Radiotherapy uses x-rays to kill cancer cells or injure them so they cannot multiply. The radiation can be targeted at cancer sites in your body. Treatment is carefully planned to do as little harm as possible to your healthy body tissues.
Whether you have radiotherapy or not will depend on the stage of your cancer, its size, whether it has spread to the lymph nodes and, if so, how many nodes are affected.
You may be given radiotherapy externally, where a machine directs radiation at the cancer, or internally, where radioactive material is put in thin tubes into your body on or near the cancer. Whether you are given internal or external radiotherapy will depend on your individual circumstances, the size of the cancer and its response to initial radiation.
When you are given radiotherapy will depend on a number of factors:
- Radiotherapy before surgery: Sometimes radiotherapy is given before surgery to shrink the cancer and make it easier to remove. This is called neo-adjuvant radiotherapy.
- Radiotherapy after surgery: Radiotherapy may be given to the vulva and the lymph nodes after surgery to make sure that any remaining cancer cells are destroyed, and to reduce the risk of the cancer coming back. Radiotherapy given after surgery is called adjuvant treatment.
- Radiotherapy used instead of surgery: If the cancer is known to have spread to the lymph nodes, radiotherapy may be used instead of surgery to treat this area.
- To control symptoms: In advanced vulval cancer (where the cancer has come back or spread), radiotherapy may be used to shrink a tumour, reduce symptoms and improve quality of life. This is called palliative radiotherapy.
External radiotherapy is normally given as a series of short daily treatments in the hospital radiotherapy department. High-energy x-rays are directed from a machine at the area of the cancer.
The number of radiotherapy treatments will depend on the type and size of the cancer, but the whole course of treatment for vulval cancer will usually last a few weeks. Each treatment takes about 10–15 minutes, but it can take several hours to undergo a simulator session (work out where the radiotherapy needs to be given), set up the machine, see the doctor and have any other necessary tests, such as blood tests. Blood tests are performed to make sure you are not becoming anaemic and to monitor your electrolytes, which can be affected by the treatment.
During the treatment, you will lie on a metal table under the radiotherapy machine. Once the machine is turned on, you will be alone in the room, but you will still be able to talk to the radiation therapist through an intercom. The treatment is painless when it is given.
External radiotherapy will not make you radioactive and it is safe for you to be with other people, including children, after your treatment.
Internal radiotherapy, also called brachytherapy, involves putting a radioactive material directly into the cancer, so radiation can be given with minimal effect on nearby organs. Internal radiotherapy is done in less than 2 per cent of women with vulval cancer.
This type of therapy is given by inserting radioactive needles or wires into the cancer while you are under a general anaesthetic. Over a few days, the needles or wires give a high dose of radiotherapy directly to the tumour from the inside.
You will need to be cared for in a single room in hospital for a few days until the doctor has removed the radioactive needles or wires from your body.
Although it will be safe for your family and close friends to visit you for short periods, children and pregnant women will not be allowed to visit, to avoid any chance of them being exposed to even tiny amounts of radiation.
The safety measures and visiting restrictions might make you feel very isolated, frightened and depressed at a time when you might want people around you. The isolation only lasts while the radioactive wires are in place (usually a few days).