Types of treatment used

Surgery is the main treatment for cancer of the vulva. It may be used either alone or in combination with radiotherapy and chemotherapy. All these treatments are explained in more detail in the following pages.

During surgery only the minimum amount of tissue that is necessary to get rid of the tumour will be removed. However, the type of surgery will depend on the size and position of the cancer.

It is sometimes possible to have a small operation to remove the cancer, together with some surrounding normal tissue. Sometimes this may be all the treatment that is needed.

Unfortunately, some women may need a larger operation that involves removing the labia and sometimes the clitoris.

Radiotherapy may sometimes be given before surgery to shrink the cancer. It can also be given after surgery to make sure any remaining cells are destroyed, or it can be used instead of surgery.

Often radiotherapy and chemotherapy can be used together (chemoradiation) to improve the results of treatment. Occasionally, if the cancer has spread to other parts of the body, chemotherapy may be used on its own. The main treatment for cancer of the vulva is surgery. Radiotherapy and chemotherapy may also be used.

Planning your treatment

Your doctor will plan your treatment by taking into consideration a number of factors, including the type of cancer, its position and size, whether it has spread (stage) and your general health.

You may find that other women with cancer of the vulva at the hospital are having different treatments. This will often be because their illness takes a different form, so they have different needs.

Cancer specialists follow national guidelines for treating vulval cancer. The treatment you receive will be based on the guidelines, but tailored to your particular situation. Sometimes you may be asked to take part in a clinical trial of a new treatment.

If you have any questions about your own treatment, don’t be afraid to ask your doctor or nurse. It often helps to make a list of questions for your doctor and to take a close friend or relative with you. They can remind you of questions you wanted to ask, and afterwards help you remember what the doctor said.

Giving your consent

Before you have any treatment your doctor will explain the aims of the treatment to you and you will usually be asked to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment.

No medical treatment can be given without your consent, and before you are asked to sign the form you should have been given full information about:

• the type and extent of the treatment you are advised to have
• the advantages and disadvantages of the treatment
• any possible alternative treatments that may be available
• any significant risks or side effects of the treatment.
  

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need repeated explanations.

Patients often feel that the hospital staff are too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you and the staff should be willing to make time for you to ask questions.

You can always ask for more time to decide about the treatment, if you feel that you can’t make a decision when it is first explained to you. You are also free to choose not to have the treatment and the staff can explain what may happen if you do not have it.

It is important to tell a doctor, or the nurse in charge, immediately so that he or she can record your decision in your medical notes.

You do not have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.

The benefits and disadvantages of treatment

Many people are frightened at the prospect of cancer treatments, particularly because of the potential side effects that can occur. Some people ask what would happen if they did not have any treatment.

Although many of the treatments can cause side effects, knowledge about how these treatments affect people and improved ways of reducing or avoiding many of these problems have made most of the treatments much easier to cope with.

Treatment can be given for different reasons and the potential benefits will vary depending upon the individual situation. In people with early-stage vulval cancer, surgery is often done with the aim of curing the cancer. Occasionally additional treatments are also given to reduce the risks of it coming back.

If the cancer is at a more advanced stage the treatment may only be able to control it, leading to an improvement in symptoms and a better quality of life. However, for some people the treatment will have no effect upon the cancer and they will get the side effects without any of the benefit.

If you have been offered treatment that aims to cure your cancer, deciding whether or not to accept it may not be difficult. However, if a cure is not possible and the treatment is being given to control the cancer for a period of time, it may be more difficult to decide whether to go ahead with treatment.

Making decisions about treatment in these circumstances is always difficult, and you may need to discuss this in detail with your doctor. If you choose not to have treatment, you can still be given supportive (palliative) care, with medicines to control any symptoms.

Second opinion

A number of cancer specialists work together as a team to decide the most suitable treatment for each patient. Even so, you may want to have another medical opinion.

Most doctors will be willing to refer you to another specialist for a second opinion, if you feel it will be helpful. The second opinion may cause a delay in the start of your treatment, so you and your doctor need to be confident that it will provide useful information.

If you do decide to have a second opinion, it may be a good idea to take a friend or relative with you, and to have a list of questions ready, so that you can make sure your concerns are covered during the consultation.