Do What You Can to Ease Side Effects of Treatment of Vulvar Cancer

Anxiety and depression

Many people feel blue, anxious, or distressed after being told they have cancer. These feelings are normal and may continue or come back throughout treatment. Taking these actions may ease your mental stress:

Talk with your family or friends.

Consider joining a cancer support group or finding a cancer "buddy" who can help you cope.

Consider learning relaxation techniques, meditation, or yoga to help control and ease mood swings.

Exercise to help boost your mood and ease anxiety.

Ask your doctor about medications for depression and anxiety.

Consider getting a referral to talk with a social worker, psychologist, or psychiatrist.

Appetite changes

People who eat well during cancer treatment are more likely to maintain their strength, are more active, and are better able to lower their chance of infection. It's important to remember that your body needs energy to heal itself. Maintaining your weight is a good way to know if you are giving your body the energy it needs.

When you're being treated for cancer, a diet high in calories and protein is usually best. The problem is that side effects of treatment, especially chemotherapy, can make you not want to eat. Some chemotherapy treatments can change the way food tastes to you. If this is the case, focus on eating a balanced diet and maintaining your activity level. Ask your doctor for a referral to a registered dietitian if you are having trouble with your appetite or your weight.

Also, try these tips to stimulate your desire to eat:

If you can, eat foods high in protein several times a day. These foods include milk, cheese, cottage cheese, yogurt, meat, fish, eggs, beans, peanut butter, and nuts. Protein helps build and repair tissue, and cancer treatments cause you to use more protein than usual.

To maintain your weight, eat high-calorie foods, such as margarine or butter, sugar, honey, jams, jellies, cream cheese, dried fruit, gravies or sauces, mayonnaise, and salad dressing.

Get plenty of fluids to help control your body temperature and improve food elimination. In addition to water, fruit juices, and other liquids, try gelatin, pudding, soups, fruit bars, and ice cream.

Eat small, regular meals throughout the day instead of three large ones.

Keep snacks handy to eat when you are hungry.

Eat with friends or play your favorite music at mealtime to boost your appetite.

Eat your biggest meal in the morning. Many people getting treatment for cancer find that this is when their appetite is greatest.

If you can, increase your activity level. Doing so may also boost your appetite.

On days you don't feel like eating at all, don't worry about it. Try again the next day. If you find your appetite doesn’t improve in several days, talk with your doctor or nurse.

Bleeding problems (thrombocytopenia)

Certain kinds of chemotherapy may reduce your blood platelet count. Without enough platelets, your blood may have difficulty clotting and lead to a problem called thrombocytopenia. If your doctor tells you that your platelet count is low, take these actions to avoid causing injuries that could lead to bleeding problems:

Protect your skin from cuts, scrapes, and sharp objects.

Shave with an electric razor.

Use a soft toothbrush to prevent bleeding gums. Ask your doctor if it's OK to floss.

Take steps to prevent constipation. This can lead to straining and hemorrhoids, which can often cause bleeding.

Call your doctor if you develop a rash, bleeding, or bruising.

Constipation

Constipation, which includes difficult or infrequent bowel movements, can range from mildly uncomfortable to painful. Taking pain medications can lead to constipation so it's wise to take these preventive actions. These same steps will give you relief if you are already constipated:

Drink 6 to 8 glasses of fluids a day, especially water and prune juice.

Eat foods high in fiber, such as cereals, whole grains, and uncooked fruits and vegetables.

Exercise.

Take stool softeners or a laxative only as prescribed by your doctor.

Diarrhea

Radiation and chemotherapy can cause bowel changes. Diarrhea, which includes loose or frequent bowel movements, or both, may lead to dehydration if you don't take these precautions. Try these steps:

Avoid milk and milk products.

Avoid gas-producing vegetables, dried fruit, fiber cereals, seeds, popcorn, nuts, corn, and dried beans.

Eat low-residue, low-fiber foods such as those found in the BRAT diet (bananas, rice, applesauce, and toast).

Increase your intake of fluids, such as water and broth, to prevent dehydration.

Ask your doctor about medications that may help.

