Vulva cancer treatment information for patients

You have attended our gynaecology-oncology clinic in the Rosie Hospital, Addenbrooke’s. You will have probably had some tests done prior to this appointment and maybe unsure of what is happening at this stage. The aim of this leaflet is to provide you and your support team with information regarding what has been discussed in clinic.

You will be seen by one of our consultants with a clinical nurse specialist (CNS), together with anyone you may wish to bring with you. They may ask you some questions about your general health and wellbeing, complete a physical examination and an internal examination, if required, and talk through your options with you.

We aim to answer all of your questions during your appointment but this can be an overwhelming time with lots of information given.

It will outline background information about your diagnosis, surgery options, what to expect before and after your surgery and the recovery process.

If you have any further questions or need further support please do not hesitate to contact us.

Your diagnosis

Being told you have cancer requiring treatment will mean you may experience many different emotions; perhaps shock, fear, anger, a sense of helplessness and a loss of control. You may not believe this is happening if you don’t feel ill. You may be frightened about the future and what this may hold for you. These are all normal reactions which may affect you, your family and friends at this time.

We understand this is a very difficult time for you. We aim to keep you and your family informed about your treatments. These will be discussed with you on an individual basis at every stage. It can be very difficult to take everything in when you are first told about your cancer diagnosis. This leaflet is intended to supplement the information given to you by other members of the healthcare team involved in your care.

What is cancer?

The body is made up of groups of specialised cells, such as skin, liver, bone, breast cells. Worn-out cells are replaced by new ones. The growth and repair of these occurs in an organised and controlled manner. The right numbers of new cells are produced to replace the old ones.

This process can go wrong. One cell may develop its own pattern of growth and division, producing more and more abnormal cells. These abnormal cells may eventually develop into an abnormal mass of tissue or form a lump, referred to as a tumour. By examining cells, a pathologist can tell whether a tumour is benign or malignant.

Benign tumours are generally harmless. Unless they are causing problems, such as pain, they are generally left alone.

Malignant tumours consist of cancer cells. Some cancer cells have the ability to break away from the original (or primary tumour) and spread to other parts of the body. When these cells reach other parts of the body, they can continue to grow and divide to form a new tumour. This is referred to as a secondary deposit or metastasis. Treatment can be offered for both primary and secondary disease.

It is important to remember that cancer is not one disease. There are many different types, and each is treated in a different way. For this reason, you may find that other patients are undergoing different treatment to you.

The role of the gynae-oncology clinical nurse specialist (CNS)

A gynae-oncology CNS is a nurse who specialises in the care of women with gynaecological cancers, and their families. They are your key worker and can provide information, advice and support for you and your family, from diagnosis onwards. This may include:

• surgery
• chemotherapy/radiotherapy
• psychosexual issues
• support agencies
• hormone replacement therapy (HRT) and menopause information
• fertility and infertility advice or information
• lymphoedema services
• finance
• pain and symptom control
• local and national services
• hospice care

You may meet your CNS at the outpatient clinic or on the ward.

Your CNS can be contacted on 01223 586892, Monday to Friday 08.00 (8am) to 16.00 (4pm). We have a voicemail service, so if no one answers your call please leave a message and we will call you back as soon as possible.

If you have any urgent problems over the weekend please contact your out–of-hours GP.

We are always available for advice. Please do not hesitate to contact us.

If you have had surgery recently, advice is available from Daphne Ward and Clinic 24 - Gynaecology Assessment Unit; both are located in the Rosie Unit:

• Daphne Ward: 01223 257206
• Clinic 24: 01223 217636

Vulva cancer

Cancer of the vulva is rare. It is most likely to occur in women over the age of 60, but can affect younger women too.

The vulva is made up of two pairs of lips. The outer pair is called the 'labia majora' and the inner pair is called the 'labia minora'. Vulva cancer can develop on any part of the external female sex organs. It commonly develops on the labia minora and labia majora, but can also involve the clitoris and Bartholin glands (situated at each side of the vagina).

Vulva cancer most commonly starts with pre-cancerous changes to cells which slowly develop into cancer cells.

Causes of vulva cancer

The exact causes of vulva cancer are unknown. Like other cancers, it cannot be passed on to other people. Vulva cancer is not caused by a faulty gene. This means that other members of your family are very unlikely to develop it.

Infection with the human papilloma virus (HPV) is known to be a risk factor for vulva cancer. HPV is a very common virus that affects the majority of women who have had sexual contact. In most cases, a woman’s immune system will clear the virus, but in some the virus persists and can cause changes in the lower genital tract, sometimes leading to vulva cancer.

