Chemotherapy (chemo) uses anticancer drugs that are usually given intravenously (into a vein), by mouth, or applied to the skin in an ointment. Drugs taken by mouth or injected into a vein, called systemic chemotherapy, enter the bloodstream to reach throughout the body, making this treatment potentially useful for cancer that has spread to distant sites.

Drugs most often used in treating vulvar cancer include cisplatin, mitomycin, and fluorouracil (5-FU). Sometimes a combination of drugs is given as this is often more effective than using just a single drug alone.

The role of chemotherapy in treating vulvar cancer remains to be determined. In more advanced disease, chemotherapy may be given with radiation therapy before surgery. This combined treatment may shrink the tumor, making it easier to remove it with surgery. So far, the results of treating vulvar cancers that have spread to other organs with chemo have been disappointing.

Many of the drugs used in cancer chemotherapy work by attacking cells that are rapidly dividing. This is helpful in killing cancer cells, but these drugs can also affect normal cells, leading to side effects. Side effects of chemotherapy depend on the type of drugs, the amount taken, and the length of time you are treated. Common side effects include:

• nausea and vomiting
• loss or increase of appetite
• temporary loss of hair
• mouth or vaginal sores
• increased chance of infections (due to low white blood cell count)
• increased chance of bleeding and bruising (due to low blood platelet count)
• tiredness (due to anemia, that is, low red blood cell count)
• changes in the menstrual cycle, premature menopause, and infertility (inability to become pregnant). Note: Most women with vulvar cancer are postmenopausal.

Other side effects can occur depending on what drug is used. Most side effects are temporary and stop when the treatment is over, but chemo drugs can have some long-lasting or even permanent effects. For example, cisplatin can cause nerve damage (called neuropathy). This can lead to numbness, tingling, or even pain in the hands and feet. Ask your cancer care team about the chemo drugs you will receive and what side effects you can expect. Also be sure to talk with them about any side effects you do have so that they can be treated. For example, you can be given medicine to reduce or prevent nausea and vomiting.

Sometimes fluorouracil (5-FU) is applied as a cream directly to the skin. This is called topical chemotherapy. It is rarely used to treat VIN and is not a treatment for invasive cancer of the vulva. Chemotherapy applied directly to the skin as an ointment will cause local irritation and peeling. This is normal and is part of the local destruction of cancer cells. Medicated ointments suggested by the health care team can help relieve the discomfort of this treatment. Topical chemotherapy for VIN is less effective than laser treatment or surgery.

Last Medical Review: 12/30/2008
Last Revised: 05/14/2009