Vulvar Cancer: Radiation Therapy

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 or near the edges of the removed tumor (called positive or close margins), the removed tumor has aggressive features when looked at under the microscope, or the 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 could be used instead of surgery if it has spread to the lymph nodes in the groin and pelvis.

• As the main treatment. Radiation alone or chemoradiation can be used if a woman isn't healthy enough to go through surgery.

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:

• The goal of radiation

• The type of radiation you need

• The dose needed

• How long you need treatment

A radiation treatment team will work with you. This team might include:

• Radiation oncologist

• Radiation therapists. They operate the machines that deliver radiation.

• Nurses

• Dosimetrists. They help calculate and monitor dosages of radiation.

• Medical Physicists. They specialize in the reaction of the body to radiation.

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 external beam 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 (Monday through Friday) 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. The therapists may ask you to drink some water 30 minutes before your treatment in order to keep your bladder full.

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 takes only 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), especially around the vulva or groin area

• Skin sores or infection

• Severe tiredness (fatigue)

• Diarrhea

• Nausea and vomiting

• Problems with urination, including burning with urination

• Not having periods (premature menopause) due to ovary damage

• No longer being able to 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 any 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 and when to report them. 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 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. If you want to have children in the future, talk to your healthcare provider about fertility options before starting treatment.