About radiotherapy for vulval cancer

Radiotherapy uses high energy waves to treat cancer. For vulval cancer, your specialist may suggest radiotherapy

• Before surgery
• After surgery
• If your cancer wasn't completely removed
• If you can't have surgery
• To control symptoms of advanced cancer

Before surgery

Doctors call this neoadjuvant treatment. The idea is that the treatment will shrink your cancer. It may mean that 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 chemoradiation, chemoradiotherapy or concurrent therapy. So you may hear your treatment called neo adjuvant concurrent chemoradiation.

After surgery

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. This means that there is quite a high chance of the cancer coming back if you did 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 though, doctors prefer to use surgery to remove lymph nodes that could contain cancer cells. Radiotherapy may cause fewer long term side effects. But a treatment review, published in 2001 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. But remember that radiotherapy is a perfectly acceptable treatment if there is any reason why you should not have surgery to remove your lymph nodes. This publication was updated in 2009 and you can read this review of radiotherapy for early vulval cancer in the Cochrane Library. It was written for researchers and specialists so is not in plain English.

If your cancer wasn't 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).

Sometimes, when the tissue that has been removed is examined after surgery, the border of healthy tissue around the cancer isn't big enough. Your doctor may say you did not have a healthy margin of tissue removed. 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 can 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. And so your vulva and groin can become very sore and painful. This will get better over time after your treatment has finished, but it can be hard for a while.

There is information about radiotherapy side effects on the next page in this section.

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 will help 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. There is more information about radiotherapy for cancer wounds in the treatment section. And there is more information about managing fungating wounds in the coping physically section.

You have radiotherapy treatment in the hospital radiotherapy department. You are most likely to have treatment once a day, Monday to Friday, with a rest at the weekends. Each treatment is called a fraction. The dose you have for each fraction adds up to the total dose of radiotherapy your specialist has prescribed for you. You have the treatment in fractions because the total dose all in one go would cause too many side effects.

Most people are able to have this type of treatment as an outpatient. You will have to travel to the hospital every day. It is a good idea to bring someone with you. You may not feel like driving yourself, or getting yourself home on public transport alone. If travelling costs seem a bit much, ask your nurse specialist to put you in touch with a social worker, who might be able to arrange some funding for you to help cover the cost. If you are having difficulties getting around, you could ask your nurse if it is possible for you to get hospital transport.

If you live a long way from your nearest cancer centre, you may have to stay at the hospital. You will be able to go home at the weekends, when you are not having any treatment.

Radiotherapy has to be carefully planned. At your first visit you will lie under a large machine called a simulator. The doctor uses this to work out where to give your treatment to kill the most cancer cells and miss as much healthy body tissue as possible.

The actual treatment only takes a few minutes. The radiographer will help position you on the couch and make sure you are comfortable. You will be left alone for the minute or two the machine is switched on. But the staff will be able to hear you through an intercom, so call if you need them. The treatment does not hurt. You will not be able to feel it at all. You must lie very still for the few minutes it takes to treat you.

Having external radiotherapy does not make you radioactive. It is perfectly safe to be with other people, including children, throughout your treatment course.

For more information look at the main radiotherapy section.  It tells you more about

• What radiotherapy is
• How radiotherapy is planned
• Possible side effects

Or you could contact the cancer information service.  They may have booklets and leaflets they can give you. Look at the general cancer organisations page for details.