Hair loss (alopecia)

Many types of chemotherapy can cause hair loss. Losing your hair can be upsetting because thinning or baldness is a visible reminder that you are being treated for cancer. Keep in mind that your hair will grow back after treatment, though it may look different than it did before.

Try these coping tips:

Consider cutting your hair short before treatment starts.

Think about getting a wig, hat, or scarf before your hair loss starts. That way, you can get a wig that matches your hair, and you'll be ready with head coverings, if you choose to use them.

Because your scalp may be more sensitive to temperature and sun, protect it with sunscreen and hats or scarves.

Hot flashes

A hot flash is also called a hot flush. It is a sudden rush of warmth, with or without sweating, to the face, neck, upper chest, and back. It can last for a few seconds to an hour or more. Hot flashes can occur with chemotherapy. Some women have mild symptoms, while others have more severe ones. In many cases, hot flashes stop when treatment stops. To ease them, try these tips:

Limit your intake of hot drinks, caffeine, alcohol, and spicy foods.

Avoid strenuous exercise.

Layer your clothing so that you can add or remove as needed.

Stay out of environments with very warm temperatures.

Use sprays or moist wipes to help lower skin temperature.

Ask your doctor about relaxation training or acupuncture.

Ask your doctor about medications you can take to ease symptoms.

Increased risk of infection (neutropenia)

Without enough white blood cells, your body may not be able to fight infection. Many types of chemotherapy can cause a low white blood cell count, which is called neutropenia.

If your doctor tells you that your white blood cell count is low, take these actions to stay healthy:

Avoid crowds or people with colds.

Wash your hands often throughout the day to kill germs. Bathe daily to keep the number of bacteria down.

Call your doctor right away if you have any of these signs of infection: a temperature of 100.5 degrees Fahreinheit (38 degrees Celsius) or higher, severe chills, a cough, pain, a burning sensation during urination, or any sores or redness.

Insomnia (trouble sleeping)

Insomnia can be caused by anxiety, depression, or your cancer treatment. Use these tips to improve your rest:

Keep a regular bedtime schedule.

Use your bed only for sleeping, not watching TV or working on your computer.

If you don't fall asleep within 15 minutes, get up, do something else, and try again later.

Avoid stimulants such as caffeine and tobacco, especially close to bedtime.

Don't eat, drink fluids, or exercise close to your bedtime.

Avoid long naps during the day since this can interfere with your ability to sleep at night.

Menopausal symptoms

Surgery for vulvar cancer could involve removal of the ovaries. Also, radiation treatment and some types of chemotherapy can damage the ovaries or cause menopausal symptoms in women who've not yet reached menopause. They include symptoms, such as hot flashes, vaginal dryness, mood swings, and weight changes. If you were premenopausal, periods may become irregular or may stop, and you may not be able to get pregnant. However, some women may still be able to get pregnant after treatment:

If needed, talk with your doctor about birth control before treatment begins.

Talk with your doctor about ways to manage menopausal symptoms, such as using lubricants for vaginal dryness, exercising, and talking with a therapist about mood swings or signs of depression.

Report any unusual bleeding to your doctor.

Continue with regular pelvic exams.

Also see tips for Hot Flashes and Vaginal Dryness.

Mood swings

It's normal to experience emotional changes, both during and after cancer treatment. Even if cancer treatment is successful, many people experience fears about what the future holds. Talk with your doctor or nurse about ways to manage these changes and consider these tips as well:

Be as open as you can with loved ones about your fears.

Remember that exercise, sleeping, and eating well can greatly influence your mood for the better.

Get a referral to a psychiatrist, psychologist, or other counselor.

Look into cancer support groups.

If your symptoms are severe, ask your doctor whether any medications might help.

Mouth sores (mucositis) and dryness

Some types of chemotherapy may cause mouth sores and dryness. Mouth sores may hurt and make it hard to eat. Chronic dryness can impair your ability to taste, chew, and even speak.

To prevent sores or to treat dryness in your mouth, take these actions:

Gently brush your teeth after meals and before bedtime. Floss every day if your doctor says it's OK to do so.

Keep your mouth and lips clean and moist. Lip salves may help.

Suck on sugar-free candies or chew sugar-free gum to increase moisture in your mouth.

Sip water frequently.

Eat soft and pureed foods that are easier to swallow.

