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Chemotherapy (chemo) uses anti-cancer drugs that are usually given intravenously (IV or into a vein), by mouth, or applied to the skin in other ways, such as in an ointment. Drugs taken by mouth or injected into a vein, called systemic chemo, enter the bloodstream and go throughout the body, making this treatment potentially useful for cancer that has spread beyond the vulva.

The role of chemo in treating vulvar cancer is not clear. There are no standard chemo treatment plans.

In more advanced disease, chemo might be given with radiation therapy before surgery. Chemotherapy helps the radiation work better, and this may shrink the tumor so it's easier to remove with surgery.

At this time, chemo is most often used for vulvar cancers that have spread or have come back after surgery. But so far, the results of using chemo to treat vulvar cancers that have spread to other organs have been disappointing.

Common chemo drugs used for vulvar cancer

Drugs most often used in treating vulvar cancer include cisplatin with or without fluorouracil (5-FU). Another chemo drug, mitomycin, is less commonly used. These are often given at the same time as radiation therapy. (You may hear this called chemoradiation.)

More advanced vulvar cancers may be treated with one or more of these drugs:

• Cisplatin
• Carboplatin
• Vinorelbine
• Paclitaxel
• Erlotinib

Different drugs are used to treat vulvar melanoma. Melanoma Skin Cancer has more information on drug treatment for advanced melanomas.

Chemo side effects

Many of the chemo drugs used 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 chemo depend on the type of drugs, the amount taken, and the length of time you are treated. Common side effects of some of the drugs used to treat vulvar cancer include:

• Nausea and vomiting
• Loss of hair
• Mouth or vaginal sores
• Changes in the menstrual cycle, premature menopause, and infertility (inability to become pregnant). But most women with vulvar cancer have already gone through menopause.
• Diarrhea

Chemo often affects the blood-forming cells of the bone marrow, leading to low blood counts. This can cause:

• Increased chance of infections (low white blood cell count)
• Increased chance of bleeding and bruising ( low blood platelet count)
• Tiredness (from anemia, which is a low red blood cell count)

Other side effects depend on what drug is used. Most side effects are short-term and stop when the treatment is over, but some chemo drugs can have long-lasting or even permanent effects. For instance, cisplatin can cause nerve damage (called neuropathy). This can lead to numbness, tingling, or even pain in the hands and feet. Cisplatin can also damage the kidneys. To lower the risk of kidney damage, plenty of fluids are given intravenously (IV) before and after each dose.

Ask your cancer care team about the chemo drugs you'll get 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.