Treatment

Surgery

The type of surgery you may be offered will be dependent upon type, size, and location of the cancer. Your surgeon will discuss the best options with you, based on your individual disease and clinical information.

Wide local excision

The surgeon removes the area containing the cancer, along with a border of healthy tissue, called the 'margin', around it. The important thing is to ensure that the margin does not contain cancer cells, as this reduces the risk of the cancer returning. Your surgeon might also want to remove some nearby lymph nodes.

Vulva surgery can change the appearance of the external genitalia. You may be anxious about this; your consultant and specialist nurse will be able to advise and support you.

Lymph nodes

The lymph nodes in the groin are usually the first place where cancer cells spread from the vulva. An operation to remove the lymph nodes is called a lymph node dissection or lymphadenectomy. This surgery can make it less likely that the cancer will come back.

Your surgeon may remove the lymph nodes on one or both sides of your groin. This will depend on the size and position of the cancer. Your doctor may suggest you have a test to check your lymph nodes if your cancer is smaller than 4cm and you only have one area of cancer.

This operation used to be done by removing the vulva and the lymph nodes together through one large cut (incision). It is more usual nowadays to make separate smaller incisions in the groin to remove the lymph nodes. Using several smaller incisions means that it is easier for you to recover, and you are less likely to have problems after the surgery.

Surgery to remove lymph nodes from your groin can affect fluid drainage in your legs. This can cause a build-up of fluid, which is referred to as lymphoedema.

Sentinel node

The sentinel node is the first node that fluid drains to from the vulva. This means it’s the first lymph node the cancer could spread to. If this node does not contain cancer, it’s likely that no further lymph nodes contain cancer cells.

To find the sentinel lymph node, the doctor injects a dye or small amount of a weak radioactive chemical (called a tracer) into the area around the cancer. As the body drains tissue fluid into the lymph nodes in the normal way, the dye or radioactive tracer will show the route it takes. The first lymph node that the dye or tracer reaches is the sentinel node. The surgeon removes this and sends it to the lab to be examined for cancer cells. This procedure will be carried out under general anaesthetic (GA) and will be explained to you by your surgeon.

Additional treatment

Radiotherapy

Radiotherapy uses high-energy rays to destroy cancer cells. To reduce the risk of local recurrence, you may have radiotherapy after surgery if the cancer isn’t completely removed or if there is cancer in the lymph nodes. Alternatively, a combination of chemotherapy and radiotherapy can be considered in locally advanced disease. This is known as chemoradiotherapy.

Radiotherapy can be internal or external (brachytherapy):

• Internal radiotherapy – a radioactive implant is placed inside your body near the cancer, or a radioactive liquid is swallowed or injected.
• External radiotherapy – a machine directs beams of radiation at the cancer.

Radiotherapy for vulva cancer is usually external, but your options will be explained fully to you by your oncologist if appropriate.

Chemotherapy

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. Chemotherapy can be given intravenously (IV) via a drip, or taken orally. Chemotherapy can be used in vulva cancer when the cancer has spread to other parts of the body, and can also be used in conjunction with radiotherapy (chemo-radiation). If this is suitable, your oncologist will talk you through the options for this.

Clinic follow-up

You will be followed up at the surgical outpatients after surgery. Your doctor or nurse will want to examine you to ensure that you have no signs or symptoms or anything you are worried about or any issue that may worry you.

You will go to the cancer clinic if you are having or have had chemotherapy or radiotherapy. The surgeon and the oncologist might share your follow-up care. This means you see the surgeon sometimes and the oncologist at other times.

Contact your doctor or specialist nurse if you have any concerns. You should also contact them if you notice any new symptoms between appointments – you don’t have to wait until your next visit.

Patient-led follow-up

This system leaves it to you, the patient, to take the lead in arranging to see your doctor or specialist nurse. When you first finish treatment we arrange the appointment, but once your doctors are happy with your progress you can arrange these appointments yourself. You may, for instance, want to make an appointment if you have noticed any symptoms that are worrying you or if you have concerns about your health. You can call us on 01223 216251 or 01223 586892.

Your operation (surgery)

Before your operation

Between the time of your diagnosis and admission to hospital for surgery the gynae-oncology nurses can provide support, advice and information. Everyone has different needs at this time.