To ease the pain if you get sores in your mouth, take these actions:

Avoid alcohol and mouthwashes containing alcohol because they may irritate the sores.

Avoid hot, rough, or spicy foods because they may irritate the sores.

Avoid tobacco because it may irritate sores.

Ask your doctor about topical mouth medications.

Take over-the-counter pain medication, such as Tylenol (acetaminophen), if your doctor or nurse says it's okay to do so.

Call your doctor or nurse if your temperature reaches 100.5 degrees Fahreinheit (38 degrees Celsius) or higher.

Nausea or vomiting

Nausea or vomiting as a result of chemotherapy and radiation treatment for vulvar cancer may range from barely noticeable to severe. It may help you to understand the different types of nausea:

Acute-onset nausea and vomiting occurs within a few minutes to several hours after chemotherapy. The worst episodes tend to be 5 to 6 hours after treatment, and the symptoms end within the first 24 hours.

Delayed-onset vomiting develops more than 24 hours after treatment.

Anticipatory nausea and vomiting are learned from previous experiences with vomiting. As you prepare for the next dose of chemotherapy, you may anticipate that nausea and vomiting will occur as it did previously, which triggers the actual reflex.

Breakthrough vomiting means vomiting occurs despite treatment to prevent it. It requires other types of treatment.

Refractory vomiting occurs after taking one or more antinausea treatments. Essentially, you're no longer responding to antinausea treatments.

To prevent nausea, take these actions:

Ask your doctor about getting a prescription medicine to control nausea and vomiting. Then, make sure you take it as directed. If you are vomiting and cannot take the medicine, call your doctor or nurse.

If you have bothersome nausea and vomiting even though you are taking your medicine, call your doctor or nurse. Your medicine may be changed or a new medicine may be added.

To help ease nausea or vomiting if you have it, try these tips:

Try eating foods and drinking beverages that were easy to take or made you feel better when you had the flu or were nauseated from stress. These might be bland foods, sour candy, pickles, dry crackers, ginger ale, flat soda, or others.

Drink 6 to 8 glasses of liquids, such as water, broth, or Gatorade, a day to avoid dehydration.

Do not eat fatty or fried foods, very spicy foods, or very sweet foods.

Eat foods that are at room temperature or cold. The smells from hot foods may make your nausea worse.

Ask your doctor or nurse if he or she can help you learn a relaxation exercise. This may make you feel less anxious and more in control, and decrease your nausea.

Ask your doctor or nurse about using acupressure bands on your wrists, which may help decrease your nausea.

Pain

You may have pain following surgery. Try these tips to ease pain:

Over-the-counter pain medication can help with mild to moderate pain in many parts of your body.

Take your pain medications regularly and don't wait for your pain to become severe. (Take steps to avoid constipation, a common side effect of pain medications.)

Change your activity level. See if you feel better if you rest more or move around more.

Distract yourself with music, funny videos, or computer games.

Use heat, cold, or relaxation techniques, such as yoga, meditation, or guided visualization. Ask your doctor or nurse where you can learn more about these.

Call your doctor or nurse if you are having trouble with pain control.

Sexual problems

Feelings of depression from having cancer, having all or part of your vulva removed or radiated, or fatigue from other treatments can have a negative impact on your sexual desires. After radiation therapy, a woman might find that her vulva has changed and her vagina is narrower and less flexible. Sexual intercourse may be difficult because the vulvar skin in the treated area can be sensitive.

Here are some ways to cope so that you can better focus on your physical recovery:

Ask your doctor or nurse about maintaining or resuming sexual activity.

Include your partner in discussions.

Remember that the cancer is not contagious, and that being intimate will not stimulate it to come back or grow.

Share your feelings and fears with your partner, who is also affected by your cancer.

Explore different ways of expressing love (hugging and holding, stroking and caressing, talking).

Choose a time when you and your partner are rested and free from distractions.

Create a romantic mood.

Explore other sexual positions and alternative forms of sexual expression with your partner. Discuss your options with your doctor or nurse.

Use lubricants liberally if vaginal dryness or tightness makes intercourse painful or difficult.

Skin changes

Radiation treatment of the vulvar skin may produce a reaction similar to sunburn. Chemotherapy applied as an ointment may also irritate skin. Ask your radiation oncologist or radiation oncology nurse about a skin cream to provide relief.

