming back, if you do not have any further treatment. The radiotherapy is used to try to kill off any cancer cells in the lymph nodes left behind after your operation. The treatment is given to the groin on one or both sides, depending on where the cancer was.
Generally, doctors prefer to use surgery to remove lymph nodes that could contain cancer cells. Although radiotherapy may cause fewer long term side effects, a treatment review, reported that there is not enough evidence to say it is as good at stopping the cancer coming back as surgery, to remove the lymph nodes.
Remember that radiotherapy is a perfectly acceptable treatment, if there is any reason why you can't have surgery to remove your lymph nodes.
For cancers that haven't been completely removed
Your specialist may suggest you have radiotherapy after surgery if it was not possible to remove all of your vulval cancer. This can happen when the area containing cancer cells is too close to other important structures, such as your anus or the tube that drains your bladder (the urethra).
When the surgeon removes your cancer, they also remove a border of healthy tissue around it. This is called the margin. Sometimes, when the doctor examines the margin after surgery, it contains cancer cells. Your surgeon may tell you that they did not remove a clear margin of tissue. So, some cancer cells could have been left behind.
In this situation, your surgeon may suggest more surgery. Or you could have a course of radiotherapy to kill off any cancer cells that have been left behind.
If you can't have surgery
You may have radiotherapy instead of surgery if you are not well enough for an anaesthetic, or to make a good recovery from the operation. A course of radiotherapy designed to cure a cancer is sometimes called radical radiotherapy. This is a difficult decision to make.
A course of radiotherapy designed to cure the cancer is not an easy option. The skin in the vulva and groin is very delicate. It can break down because of the treatment. Your vulva and groin can become very sore and painful. This gets better over time after your treatment has finished, but it can be hard for a while.
To control symptoms of advanced cancer
In advanced vulval cancer, the area sometimes breaks down and forms an unpleasant wound. The wound may ooze. The discharge can smell and the wound can be painful. You may hear this called a fungating wound. They can happen in many different types of cancer.
Your nurse helps you to manage the wound. There are dressings available that have been designed to cope with this sort of problem. They can absorb the discharge and contain charcoal, which helps to control any smell. But it is better if the wound can be treated.
Radiotherapy is very good at shrinking the cancer. It can help to stop the discharge and make the area more comfortable. The area may even heal over completely.