Pre-assessment

Prior to surgery you will be asked to attend for ‘pre assessment'. This may be straight after you are seen in clinic or at a pre-arranged later date. This involves:

• a check of general state of health
• current medication
• a number of routine tests may be carried out, such as a chest x-ray, electrocardiogram (ECG)
• blood tests

You may be examined again and the side of your operation marked.

You will have been given your consent forms to read through. Please sign these and bring them with you on the day of your surgery. You will have an opportunity to see your surgeon before your operation, and you will go through your consent form together.

On the day of your operation

Planned date for surgery: ____________________________
Please go to: ____________________________ at: ____________________________

On the morning of your surgery please remember:

• do not eat after ____________________________ (this includes chewing gum)
• you may drink clear water only (non-carbonated and without flavouring) until ____________________________

Please do not consume anything after these times as this may cause delay or cancellation to your surgery.

We advise you wear loose and comfortable clothing. We would also advise you to stop smoking for two days prior to surgery.

There will be some waiting involved during the day so we suggest that you bring something with you to keep yourself occupied (such as a book). If possible, have a friend or family member to be with you while you wait.

General anaesthetic (GA)

Before having an operation, you will be assessed for suitability for a GA. This will be done at pre-assessment.

During a GA, medications are used to induce sleep, so you are unaware of procedure/operation and do not feel any pain or move whilst it is being undertaken. The anaesthetic will be given you as either:

• a liquid injected into your veins through a cannula (a thin, plastic tube that feeds into a vein, usually on the back of your hand)
• a gas that you breathe in through a mask

The anaesthetic should take effect very quickly. You'll start feeling light-headed and will become unconscious within a minute or so. Your anaesthetist will stay with you throughout the procedure. They'll make sure you continue to receive the anaesthetic and that you stay in a controlled state of unconsciousness. They will also give you pain-relieving medicine into your veins so that you're comfortable when you wake up.

General anaesthetics have some common side effects, such as nausea and vomiting, dizziness, confusion, bruising and soreness. Your anaesthetist will discuss these with you before your surgery and you will be monitored throughout your time in hospital.

Depending on your circumstances, you'll usually need to stay in hospital for a few hours to a few days after your operation.

General anaesthetics can affect your memory, concentration, and reflexes for a day or two so, if you're allowed to go home, it's important for a responsible adult to stay with you for at least 24 hours after your operation. You will also be advised to avoid driving, drinking alcohol, and signing any legal documents for 24 to 48 hours.

If you should have any further questions, your anaesthetist or pre-assessment team will be able to help. For more information, please refer to NHS Choices – General anaesthetics (opens in a new tab).

After your operation ('post-op')

Immediately after your operation, you will be transferred to the recovery area in theatre where you will be looked after until you have woken up from your anaesthetic. You may feel drowsy and sleepy for a few hours.

You will then return to Daphne Ward. This is a 19-bed female general gynaecology ward on level 2 in the Rosie Unit. The ward’s telephone number is 01223 25720. Visiting hours are 15:00 (3pm) to 20:00 (8pm); please contact the ward to arrange visiting outside of these hours.

Post-op care

Pain

The amount of pain experienced following surgery is different for each individual and the operation you have. Overall, most women experience less pain than expected. You will be given painkillers after your operation, including some to take home with you.

• Patient-controlled analgesia (PCA) – You will likely wake up after surgery with a PCA, which is a pump containing a painkiller that is connected to your intravenous (IV) line that allows you to administer regular pain relief. We will monitor your pain and consider converting to oral painkillers when it is controlled.
• Epidural – this is an injection in the back to help with pain post-operatively. If this is an appropriate option for you your consultant or anaesthetist will discuss this with you prior to surgery.

Getting up after your operation

In hospital we will encourage you to mobilise (walk or move around) after your operation as this prevents post-op complications and helps speed up your recovery process.

You will also be required to wear anti-embolism ('TED') stockings, which help to prevent blood clots. On discharge, we will explain how long you will be expected to wear these.

Catheter care

During the operation a catheter will be inserted which will remain in for possibly six to 72 hours. It will usually be taken out, on the ward, the morning after your surgery but this will be decided by your medical team.

Before you go home, we will check that you are emptying your bladder properly. If there are complications you can go home with a catheter in and appropriate follow-up.

If after removal of a catheter you are initially unable to pass urine or are storing it in your bladder, we may talk to you about the option of self-catheterisation. This is usually a temporary measure.

Wound care

Your wound will depend on the operation you undergo. Dissolvable stitches are used in most operations. Your medical team will inspect your wound during your stay in hospital. Please monitor for redness, swelling, the wound becoming hot to touch, and discharge. If you have concerns when you are at home, please contact us.

