Radiotherapy treats cancer by using high-energy rays which destroy the cancer cells, while doing as little harm as possible to normal cells.

Radiotherapy may be given to the vulva and the lymph nodes after surgery. This is to make sure that any remaining cancer cells are destroyed, and so reduce the risk of the cancer coming back. Whether you have radiotherapy or not will depend on the stage of your cancer, its size, and also whether it has spread to the lymph nodes (and if so, how many are affected).

Sometimes radiotherapy is given before surgery to shrink the cancer and make it easier to remove.

If the cancer is known to have spread to the lymph nodes, radiotherapy may be used instead of surgery to treat this area. Radiotherapy and chemotherapy may be given at the same time. This is known as chemoradiation.

In advanced vulval cancer (where the cancer has come back or spread) radiotherapy may be used to shrink a tumour and reduce symptoms to improve quality of life. This is known as palliative radiotherapy.

We have a separate section on radiotherapy, which gives detailed information about the treatment and its side effects.

Each woman's treatment will be designed individually. A course of treatment may be with external radiotherapy only, or may consist of two or more ‘phases’ of treatment. The first phase may be external x-ray treatment and the second may involve more external treatment given to a smaller area, or may be internal radiotherapy with radioactive wires. Internal radiotherapy is known as brachytherapy. Sometimes a mould may be used to hold radioactive metal next to the vulva to give a dose of radiotherapy. These treatments are 'tailor-made', and the details of the treatment will be discussed with you beforehand.

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 treatments are usually given from Monday to Friday, with a rest at the weekend. The number of 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 around 10–15 minutes. Your doctor will discuss the treatment and possible side effects with you.

Before each session of radiotherapy the radiographer will position you carefully on the couch and make sure that you are comfortable. During your treatment you will be left alone in the room, but you will be able to talk to the radiographer who will be watching you carefully from the next room.

Radiotherapy is not painful, but you have to lie still for a few minutes while your treatment is being given. External radiotherapy will not make you radioactive and it is perfectly safe for you to be with other people, including children, after your treatment.

Side effects

Radiotherapy to the vulva and groin causes general side effects such as diarrhoea and tiredness, and it can also cause other specific side effects. These side effects can be mild or troublesome, depending on the strength of the radiotherapy dose and the length of your treatment. Your radiotherapy doctor (clinical oncologist) will tell you what to expect.

Skin reaction As the skin in the area of the vulva and groin is very sensitive, radiotherapy will cause soreness. Only use lukewarm water to wash the treatment area, and pat the area dry gently with a towel. Talc or perfume may cause irritation, so avoid using these. Your specialist can prescribe cream to help soothe the soreness. Your radiographer or nurse can advise you on how to look after your skin during this time.

Inflammation of the bladder lining (cystitis) Radiotherapy to the groin may cause inflammation of the lining of the bladder, which can make you feel that you want to pass urine frequently. You may also feel a burning sensation when you pass urine. Your doctor can prescribe medicines that can make passing urine less uncomfortable. It helps to drink plenty of water and other fluids to make your urine more dilute.

Diarrhoea Radiotherapy may also irritate the bowel and cause some diarrhoea. If this is a problem let your doctor know, as medicines can be prescribed to reduce it. It is important to drink plenty of water to replace the fluid lost through diarrhoea.

Tiredness As radiotherapy makes you tired, try to get as much rest as you can, especially if you have to travel a long way for treatment each day.

The side effects listed above may continue for several weeks and then gradually disappear once your course of treatment is over. It is important to tell your doctor if they continue.

Hair loss Radiotherapy can make your hair fall out in the area being treated, and this may be permanent.

Narrowing of the vagina The vagina can be affected by radiotherapy to the pelvic area. While having radiotherapy, and for a few weeks after treatment, the vagina will become tender. In the long term this irritation can leave scarring which makes the vagina narrower and less flexible. This may make having sex uncomfortable or difficult. Because of this you will be advised to use a vaginal dilator with a lubricating jelly, to keep the vaginal walls open and supple. The dilators are usually made of plastic and can be given to you by your nurse or doctor, who will advise you how to use them.

Applying a hormone cream to your vagina may help. These are available on prescription from your doctor. Regular intercourse may also help to prevent the vagina from shrinking. But you may, understandably, not feel ready for this for some time.

We have a section on pelvic radiotherapy in women, which has information on side effects, and ideas on how to cope with them.

Internal radiotherapy (also called interstitial radiotherapy, implant therapy, or brachytherapy) involves putting a radioactive material directly into the 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.

As the implant is radioactive you will need to stay in your room in hospital, and visitors will be limited. While the radioactive wires or needles are in place, low levels of radiation are given out from them. You will need to stay 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 doctors and nurses caring for you will also only be able to stay in your room for short periods at a time. This is because they may be looking after several people having internal radiotherapy treatment, and they must keep their exposure to the low level of radioactivity to a minimum.

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. If you have these feelings it is important that you let the staff looking after you know. It might also be helpful to take in plenty of reading material and things to keep you occupied while you are in isolation. The isolation only lasts as long as the radioactive wires are in place (usually for a few days). Once the wires are removed the radioactivity disappears and it is perfectly safe to be with other people.

Side effects

While the needles are in place, the tissues around them will become swollen. This usually settles by the time they are removed. The treated area will become sore about 5–10 days after the needles or wires have been removed and this may last for several weeks. Your doctor can prescribe painkillers to help to relieve the discomfort.

Long-term effects of radiotherapy to the vulva

As the skin of the vulva is very sensitive to radiation it can become discoloured (reddened or darker) and swollen for months or sometimes years after radiotherapy. The swelling can be reduced by gentle, upwards massage, which you can be taught to do by a specialist nurse or physiotherapist, but unfortunately the discoloration of the skin is permanent.