About radiotherapy

Not everyone will have radiotherapy. If you do, you usually have external beam radiotherapy. This means directing radiotherapy beams at your cancer from outside the body. 

When you have radiotherapy

You usually have radiotherapy after surgery to the vulva. But some people have it before their operation. It is also used to treat advanced vulval cancer if surgery is not possible.    

The decision to have radiotherapy depends on where the cancer is, how big it is and whether it has spread.

Before surgery

Doctors call this neo adjuvant 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.

After surgery

Doctors sometimes use radiotherapy after surgery. The aim is to try to stop the 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: 

  • one or more of the lymph nodes removed contain cancer cells
  • the cancer has broken through the capsule that surrounds the lymph node

In these situations, 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.

You might have treatment to the groin on one or both sides, depending on where the cancer was. You may also have radiotherapy to the lymph nodes in the pelvic area.

Generally, doctors prefer to use surgery to remove lymph nodes that could contain cancer cells. Having radiotherapy instead of surgery (to remove the lymph nodes) may cause fewer long term side effects. But doctors are not yet sure whether radiotherapy is as good as surgery at stopping the cancer coming back as surgery.

A large trial called the GROINSS-VII trial is looking at this issue. It has finished recruiting patients and we are now waiting for the results. You can read more about this in our trials database.

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 parts of your body. For example, your back passage (anus) or the tube that drains your bladder (the urethra).

Diagram showing the anatomy of the vulva with Bartholinns glands

When the surgeon removes your cancer, they also remove a border of healthy tissue around it (a clear 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

Radiotherapy on its own

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
  • it is not possible to remove the cancer by surgery if it is large
  • the groin nodes are large, causing the skin around the groin to ooze or bleed

You might have radiotherapy to cure your cancer or treat symptoms.   

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.

Radiotherapy and Chemotherapy

You may have chemotherapy with your radiotherapy. This is called chemoradiotherapy.

How you have this depends on the chemotherapy drugs you have. For example, you might have chemotherapy on one day each week and daily radiotherapy, for a few weeks. Your radiotherapy doctor will explain this in more detail.

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 can 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.

Vulval cancer that has come back after treatment

You may have radiotherapy if your cancer comes back after treatment. This depends on where the cancer is and how much radiotherapy you may have already had. Your radiotherapy doctor will explain the best treatment for you in this situation.

Radiotherapy boost

You may have a radiation boost at the end of your main radiotherapy treatment. The boost gives a higher dose of treatment, to a smaller part of the treatment area. You usually have around 5 to 10 boost treatments. Women usually have boost treatments as external radiotherapy, but some may have their boost as internal radiotherapy. 

You may have a boost in one of the following situations.

After your surgery and main radiotherapy

You have this if the margin around the vulva or groin nodes is not clear, and more surgery is not possible. The boost helps reduce the risk of the cancer coming back.

For advanced cancer

You may this if the cancer has spread and not suitable for surgery. The boost may include the vulva and groin nodes.

How you have internal radiotherapy boost

Some women may have a boost dose of internal radiotherapy. Internal radiotherapy means having a very high dose of radiotherapy on or very near the cancer. 

You may have internal radiotherapy using an implant or a mould. 

To have implants put in, you have a general anaesthetic. While you are asleep the doctor puts thin hollow tubes (applicators) into the skin of the vulva. The applicators stay in for 2 to 3 days throughout your treatment. You stay in the ward, then go to the radiotherapy department for each treatment. 

At the start of each treatment the radiographer connects the applicators to a machine. This delivers the radiotherapy directly to the area through the applicators. When you finish all your treatment the applicators are removed.

Sometimes you may have a mould of the vulva made. The mould is put in position for each treatment. The applicators attach to the mould to deliver the radiotherapy. The mould is then removed after each treatment. 

You usually have 3 to 4 treatments and may have 2 in one day. Each treatment takes about 15 to 20 minutes. Depending on the type of treatment you have you may have this as an inpatient or outpatient.  

Internal radiotherapy doesn't make you radioactive. So you can have visitors while you are in hospital. Or if you go home in between treatments you can be in contact with people as normal.

This is specialist treatment. Your radiotherapy team will explain things to you in more detail and answer any questions you have.

Last reviewed: 
09 May 2019
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    Souhami, R and Hochhauser, D
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    FIGO cancer report 2018

    L Rogers and M Cuello

    International Journal of Gynaecology and Obstetrics, 2018. Vol 143, Issue S2, Pages 4-13

  • External Beam Therapy
    Peter Hoskin
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  • Impact of adjuvant chemotherapy with radiation for node-positive vulvar cancer: A National Cancer Data Base (NCDB) analysis.
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  • Guidelines for the Diagnosis and management of Vulval Carcinoma
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  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in if you need additional references for this information.

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