Side effects of vulval cancer radiotherapy

Generally, it takes a while for radiotherapy side effects to come on. You may not notice any for a couple of weeks. Then, most side effects go away within a few weeks of your treatment course finishing. Doctors call these acute side effects.

But there are some side effects that can come on after your treatment has finished or continue to be a problem long after your treatment is completed. You may hear these called chronic side effects, late side effects or long term side effects.

There is more information about having radiotherapy to the pelvis in the sex and cancer for women section.

Skin reactions in the treatment area are common. This is an acute side effect, which will come on during your course of treatment and then get better once it is over. Your skin may look and feel sunburned. The skin in the groin is very delicate. If you are having a course of radical radiotherapy, designed to cure your cancer, you may have a more severe reaction. The skin can break down in the treatment area. This is more likely to happen towards the end of your course of treatment. The nurses in the radiotherapy department will keep an eye on this and advise you on how to care for it. If you have a bad reaction, you may need to have a break in your course of treatment to allow some healing. But your specialist will try to avoid this if at all possible.

You will be told how to care for your skin during your radiotherapy treatment. Most centres suggest you wash only with plain warm water. Lotions, creams and powders will only make the problem worse. You should only use preparations that have been provided or suggested by your radiotherapy department. These skin reactions are uncomfortable and can be painful. But the skin will heal when your treatment is over. If you are having trouble coping with this, do tell your radiographer or radiotherapy nurse. They will be able to help you to look after your sore skin. And you can have painkillers if you need them.

Tiredness is a very common problem with radiotherapy to any part of the body. It tends to come on within a couple of weeks of starting your course of treatment and then go away within a few weeks of finishing. Of course, travelling back and forth to the hospital for treatment every day doesn't help. And stress will also make you feel less energetic. But radiotherapy itself seems to cause fatigue. How it affects people varies a lot. At its worst, people just want to sleep all the time. But this would be very unusual with vulval radiotherapy. If you feel tired, try planning and taking regular naps. Your body is telling you that you need to sleep, so that's the best thing to do. You may want to get into the habit of having a lie down when you get back from the hospital.

If you have radiotherapy to the vulva, it is not possible to completely protect some of the organs nearby. So the treatment may cause problems with your bowel or bladder. Diarrhoea is a common side effect. Your doctor can give you anti-diarrhoea medicine to help control it.

You may get symptoms of sore bladder (cystitis). You may feel you need to empty your bladder more often than normal. And when you do pass urine, it may cause a burning sensation or be painful. This side effect usually gets better on its own.

These are all acute side effects that should start to get better within a week or so of finishing your treatment. It is not impossible to get long term bladder and bowel problems after radiotherapy for vulval cancer, but it is rare.

The vagina and ovaries are also affected by radiotherapy. If you are still having periods, your ovaries may stop working and you may have a premature menopause. If you do get this, it is likely to be permanent. This means that you will become infertile. Menopause can cause symptoms such as

• Feeling emotional
• Hot flushes
• Sweats
• Dry skin and dry vagina
• Tiredness
• Anxiety and loss of confidence
• Thinning bones

These symptoms can be quite intense and can go on for a long time. Unfortunately, as with a natural menopause, it is not possible to predict how long you will have them.

You may want to take hormone replacement therapy (HRT) to control your menopause symptoms. You can talk to your surgeon about this before your operation so that you can start HRT as soon as you have the surgery if you wish to. There is no medical reason why you shouldn't take HRT after having had vulval cancer.

If you don't want to take HRT, there are suggestions for other ways to help control menopausal symptoms in the section about sex and cancer for women. We have information about dealing with sweating in our section on coping physically with cancer.

Your vagina may shrink and lose its ability to stretch (elasticity). You may also have vaginal dryness. Both of these are likely to be long term problems after radiotherapy to this part of the body. They can cause difficulty with sexual intercourse, which may become painful. There are different moisturisers and creams available to help with dryness. You may also find that using dilators helps to improve the stretchiness and make sex more comfortable. For more information about ways to cope with these symptoms and the types of treatment to prevent them, look in the sex and cancer for women section.