At home

In the first few days following your operation, a vast amount of ‘internal energy’ will be required by your body to repair itself. This may leave you with only small amounts of energy for the rest of the day. You will find that your body will naturally pace itself. After a particular activity you may find your energy levels are dipping and you require more frequent rests.

It is important that you keep mobile, moving around the house and taking regular deep breaths whilst resting to reduce risk of blood clots in the legs and also chest infections and pneumonia.

As the days and weeks pass, your energy store will increase until you may be back to your normal pattern. During this time you may find that there are good days when you have lots of energy and days you feel more tired. This is normal.

Housework

In the first few weeks you may find you are only able to do light housework such as dusting and preparing light meals. As your energy levels increase you will be able to incorporate more of your daily tasks into your routine; but listen to your body.

Physical exercise

If you participate in regular exercise, it is advisable to refrain from this in the first few days to weeks. When your energy levels increase, gentle exercise is encouraged but build this up slowly.

Driving

The main requirement for driving is that you feel safe behind the wheel. This involves being able to perform an emergency stop or to swerve very quickly. This is not usually possible in the first few weeks and often takes up to six weeks. When you feel ready we would recommend that you go for a short drive to see how well you can manage.

It is also advisable to check with your insurance company as some impose restrictions on driving for a minimum period after surgery.

Obtaining insurance

Just because you have a cancer diagnosis does not mean you will be unable to get insurance. If you need information on such matters such as life insurance, travel or mortgage insurance, you could visit the AMII website for assistance (opens in a new tab) (www.amii.org.uk (opens in a new tab)) or contact Macmillan for advice.

Please refer to the Royal College of Obstetricians and Gynaecologists (RCOG) page on Abdominal hysterectomy – recovering well (opens in a new tab).

Additional treatment and therapies

Gynaecological cancers can be treated with a combination of different treatments. Each case is different and your treatment will be tailored to your individual needs.

Surgery

There are several different types of surgery. Your surgeon will discuss these with you based on your individual case.

Chemotherapy

Chemotherapy is a medicine that kills cancer cells. The aim may differ according to the stage of disease; some people may not require any chemotherapy at all.

Chemotherapy is administered in tablet form or as a drip. It can be used to shrink disease prior to surgery, after surgery to kill any remaining cancer cells or if your cancer returns after initial treatment.

Chemotherapy is given in cycles, with a period of treatment followed by a period of rest to allow your body to recover. There are documented side effects when receiving the treatment; these are dependent on the drug, the dose and your individual reaction to it.

Side effects may include nausea and vomiting, tiredness, fatigue, hair loss, sore mouth, numbness or tingling in hands or feet and increased risk of infection. There are medications that can help with some of these side effects.

Radiotherapy

Radiotherapy uses high-radiation beams to kill cancer cells. Although not often used as the main treatment for cancer, but it can be helpful in shrinking any secondary tumours, or for symptom control. Your oncologist will advise you on whether radiotherapy is appropriate, and discuss it and the associated side effects.

Hormonal treatment

Some gynaecological malignancies, such as endometrial cancers, are sensitive to hormonal treatment and this can be used to shrink the tumour. Your oncologist will speak about this option if appropriate.

Clinical trials

A clinical trial may be considered as a potential treatment. Any discussion does not commit you to taking part. You can ask your doctor whether there are any clinical trials appropriate to your diagnosis.

Getting back on track

Those who have gone through a cancer treatment describe the first few months as a ‘time of change’; not so much getting back to normal but finding out what is normal. Things may still change during your recovery and because of your surgery.

Nutrition

Eating and drinking are an important part of our lives. When you have cancer, you may become more aware of what you eat and drink. You may wish to find out how diet can play a role in your recovery and future health. A well-balanced diet is important. For a healthy diet it is important to:

• eat a variety of different foods
• eat at least five portions of fruit and vegetables in one day
• limit sugary food and drinks
• drink water
• reduce your salt intake
• drink alcohol in moderation
• most importantly: enjoy your food.

Fatigue

During recovery, you may feel tired or worn out; in fact, fatigue is one of the most common complaints during the first year. Rest or sleep may not cure the type of fatigue that you have.

Here are some ideas for coping with fatigue:

• Prioritising: Decide which activities are of most value each day and cut out unnecessary tasks.
• Pacing: Balance Activity and rest. Take frequent breaks. Gentle exercise can help fatigue.
• Planning: Consider whether time of day affects your fatigue and avoid unnecessary exertion. Try to space activities out throughout the week and not concentrate all activities into one day.
• Posture: Avoid bending and twisting, which can be tiring. Try not to sit or stand in the same position for too long without changing your position.
• Permission: Give yourself permission not to do something that you 'feel you should', and try to delegate to others!

