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Treatment for vaginal cancer
The treatment recommended by your doctor will depend on the results of your tests, the type of cancer, where the cancer is, whether it has spread, and your general health. Treatment may involve radiation therapy, surgery and/or chemotherapy. Most women with vaginal cancer will have radiation therapy because vaginal cancer that is close to the urethra, bladder and rectum is often difficult to remove completely with surgery. Surgery may be used for small cancers found in the upper part of the vagina.
Also known as radiotherapy, this treatment uses a controlled dose of radiation, such as x-rays, to kill or damage cancer cells. Radiation therapy is a common treatment for vaginal cancer. Some women with vaginal cancer are treated with a combination of radiation therapy and chemotherapy. This is called chemoradiation or chemoradiotherapy. Radiation therapy can also be used to control symptoms of advanced cancer (palliative treatment).
There are two main ways of delivering radiation therapy: externally or internally. Most women with vaginal cancer have both types of radiation therapy. Your radiation oncologist will recommend the course of treatment most suitable for you.
External beam radiation therapy (EBRT)
This precisely directs the radiation at the cancer from outside the body. You will lie on a treatment table under a machine called a linear accelerator, which delivers the radiation to the affected areas.
EBRT is usually given as a series of daily treatments, Monday to Friday, over 4–6 weeks. The exact number of sessions you have will depend on the type and size of the cancer, and whether it has spread to the lymph nodes. Each session takes about 20 minutes.
Radiation therapy to the vagina and groin is painless, but it can cause side effects.
Internal radiation therapy
Also called brachytherapy, internal radiation therapy is a way of delivering radiation therapy directly to the tumour from inside your body. You may have this after finishing a course of external beam radiation therapy. The main type of internal radiation therapy used for vaginal cancer is high-dose-rate (HDR) brachytherapy. With HDR, bigger doses are given in a few treatments, usually as an outpatient. At each HDR treatment session, you will be given pain medicine to make you more comfortable. Some women receive the radiation through small probes inserted near the cancer, but in most cases HDR brachytherapy is delivered through an applicator that is put into the vagina. The applicator is hollow and shaped like a small round-ended cylinder. It is connected to a machine that holds a radioactive seed. You will have to lie still while the seed goes into the applicator
Side effects of radiation therapy
The side effects you experience will vary depending on the dose of radiation and the areas treated. Many will be short-term side effects. These often get worse during treatment and just after the course of treatment has ended.
Short-term side effects
- fatigue – Your body uses a lot of energy to heal itself after the treatment, and travelling to treatment can also be tiring. The fatigue may last for weeks after treatment ends.
- bladder and bowel problems – Radiation therapy can irritate the bladder and bowel. You may pass urine more often or have a burning sensation when you pass urine. Bowel motions may be more frequent, urgent or loose (diarrhoea), or you may pass more wind than normal. Less commonly, women may have some blood in the stools (faeces). Always tell your doctor about any bleeding.
- nausea and vomiting – Because the radiation therapy is directed near your abdomen, you may feel sick (nauseous), with or without vomiting, for several hours after each treatment. Your doctor may prescribe anti-nausea medicine to help prevent this.
- vaginal discharge – Radiation therapy may cause or increase vaginal discharge. Let your treatment team know if it smells bad or has blood in it. Do not wash inside the vagina with douches as this may cause infection.
- skin redness, soreness and swelling – The vulva may become sore and swollen. It may start by being pink or red and feeling itchy, and progress to peeling, blistering or weeping. Your treatment team will recommend creams and pain relief to use until the skin heals. Wash the area with lukewarm water or weak salt baths, and avoid perfumed products and talcum powder.
Long-term or late effects
- hair loss – You may lose your pubic hair. For some women, this can be permanent. It will not affect the hair on your head or other parts of your body.
