About radiotherapy for vaginal cancer

Radiotherapy uses high energy rays to kill cancer cells. It is painless. But a course of a few weeks does usually have some side effects and it is common for treatment to such a delicate area of the body to cause soreness.

You can have radiotherapy for vaginal cancer in two main ways

• External radiotherapy
• Internal radiotherapy

External radiotherapy

For external radiotherapy, you go to the hospital daily, usually for a few weeks, to lie under a radiotherapy machine. The treatment only takes a few minutes a day. But with hospital waiting time and travel to and from the hospital each day, it can take up more time than you may expect. There is information about having external radiotherapy for vaginal cancer on the next page in this section.

Internal radiotherapy

You may have internal radiotherapy as

• Interstitial radiotherapy or

• Intracavity radiotherapy

Interstitial radiotherapy

In interstitial therapy, a surgeon implants radioactive wires or seeds into the cancer. They leave the wires or seeds in place for a few days.They give a high dose of radiotherapy to the cancer, but the dose drops away very quickly so the surrounding area receives much less. Doctors use this type of therapy for small tumours (less than 2cm wide). In order to put the the wires or seeds in exactly the right place, the tumour must be easy to reach inside the vagina. So you are less likely to have this type of treatment for a tumour high up in the vagina.

Intracavity radiotherapy

Intracavity radiotherapy means putting a radioactive metal object called a source into the vagina. You may have this treatment following a course of external radiotherapy.

You have to go to hospital for intracavity radiotherapy. You may either stay in for up to 5 days or visit the outpatient department each week for a few short treatments. This depends on the system your hospital uses. They may either have the faster high dose rate system or the slower low dose rate system. With the faster system, you have two or more treatments over about 10 minutes each. For the slower system you go into hospital for anything between 2 to 5 days. These treatments work equally well in treating the cancer.

You receive more radiation more quickly with the high dose rate system, so you need a break between treatments. With the slower system, you have a continuous, lower dose of radiation. Your specialist works out the total dose of radiation you need and it will be the same whichever treatment method you have.

There is detailed information about having internal radiotherapy on the next page in this section.

For vaginal cancers, you may have

• Radiotherapy as your main treatment
• Radiotherapy to treat a cancer if you can't have surgery
• Radiotherapy to help stop cancer coming back after surgery
• Radiotherapy to treat a cancer that couldn't be completely removed
• Radiotherapy and chemotherapy combined

Radiotherapy as your main treatment

Radiotherapy is the main treatment for many women with vaginal cancer. Most women with stage 2 or 3 vaginal cancers will have radiotherapy to try to cure their cancer.

A course of radiotherapy designed to cure a cancer is called radical radiotherapy. This treatment usually works well. It causes different side effects to surgery and it may take you a few weeks to recover from it. The skin in the vaginal area and the groin is very delicate. It can break down because of the treatment. And so your groin area can become very sore and painful. This will get better after your treatment course is over, but it can be hard to cope with at the time.

Radiotherapy to treat a cancer if you can't have surgery

You can have radiotherapy instead of surgery if it is not possible for you to have an anaesthetic for any reason. This would usually be because you have another chronic health condition, such as heart or lung problems.

Radiotherapy to help stop cancer coming back after surgery

Radiotherapy is sometimes used to try to prevent cancer from coming back in the lymph nodes after you have had surgery. Doctors call this adjuvant treatment, which means you have it alongside surgery. You are most likely to have this treatment if 2 or more of the lymph nodes that your surgeon removed contained cancer cells. Having cancer in the lymph nodes means there is quite a high chance of the cancer coming back if you don't have any further treatment. The idea is that the radiotherapy kills off any cancer cells left behind after your operation. You have treatment to the lymph nodes in the groin. One or both sides may be treated, depending on where the cancer was.

Radiotherapy to treat a cancer that couldn't be completely removed

Your specialist may suggest that you have radiotherapy after surgery if it was not possible to remove all your vaginal cancer. The cancer may have been too close to other important structures, such as the tube that drains your bladder (the urethra) or your anus.

When you have cancer surgery, the surgeon sends the tissue they remove to the laboratory. In the laboratory a pathologist checks the tissue for cancer cells. There should be a border of cancer free tissue all round the edge. Doctors call this a clear margin. Having this cancer free border helps your surgeon to be as sure as they can that all the cancer is gone. But sometimes there is no border of cancer free tissue. So some cancer cells could have been left behind. In this situation, your specialist may suggest more surgery, or possibly a course of radiotherapy, to kill off any cancer cells that may have been left behind.

Radiotherapy and chemotherapy combined

Your doctor might suggest having chemotherapy alongside your radiotherapy treatment. This is called chemoradiation. Giving radiotherapy and chemotherapy at the same time seems to work better at killing cancer cells than having these treatments alone. The reason for this is not very clear. Researchers think it may be because the chemotherapy makes cancer cells more sensitive to radiotherapy, or vice versa.

For this treatment, you have radiotherapy as normal, but you have chemotherapy at the same time. Usually, this means an injection of a chemotherapy drug called cisplatin, once a week throughout your course of radiotherapy.

Radiotherapy treatment can help to relieve symptoms in advanced cancer of the vagina. This is called palliative radiotherapy. The treatment can shrink the cancer for a time and this helps to relieve symptoms. Radiotherapy also helps to relieve pain. You usually have this type of treatment as a short course, over a few days.

In advanced vaginal 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. Doctors and nurses often call this a fungating wound or ulcerating cancer, which are not very pleasant names.

Your nurse will help you to manage the wound. Dressings are available that are designed to cope with this sort of problem. They can absorb the discharge and they contain charcoal, 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 wound may even heal completely. Your doctor might also prescribe antibiotics for you, because these can help to stop any discharge and clear up any infection.

You can find detailed information about palliative radiotherapy in the radiotherapy section. And there is more information about fungating wounds in the section about coping physically with cancer.

Your specialist will plan your radiotherapy very carefully. At your first visit you lie under a scanner or a large machine called a simulator. Here is a picture of a simulator.

Your doctor uses the scans to work out where to give your treatment to kill the most cancer cells and miss as much healthy body tissue as possible. For external radiotherapy you may have radiotherapy skin markings made on your skin. Your radiographer uses these markings to line up the radiotherapy machine every day when you have your treatment. You must be careful not to wash pen markings off. They will probably fade a bit as you go through your course and your radiographer will ink them in again for you.

Look at the radiotherapy section in CancerHelp UK. It tells you more about this type of treatment including

• What it involves
• How your radiotherapy treatment is planned
• Possible side effects

There are books and booklets about radiotherapy, some of which are free. You can find details on the cancer and treatments reading list.