Sex and intimacy

You’ll probably need time to recover and adapt to body changes before you feel comfortable about having sex. How long this takes depends on what feels right for you and your partner. As with all other aspects of cancer, care information needs regarding sexuality differ for each individual.

Your partner may also have concerns. Talking openly can have a positive effect on your relationship and make you feel more comfortable with each other.

If you experience difficulties with your sex life and these don’t improve, talk to your doctor or specialist nurse. Try not to feel embarrassed – they’re used to giving advice on intimate problems. They can give information and advice on different ways of looking at problems or other specialist services.

For support in this area, you could look to:

• Macmillan cancer support (opens in a new tab)
• Cancer Research UK (opens in a new tab)

Psychological support

There are a lot of emotions when dealing with cancer. It’s natural to have many different thoughts and feelings after a cancer diagnosis. Some people feel upset, shocked or anxious, while others feel angry, guilty or alone. There is no right way for you to feel. Being able to talk openly with family and friends can provide a lot of comfort.

Support groups and self-help groups give you the opportunity to share your thoughts and feelings. They can also be a good way to hear how other people affected by cancer coped with their situations. The healthcare professionals caring for you and who know your situation can also be a good source of support.

Many people also use psychological services as a source of support during and after their treatment. The gynaecological oncology psychological service (GPS), established to provide a woman-centred service for dealing with gynaecological cancer, aims to provide a space for women to discuss adapting to the impact of cancer. The GPS team includes a psychological wellbeing practitioner, clinical psychologist and consultant psychiatrist who can provide a variety of interventions that can offer you an integrated and holistic approach to your treatment, health and wellbeing.

Speaking with GPS can help in many areas, such as:

• helping you to make sense of how you have been feeling
• adapting and coping with cancer
• managing difficult or distressing feelings
• learning ways to cope with and prepare for treatment procedures
• managing worries and living with uncertainty
• finding ways of solving problems and making use of your own strengths and skills
• relationship difficulties
• moving forward with life after treatment has finished.

If you think you may benefit from these services, please speak with your CNS who can complete a referral or explain more about GPS. Or you can call GPS directly on 01223 216167.

Menopause

Some types of cancer treatment can cause an early menopause. Types of cancer treatment that can cause an early menopause include:

• surgery to remove the ovaries
• radiotherapy to the pelvis
• hormone therapy
• chemotherapy

Menopause can cause:

• vaginal dryness
• hot flushes and sweating
• feeling sad or depression
• loss of confidence and self esteem
• tiredness (fatigue)
• thinning bones

Hormone replacement therapy (HRT) will reverse most of these effects for some women. It can also help with the emotional effects of menopause. Loss of sexual desire can be a problem. It is important to remember that many factors can influence the loss of sexual desire after treatment for cancer.

There are other ways to help with the symptoms of menopause if HRT is not suitable for you:

• other medications to ease symptoms eg gabapentin for flushing symptoms
• complementary therapies eg homeopathy and acupuncture
• creams and lubricants for vaginal dryness

You can discuss these with your consultant and your CNS.

Support

• Maggie's Cancer Care, Cambridge (opens in a new tab)
• Alternatives to HRT for menopause symptoms (opens in a new tab) (article)
• Menopause and alternatives to HRT (opens in a new tab) – Royal College of Obstetricians and Gynaecologists (RCOG)
• Daisy Network (opens in a new tab)
• Menopause: The One-Stop Guide: The best practical guide to understanding and living with the menopause by Kathy Abernathy (available from booksellers)

Lymphoedema

Lymphoedema is the swelling caused by a build-up of lymph fluid in the surface tissue of the body. Following some gynaecological cancers and therapy this build-up may occur as a result of damage to the lymphatic system due to surgery and/or radiotherapy to the lymph nodes. Physical systems can include:

• swelling in the legs, ankles and feet
• discomfort and infection

Lymphoedema can be a long-term condition. The symptoms usually respond well to treatment and this means in most cases it can be controlled. If you notice any swelling you are advised to contact the gynae-oncology CNSs for further advice and possible assessment.

