Vulvar Cancer: Radiation Therapy
Radiation therapy uses high-energy X-rays to kill cancer cells. It's one way to treat vulvar cancer. Radiation is a local treatment. This means it affects the cancer cells only in the area that's treated.
Radiation for vulvar cancer is most often given from a machine outside the body. This is called external radiation. It may be aimed at the vulva, or at the areas in the groin if vulvar cancer has spread. Or it may be directed at both areas. Radiation is one of the most common treatments for vulvar cancer. Another is surgery. In most cases, these treatments can cure vulvar cancer.
When is radiation used?
Radiation is most often used along with chemotherapy. This can make the radiation work better. This is called chemoradiation. It is used:
Before surgery. Treatment is used to shrink locally advanced tumors that have spread to nearby structures, such as the vagina, anus, or urethra. The goal is for the radiation to shrink the tumor so it's easier to remove.
After surgery. If cancer is found in the edges of the removed tumor (called positive margins) or cancer cells are found in lymph nodes, radiation can help kill any cancer cells left in the body.
If there's cancer in the lymph nodes. Radiation alone may be used instead of surgery to treat lymph nodes in the groin and pelvis that seem to contain cancer.
As the main treatment. Radiation alone or chemoradiation can be used if a woman isn't healthy enough to go through surgery. Or it may be done if the cancer has spread to a lot lymph nodes.
Deciding on a radiation treatment plan
For radiation, you see a radiation oncologist. This doctor specializes in using radiation to kill cancer cells. They will work closely with your gynecologic oncologist when making your treatment plan.
The radiation oncologist decides:
A radiation treatment team will work with you. This team might include a radiation oncologist, radiation therapists, nurses, dosimetrists, and medical physicists. 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 like during and after treatment.
What to expect during radiation therapy
The person who gives you the radiation is called a radiation therapist. Treatment is a lot like getting an X-ray. But it takes longer. In most cases, you’ll get 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 are quick. They don't hurt.
Before you start treatment, you will meet with your radiation treatment team for a visit called simulation. During this visit, imaging scans will be done to measure the exact location of the tumor. This is needed to plan for the beams of radiation to be focused there. Tiny ink marks or tattoos may be put on your skin to mark the treatment area. This ensures that the radiation reaches mainly the tumor, and not healthy parts of your body. Body molds, casts, or other devices might be made to hold you in the exact same position for each treatment.
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, the therapist 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. But treatment only takes a few minutes. Most of the time is spent getting you ready and in the 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. They also tend to be worse if chemo is given along with radiation. But they often can be treated.
Side effects can include:
Skin irritation, redness, blistering, and peeling (like a bad sunburn)
Skin sores or infection
Severe tiredness (fatigue)
Nausea and vomiting
Problems with urination
Stop having periods (premature menopause) due to ovary damage
Can no longer get pregnant (infertility) due to ovary damage
Sexual changes, including pain with sex or bleeding after sex due to vaginal changes
Swelling (lymphedema) from lymph nodes or lymph vessels that are damaged by radiation
Low blood counts
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 you can get help to ease or even prevent them.
Be sure to ask your healthcare provider what symptoms to watch for. In some cases, your 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 treatment ends. 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 having sex painful. Ask your healthcare provider what you might expect and what your risks are for long-term side effects.