Swelling (lymphedema)

If your doctor removes lymph nodes from your groin, you may have swelling in your legs or vulva. This is more likely if you also have radiation therapy to this area. Swelling may occur right after surgery, or it may happen later. It is caused when excess lymph collects in tissue. Swelling can also lead to pain and fatigue.

To reduce your risk of swelling or to reduce swelling, take these actions:

Wear support stockings or special compression devices.

Clean the skin of your legs daily and use moisturizing lotion.

Do not use elastic bandages with tight bands.

Do not sit in one position for more than 30 minutes.

Watch for signs of infection, such as redness, pain, heat, swelling, and fever. Call the doctor immediately if any of these signs or symptoms appears.

Do your prescribed exercises regularly. If you have swelling, keep your affected leg raised above the level of your heart, when possible.

Keep regular follow-up appointments with your doctor.

To avoid injury and infection in your legs or vulva, take these precautions:

Try not to cut or tear toenail cuticles.

Use sunscreen.

Clean cuts with soap and water, and then use antibacterial ointment.

Use gauze wrapping instead of tape. Do not wrap so tightly that circulation is cut off.

Talk with your doctor or nurse about any rashes.

Avoid extreme hot or cold such as ice packs or heating pads.

Do not overwork the affected leg.

Thought or memory problems

You may have mild problems with concentration and memory during and after treatment. Fatigue and stress can make it worse. Taking these actions may help:

Make lists and write down important information.

Use other tools to help organize your life, such as calendars, pill dispensers, or alarm clocks.

Ask your doctor about nutritional supplements that may help with memory.

Tiredness or fatigue

Tiredness is a very common symptom and side effect from chemotherapy and radiation treatments. It is also a symptom of anemia, which is a low red blood cell count as noted from blood tests. Or it can be caused from a B12 vitamin or iron deficiency, which your doctor may also find in a blood test. Whatever the cause, you may feel only slightly tired or you may suffer from extreme fatigue.

Taking these actions may help increase your energy level:

Take short rests when you feel tired. Avoid long naps during the day so that you can sleep well at night.

Add mild exercise, such as walking, to your daily routine. It may help you sleep better.

Save your energy for important tasks.

Drink plenty of fluids. Dehydration leads to increased fatigue.

Take action to treat a poor appetite, because eating improperly can make you tired.

If your fatigue is severe or chronic, ask for help with routine tasks that can drain your energy, such as grocery shopping or housework. Some people reduce their hours at work.

Urination problems

You may have problems with urination following radiation therapy. This could lead to bladder spasms and frequent, urgent, or burning urination:

Ask your doctor about prescription medication to prevent spasms.

Drink more liquids during treatment.

Vaginal dryness and other vaginal problems

If you have a hysterectomy, vaginal dryness may result. Lowered estrogen levels may also cause women to have vaginal thinning and difficult or painful intercourse. Lubricants can help with some of these problems. Vaginal infections may also occur more often. When you talk with your doctor about these problems, make sure he or she knows you've had cancer. Try these methods to ease symptoms:

Use over-the-counter vaginal moisturizers, such as Replens, Gyne-Moistrin, and Lubrin.

Before sexual activity, use water-soluble lubricants, such as KY Jelly and Astroglide.

Apply vitamin E oil to the area to ease irritation and burning.

Ask your doctor about products that may help replace estrogen vaginally.

See your gynecologist about any vaginal discharge or other symptoms that do not go away.

Wound healing

Some women experience slow healing or other problems at the site of surgery:

Make sure your doctor and nurse review with you how you should take care of your wound.

Take regular sitz baths. Be sure to dry your vulva well afterward. You can do this by using the cool setting on a blow dryer.

After urinating or having a bowel movement, clean your vulva with warm water. You can do this by squeezing water onto your vulva with a plastic squeeze bottle. Again, dry thoroughly by gently patting or using a blow dryer.

Try to avoid sitting for long periods.

Call your doctor or nurse if there is drainage that changes in odor, amount, or color, or if you have any fever.

Ask to see a wound specialist (enterostomal therapist) if you have any wound healing problems.