Support

• Lymphoedema Support Network (LSN) (opens in a new tab)
• Macmillan Cancer Support – Lymphoedema (opens in a new tab)

Glossary

• Adjuvant treatment: treatment, usually chemotherapy or radiotherapy, given after surgery.
• Bartholin glands: a pair of pea-sized glands found just behind and either side of the lips that surround the entrance to the vagina. They secrete fluid that acts as a lubricant during sex. The fluid travels down tiny tubes, called ducts, into the vagina. If the ducts become blocked, they can fill with fluid and expand to form a cyst known as a ‘’Bartholin’s cyst’.
• Benign: a non-cancerous growth within the body, which may interfere with the function of an organ, but does not spread.
• Biopsy: the removal of a sample of tissue that can be examined in a laboratory to find out the cause of an illness.
• Cytology: microscopic examination of cells.
• Histology: examination of tissues to diagnose the underlying disease.
• Human papilloma virus (HPV): a viral infection that commonly causes skin or mucous membrane growths (warts).
• Intravenous (IV): given into the vein, usually by injection so that the substance can work quickly.
• Laparoscopy: a minor operation which involves making a small incision in the abdomen and insertion of a small telescope (laparoscope) to enable examination of the abdomen and pelvis without performing a full laparotomy.
• Laparotomy: an operation to open the abdomen.
• Lymph: a clear fluid containing water, protein, minerals and white blood cells, that passes through a series of filters (lymph nodes) before rejoining the bloodstream.
• Lymphatic system: a network of vessels that transport lymph.
• Lymph nodes: small pearl-like glands connected to the lymphatic system that produce lymphocytes, as well as acting as filters to stray bacteria or cancer cells. When bacteria or cancer cells reach these nodes, they can become enlarged.
• Lymphoedema: swelling in the arms or legs, caused by blockage or damage to the drainage of the lymphatic system. It can happen because of some cancer treatments, or from the cancer itself.
• Lymphocytes: one of the types of white blood cells in the body.
• Metastatic/metastases: the spread of cancer from one part of the body to another by the lymphatic system or by the bloodstream.
• Omentum: a double layer of membrane that is rich in fatty tissue and lies in front of the intestines, like an apron.
• Primary tumour: a tumour growing at the anatomical site where tumour progression began and proceeded to produce a cancerous mass. Most cancers develop at their primary site but may then go on to metastasize or spread to other parts of the body, creating secondary tumours.
• Sentinel nodes: The sentinel nodes are the first few lymph nodes into which a tumour drains.
• Tumour markers: Substances produced by some cancers that can be measured in the bloodstream. They can be used either to assist in making a diagnosis or to monitor how the cancer is responding to treatment.

Cancer Centre contact details

If you call out of office hours, please leave a message on the answering machine and your call will be returned the next working day.

Consultant gynaecological oncologists
Mr Peter Baldwin
Mr Robin Crawford
Mr John Latimer
Mr Krishnayan Haldar
Secretaries: Kim Deal, Carole Menzies, Lisa Lester – 01223 216251

Gynaecological oncology specialist nurses (surgery)
Kate Maillou, Gemma Ferguson & Emily Warner-Smith – 01223 586892

Medical oncologists
Prof Helena Earl
Dr James Brenton
Dr Christine Parkinson
Secretary: Janet Crombie – 01223 217074

Clinical oncologists
Dr Li Tee Tan
Dr Deborah Gregory
Dr Sarah Prewett
Secretary: Janet Crombie – 01223 217074

Gynaecological oncology specialist nurse (chemotherapy)
Alison Hallett – 01223 257049

Specialist radiographer
Katie Bradshaw – 01223 216580

Support

• Gynae-oncology consultants and CNS team Addenbrooke's – 01223 586892
• Alison Hallet (Gynae-oncology CNS Chemotherapy) – 01223 256 676
• Maggies Wallace Centre Addenbrooke's – 01223 249 220
• Macmillan Cancer Support Oncology outpatients, Addenbrooke's – 01223 274801
• Macmillan Cancer Support 89 Albert Embankment London SE1 7UQ – 0808 808 0000
• Oncology Centre Addenbrooke's – 01223 216552
• Lymphoedema Support Network (LSN) – 020 7351 0990

References

• Cancer Research UK , Vulva Cancer (opens in a new tab)
• Lymphoedema Support Network (LSN) (opens in a new tab)
• Macmillan – Vulva cancer (opens in a new tab)
• Macmillan – Lymphoedema (opens in a new tab)
• NHS Choices – General anaesthesia (opens in a new tab)
• RCOG – Menopause and alternatives to HRT (opens in a new tab)
• RCOG – Abdominal hysterectomy – recovering well (opens in a new tab)