Cancer treatment team
Many hospitals use multidisciplinary teams (MDTs) to treat vulval cancer. MDTs are teams of specialists that work together to make decisions about the best way to proceed with your treatment.
Members of your MDT will probably include:
- a gynaecological oncology surgeon – a surgeon who specialises in treating cases of cancer that develop inside the female reproductive system
- a clinical oncologist (a specialist in the non-surgical treatment of cancer)
- a pathologist (a specialist in diseased tissue)
- a radiologist (a specialist in radiotherapy)
- a social worker
- a psychologist
- a specialist cancer nurse, who will usually be your first point of contact with the rest of the team
Your treatment plan
Deciding what treatment is best for you can often be confusing. Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours.
Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions that you would like to ask the specialist. For example, you may want to find out the advantages and disadvantages of particular treatments.
Surgery
In most cases your treatment plan will involve some form of surgery. The type of surgery will depend on the stage of the cancer.
To treat vulval cancer there are two surgical options:
- radical wide local excision – where the cancerous tissue from your vulva is removed as a well as a margin of healthy tissue, usually around 1cm, as a precaution
- radical vulvectomy – this involves removing a larger section of your vulva, such as one or both of the labia and the clitoris
The preferred surgical option will depend on the site and size of the cancer.
If the cancerous cells have spread into one or more lymph nodes in your groin, these will need to be assessed by an additional surgical procedure.
In some circumstances this can be done by a process to remove the lymph nodes most likely to be affected by cancer. These lymph nodes are known as sentinel nodes.
The nodes are identified by injecting a dye at the site of the tumour and then studying the flow of dye in order to locate the nodes closest to the tumour, which would be the sentinel nodes. These nodes are then removed and checked for the presence of cancerous cells.
Depending on the results of the biopsy, some or all of the nodes in your groin and upper legs will need to be surgically removed. This type of operation is known as a lymphadenectomy.
Larger tumours and cases where the lymph nodes appear enlarged are not suitable for sentinel node biopsy, and the removal of all the lymph nodes in your groin is likely to be recommended. This is called an inguino-femoral lymphadenectomy.
If lymph nodes are affected by cancer, further treatment with radiotherapy is likely to be advised.
Performing a lymphadenectomy does reduce the risk of the cancer returning but it can make you more vulnerable to infection and cause swelling in your legs due to a build-up of lymphatic fluid. This type of swelling is known as lymphoedema. Read more about the complications of surgery for vulval cancer.
In cases of advanced vulval cancer or if the cancer returns after previous treatment, an operation called a pelvic exenteration may be recommended. This involves removing your entire vulva as well as your bladder, womb and part of your bowel.
If a section of your bowel is removed it will be necessary to create holes in your abdomen, known as stoma, in order that the bowel can be passed out into collection pouches that you wear next to your body.
A collection pouch for receiving bowel content is called a colostomy.
And if your bladder is removed there are a number of options open to you. As with a colostomy, your urine can be passed out of your body into a pouch via a stoma. Or it may be possible to create a "new bladder" by removing a section of your bowel and using it to create a pouch to store urine in.
The section on complications on bladder cancer has more detailed information on the treatment options available to people who have had their bladder surgically removed.
The time it will take you to recover from surgery will depend on the type of surgery and how extensive it was. For very extensive operations such as a pelvic exenteration it may take up to eight weeks to recover.
Read more about recovering from the effects of surgery.
Reconstruction
If only a small amount of tissue has been removed, the skin of the vulva will be neatly stitched together. Otherwise, it may be necessary to have a skin graft where a piece of skin is taken from your thigh or abdomen to cover any wound in your vulva. Another option is to have a tissue flap where a sample of skin, tissue and fat is taken from another part of your body, usually the back or the abdomen, and used to help reconstruct the vulva.
Radiotherapy
Radiotherapy involves using high-energy radiation, usually X-rays, to destroy cancerous cells.
Radiotherapy can be delivered as:
- internal radiotherapy – where a radioactive implant is placed directly into cancerous tissue
- external radiotherapy – where a machine outside of the body beams the radioactive ways onto the section of the body that contains the cancer
There are two main ways that radiotherapy can be used in the treatment of vulval cancer:
- It can be given after surgery in order to destroy any cancerous cells that may be left, for example for cases where cancer cells have spread to the lymph nodes in the groins.
- It can be given to relieve symptoms in cases where a complete cure is not possible – this is known as palliative radiotherapy
Radiotherapy can also be combined with chemotherapy as an alternative to surgery if it was likely that surgery would cause extensive damage to your bladder or bowel and you were unwilling to have a stoma or new bladder.
There are different ways that internal radiotherapy for vulval cancer can be given and they can vary from specialist centre to specialist centre. If internal radiotherapy is recommended for you, your MDT will be able to provide more information on what will be involved.
External radiotherapy is normally given in daily sessions, five days a week, with each session lasting around 10-15 minutes. Most people require four to five weeks of sessions.
While the radiation is effective in killing cancerous cells, it can also damage healthy tissues leading to a number of side effects, such as:
- sore skin around the vulva area
- diarrhoea
- feeling tired all the time
- loss of pubic hair
- swelling of the vulva
- narrowing of your vagina, which can make sex difficult
- inflammation of your bladder (cystitis), which in turn can cause you to have a frequent need to urinate
In younger women external radiotherapy can sometimes trigger an early menopause. This means they will no longer be able to have any children.
Read more about radiotherapy.
Chemotherapy
Chemotherapy is usually used in combination with radiotherapy or to control symptoms when a cure is not possible or as an alternative to surgery that would require a colostomy or ileal conduit urinary diversion (where urine is passed out of the body in a method that does not involve the bladder, such as through a stoma or an internal pouch).
Chemotherapy is the use of anti-cancer medication to destroy cancer cells. It is usually given by injection.
The medicines used in chemotherapy can sometimes damage healthy tissue as well as the cancerous tissue. Unfortunately, side effects are common and include:
- feeling sick
- being sick
- hair loss
- sore mouth
- mouth ulcers
- tiredness
These side effects should stop once the treatment has finished. Chemotherapy can also weaken your immune system, making you more vulnerable to infection.
So it is important to report any symptoms of a potential infection, such as a high temperature, persistent cough or reddening of the skin to your MDT. You should also avoid close contact with people known to have an infection.
Read more about chemotherapy.