- bladder and bowel problems – Bladder changes, such as frequent or painful urination, and bowel changes, such as diarrhoea or wind, can also be late effects, appearing months or years after radiation therapy finishes. In rare cases, blockage of the bowel can occur. It is important to let your doctor
know if you have pain in the abdomen and cannot open your bowels.
- lymphoedema – Radiation can scar the lymph nodes and vessels and stop them draining lymph fluid properly from the legs, making the legs swollen. This can occur months or years after radiation therapy, and it is easier to treat if diagnosed early.
- narrowing of the vagina – The vagina can become drier, shorter and narrower (vaginal stenosis), which may make sex and follow-up pelvic examinations uncomfortable or difficult. Your treatment team will suggest strategies to prevent this.
- menopause – In premenopausal women, radiation therapy to the pelvis can stop the ovaries producing hormones, and this causes early menopause. Your periods will stop, you will no longer be able to become pregnant and you may have menopausal symptoms. Talk to your radiation oncologist about menopause or any fertility issues before treatment.
Some vaginal cancers may need to be removed with an operation. The surgeon will try to remove all of the cancer along with some of the surrounding healthy tissue (called a margin). This helps reduce the risk of the cancer coming back. Some lymph nodes in your pelvis may also be removed.
There are a number of different operations for vaginal cancer. The type of surgery recommended depends on the size and position of the cancer. Your gynaecological oncologist will talk to you about the risks and complications of your procedure, as well as possible side effects.
Types of vaginal surgery
Removing part of the vagina (partial vaginectomy) – The affected part of the vagina is removed.
Removing the whole vagina (radical vaginectomy) – The entire vagina is removed. In some cases, a reconstructive (plastic) surgeon can make a new vagina using skin and muscle from other parts of your body. This is called vaginoplasty or vaginal reconstruction, and it may be done to restore the appearance of your genitals.
Hysterectomy – Some women also need to have their uterus and cervix removed (total hysterectomy). Your gynaecological oncologist will let you know whether it is also necessary to remove your ovaries and fallopian tubes (salpingo-oophorectomy). If you are pre-menopausal, the removal of the ovaries will bring on menopause.
Recovery after surgery
The length of your hospital stay and the side effects you experience will depend on the type of surgery you have. Most women are in hospital for a few days to a week. In addition, you can expect some light vaginal bleeding, which should stop within two weeks.
Chemotherapy uses drugs known as cytotoxics to kill or slow the growth of cancer cells. It is usually given if the vaginal cancer is advanced or returns after treatment, and may be combined with surgery or radiation therapy.
The drugs are usually given by injection into a vein (intravenously) and sometimes as tablets. You will usually have several treatment sessions, with rest periods in between. Together, the session and rest period are called a cycle. Treatment can often be given to you during day visits to a hospital or clinic as an outpatient, but sometimes you may need to stay in hospital for a few nights.
Side effects of chemotherapy
Most people have some side effects from chemotherapy. There are many different types of chemotherapy drugs, and the side effects will vary depending on the drugs used. Your medical oncologist or nurse will discuss the likely side effects with you, including how they can be prevented or controlled with medicine.
Common side effects experienced after chemotherapy for vaginal cancer include feeling sick (nausea), tiredness (fatigue), hair loss, and a reduced resistance to infections. Chemotherapy may also increase any skin soreness caused by radiation therapy. Some people find that they are able to lead a fairly normal life during their treatment, while others become very tired and need to take things more slowly.
Palliative treatment helps to improve people’s quality of life by managing the symptoms of cancer without trying to cure the disease. It is best thought of as supportive care.
Many people think that palliative treatment is for people at the end of their life, but it may be beneficial at any stage of advanced vaginal cancer. It is about living for as long as possible in the most satisfying way you can.
Sometimes treatments such as radiation therapy, chemotherapy or other drug therapies are given palliatively. The aim is to help relieve symptoms such as pain or bleeding by shrinking or slowing the growth of cancer. Palliative treatment is one aspect of palliative care, in which a team of health professionals aim to meet your physical, emotional, practical and spiritual needs.