Vulvar Cancer: Radiation Therapy
Radiation therapy uses high-energy X-rays to kill cancer cells. Radiation is one way to treat vulvar cancer. Radiation is a local treatment. This means it affects the cancer cells only in the area treated.
Radiation for vulvar cancer is most often given from a machine outside the body. This is called external radiation. It may be directed at the vulva, or at the area in the groin where it can spread. Or it may be directed at both areas. Radiation is one of the two most common treatments for vulvar cancer. The other is surgery. In most cases, these treatments can cure vulvar cancer.
When is radiation used?
Radiation is used for the following:
Locally advanced tumors. This is when the cancer has spread to nearby structures such as the vagina, anus, or urethra. The goal is for the radiation to shrink the tumor. This makes it easier to remove during surgery. Your healthcare provider may give you low-dose chemotherapy with radiation. This can make radiation more effective. This is called chemoradiation. In some cases, surgery is not needed. You may only need chemoradiation.
After radical vulvectomy, when the cancer is found in the cut edges of the removed tissues (called positive margins), or cancer cells are found in lymph nodes.
Lymph nodes that may contain cancer. Radiation may be used instead of surgery to treat lymph nodes in the groin and pelvis that seem to contain cancer. This may be done if you’re not healthy enough to go through surgery. Or it may be done if the cancer has spread to many lymph nodes.
Deciding on a radiation treatment plan
For radiation, you see a radiation oncologist. This doctor specializes in the use of radiation to kill cancer cells. He or she will work closely with your gynecologic oncologist when making your treatment plan.
The radiation oncologist decides:
It may help to bring a family member or friend with you to appointments. Make a list of questions and concerns you want to talk about. During your visit, ask what the goal of radiation therapy is and what you can expect to feel during and after the treatment.
What to expect during radiation therapy
The person who gives you the radiation is called a radiation therapist. The experience is a lot like getting an X-ray. But it takes longer. In most cases, you’ll have radiation 5 days a week for several weeks in an outpatient setting. This means you will go home each day after treatment.
The radiation comes from a large machine. The machine doesn't touch you during the treatment. The treatments don't hurt. They’re quick.
Before you start treatment, your healthcare provider will do imaging scans of the area of your cancer. This is done to measure the exact location of the tumor so the beams of radiation can be focused there. Your healthcare provider may put small marks on your skin to mark the treatment area. This ensures that the radiation reaches mainly the tumor, and not healthy parts of your body.
On the day of treatment, you lie on a table and are carefully put into the right position. You may see lights from the machine lined up with the marks on your skin. These help the therapist know you’re in the right position. The therapist will leave the room while the machine sends radiation to your tumor. During this time, he or she can see you, hear you, and talk to you. When the machine sends radiation to your tumor, you’ll need to be very still. But you don't have to hold your breath. The process will likely take less than an hour. Most of the time is spent getting you ready and in the exact right position for treatment.
Side effects of radiation
Radiation affects both normal cells and cancer cells. This means it can cause side effects. The side effects you have depend on what part of your body is treated. Talk with your healthcare provider about what you might feel like during and after radiation. Side effects often get worse as treatment goes on. But they can be treated.
Side effects can include:
Skin irritation or redness
Skin sores or infection
Nausea and vomiting
Problems with urination
You stop having periods and can no longer get pregnant (premature menopause)
Sexual changes, including pain with sex or bleeding after sex due to vaginal changes
Swelling (lymphedema) from lymph nodes that are affected by radiation
Most of these side effects go away over time after treatment ends, and some can be prevented. Always tell your healthcare provider about side effects you have. This way, he or she can help ease them.
Be sure to ask your healthcare provider what symptoms to watch for. In some cases, your healthcare provider may want you to call if you have signs of infection, such as fever or pain that gets worse.
Some long-term side effects of radiation may not show up for many years after you finish treatment. These depend on the dose and location of the radiation. Examples include infertility, chronic lymphedema, bowel or bladder control problems, and changes to the vagina that can make sex painful. Ask your healthcare provider what you might expect and what your risks are for long-term side effects.