**3. Counselling for radiation**

Counselling prior to radiotherapy is of utmost importance because of three reasons:


#### *Informed consent*: [11]

Informed consent is to be taken by the radiotherapy counsellor/radiotherapy physician and it should include the diagnosis and stage of the disease, name of the procedure or treat‐ ment like external radiotherapy or brachytherapy or radio‐isotope treatment, site of the body where radiation would be delivered and Whether the procedure is done under seda‐ tion, local/regional/general anaesthesia. The duration of therapy and the proposed sessions of therapy and whether it is for curative purpose or for palliative purpose is to be stated and signed by the concerned health professional involved in the care of the woman. The most common acute side effects and late side effects should be mentioned in the document signed by the health professional. An information leaflet to the patient in the language known to her or relatives would be desirable and is of great benefit.

The second part of the consent form should include statement that the patient has understood the benefits of the therapy, the short‐term and long‐term side effects that can occur and has the opportunity to ask questions and read the management protocol. The statement should also include the liberty of the patient to ask to stop the treatment at any time during the therapy after understanding the consequences of the same. A separate statement to be obtained from the reproductive aged women that she is not pregnant at this time of initiating the therapy and would not plan to become pregnant during the course of therapy and she would inform the treating physician in case of such occurrence.

A statement for storing the data of the patient and its usage for the future purpose like research also can be included in this consent form.

Written consent would be obtained once prior to the procedure and at each session of treat‐ ment a verbal consent would be taken and this statement also to be included in the written consent form and to be signed and dated by the individual concerned.

In case of mental disease incapacitating the patient, a responsible attendant should be involved in the counselling process and in consenting in a similar way.

#### **3.1. Survival rates**

B Vaginal carcinoma: Vaginal cancer is rarely encountered and its incidence is reported to be 1 in 11,000 and ocxcurs in women more than 70 years of age and only 15% occur in women less than 40 years. Presenting symptoms are usually abnormal discharge, bleeding per vaginum, post‐coital bleeding and mass per vaginum. Symptoms during late stages include constipation, pelvic pain and difficulty in micturition. Confirmation of diagnosis is by speculum examination demonstrating a cervix free of disease and growth in the vagina. Biopsy determines the type of cancer. If the growth involves cervix and vagina, it is classi‐ fied under cervical cancer. If it involves vagina and vulva, it is classified as vulvar cancer. The most common pathological type is squamous cell carcinoma (70%); and others include

adenocarcinoma (15%), melanoma (9%), sarcoma (4%) and miscellaneous [10].

Counselling prior to radiotherapy is of utmost importance because of three reasons:

(3) To help the patient to make informed decision and consent for the process.

(1) To make the patient understand the process through which she would be going, i.e. the technique, the duration of therapy and the possible side effects and their significance and

(2) To make her compliant and complete the therapy for curative purposes or palliative pur‐ poses and follow‐up for further therapy like surgery or chemotherapy and also the pos‐

Informed consent is to be taken by the radiotherapy counsellor/radiotherapy physician and it should include the diagnosis and stage of the disease, name of the procedure or treat‐ ment like external radiotherapy or brachytherapy or radio‐isotope treatment, site of the body where radiation would be delivered and Whether the procedure is done under seda‐ tion, local/regional/general anaesthesia. The duration of therapy and the proposed sessions of therapy and whether it is for curative purpose or for palliative purpose is to be stated and signed by the concerned health professional involved in the care of the woman. The most common acute side effects and late side effects should be mentioned in the document signed by the health professional. An information leaflet to the patient in the language known to her

The second part of the consent form should include statement that the patient has understood the benefits of the therapy, the short‐term and long‐term side effects that can occur and has the opportunity to ask questions and read the management protocol. The statement should also include the liberty of the patient to ask to stop the treatment at any time during the therapy after understanding the consequences of the same. A separate statement to be obtained from the reproductive aged women that she is not pregnant at this time of initiating the therapy

**3. Counselling for radiation**

sibility or chances of recurrence.

or relatives would be desirable and is of great benefit.

management.

70 Radiotherapy

*Informed consent*: [11]

It is important to appraise the women and the relatives regarding prognosis and survival in addition to side effects whenever therapy is instituted. Though survival depends on many factors like age at the development of the malignancy, type of the tissue involved for example, cervix or endometrium or adnexa, histopathological type, modality of therapy, complications of therapy, compliance to therapy, associated co‐morbidities and the chance for recurrence, the most important factor is found to be the stage of the disease. In other words, spread of the cancerous tissue is the most important factor that is used to prognos‐ ticate and explain the modality of therapy and its outcomes like overall survival. Survival rates are expressed variously and the standard way is to express in terms of 5‐year survival. The survival rates for carcinoma cervix, endometrium and vulva are shown in **Tables 2**–**4**, respectively, and these should guide the clinician to explain the patient while undertaking counselling.

For carcinoma cervix, the survival rates reported in India include 47.7% in Mumbai‐based registry in North India and 38% in Bangalore‐based registry from South India. The 5‐year survival rate for recurrent disease is reported to be between 30–60% and the main modality of treatment for recurrence being surgery. The prognosis is better if the recurrence occurs after 6 months of initial cure and the size of the recurrence is less than 3 cm [12].
