Vulvar Cancer: Chemotherapy

What is chemotherapy?

Chemotherapy (chemo) uses anticancer medicines to kill cancer cells. These medicines attack and kill cells that grow quickly. Some normal cells also grow quickly. Because of this, chemo can also harm those cells. This can cause side effects.

When might chemo be used for vulvar cancer?

Healthcare providers don’t often use chemo as the main treatment for vulvar cancer. But it may be used to treat vulvar cancer that has spread to other parts of the body. Or vulvar cancer that comes back after surgery.

Some chemo medicines can help radiation therapy work better. Chemo and radiation may be used before surgery to help shrink a large tumor and make it easier to remove. Or, in some cases, may be the main treatment. This is called chemoradiation.

How is chemo given for vulvar cancer?

Chemo might be taken as a pill or given through an IV (intravenous) line into one of your veins. The medicines go right into your blood and reach all areas of your body. This is called systemic treatment.

You may also get chemo as an ointment or cream. You or your healthcare provider put it on the affected skin of your vulva. This is a local treatment because it affects only the area treated. It's mostly used for precancer. It's rarely used for true cancer of the vulva.

Most people with vulvar cancer get chemo through an IV in an outpatient part of the hospital, infusion center, or at their healthcare provider’s office.

You’ll get chemo in cycles over a period of time. That means you get chemo for a set amount of time and then have a rest period. Each period of treatment and rest is one cycle. You may have several cycles. Having treatment in cycles helps by:

• Killing more cancer cells. Not all of the cancer cells are all dividing at the same time, and chemo targets cells that are dividing. Spacing out the cycles allows the medicine to kill more cells.

• Giving your body a rest.  Treatment is hard on other cells in the body that divide quickly. This includes cells in the lining of the mouth and stomach. Damage to these cells causes side effects, such as mouth sores, swallowing problems, and nausea. Between cycles, your body can get a rest from the chemo and normal cells can heal.

• Giving your mind a rest. Getting chemo can be stressful. Taking breaks between cycles lets you get an emotional break between treatments.

What common chemo medicines are used to treat vulvar cancer?

The most common chemo medicine used for vulvar cancer is cisplatin. Some of the other medicines that may be used include:

• 5-Fluorouracil (5-FU)

• Carboplatin

• Vinorelbine

• Paclitaxel

• Gemcitabine

What are common side effects of chemo?

Because chemo also damages some normal cells, you may have side effects during and for some time after treatment. These depend on the type and dose of chemo you get, as well as the length of treatment. If you get chemo as a cream on your skin, you may have some skin irritation.

These are other short-term side effects after systemic chemo. Ask your healthcare provider which are most likely to happen to you:

• Changes in appetite

• Easy bleeding or bruising

• Kidney damage

• Hearing loss

• Tingling or numbness in the fingers or toes (peripheral neuropathy)

• Hair loss

• Infections

• Menstrual cycle changes, early menopause, or infertility

• Mouth sores

• Nausea and vomiting

• Severe tiredness (fatigue)

• Diarrhea

• Constipation

Most of these side effects will get better between treatments and go away over time after treatment ends. But some side effects may last months or be permanent. Talk with your healthcare provider about ways to manage any side effects you have. There may be things you can do and medicines you can take to help prevent or control side effects. If you have concerns about infertility, talk to your provider before starting treatment.

Checking your health during chemo

Your blood will be tested often while you're getting chemo. This is to make sure you aren't having harmful reactions. Ask which problems, if any, mean you should call your healthcare provider right away. For instance, your provider may tell you to call them if you have any of these symptoms:

• Fever

• Sore throat

• Shaking or chills

• Redness, swelling, or warmth at the site of an injury or IV catheter

• New cough or shortness of breath

• Nasal congestion

• Burning during urination

• Mouth sores that keep you from eating or drinking

• Unusual bleeding

Working with your healthcare provider

It's important to know which chemo medicines you're taking. Write down the names of your medicines. Ask your healthcare team how they work and what side effects they might cause.

Talk with your providers about what signs to watch for and when to call them. Make sure you know what number to call with problems or questions. Is there a different number for evenings, holidays, and weekends?

It may be helpful to keep a diary of your side effects. Write down physical and emotional changes, and changes in the way you think. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.