Chemotherapy for Vaginal Cancer

Because vaginal cancer is relatively uncommon, much of the chemo decision-making for treatment of vaginal cancer is based on cervical cancer studies. For treatment of vaginal cancer, chemo can be given:

• At the same time as radiation (for disease that has not spread to other parts of the body)
• Alone (for disease that has already spread to other parts of the body)
• Before surgery, to shrink the tumor before surgery (this is called neoadjuvant chemo).

How is chemo used to treat vaginal cancer?

Chemotherapy (chemo) drugs may be given intravenously (into a vein), by mouth, or applied to the skin in an ointment. Drugs taken by mouth or injected into a vein are called systemic chemotherapy. They enter the bloodstream to reach throughout the body, making this treatment useful for vaginal cancer that has spread to other parts of the body.

Chemo drugs commonly used for vaginal cancer

Because vaginal cancer is rare, there haven’t been many studies to see which chemo drug is best. So, at this time, there's no standard or "best" chemo treatment plan. Treatment choices are made based on each person's needs. Most often, doctors use the same types of drugs that are used for cervical cancer. Drugs that have been used include:

• Cisplatin
• Carboplatin
• Bevacizumab (Avastin)
• Paclitaxel (Taxol^®)
• Topotecan (Hycamtin)
• Docetaxel (Taxotere)
• Fluorouracil (5-FU)

Chemo side effects

Chemo drugs 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 some 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 include:

• Hair loss
• Mouth sores
• Loss of appetite
• Diarrhea
• Nausea and vomiting
• Changes in the menstrual cycle, premature menopause, and infertility (inability to become pregnant). Most vaginal cancer patients, however, have gone through menopause.

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

• Increased chance of infections (due to low white blood cells)
• Easy bruising or bleeding (due to low blood platelets)
• Fatigue (due to low red blood cells)

Other side effects can occur depending on which drug is used. For example, cisplatin can cause nerve damage (called neuropathy). This can lead to numbness, tingling, or even pain in the hands and feet.

Most side effects are temporary and stop when the treatment is over, but chemo drugs can have some long-lasting or even permanent effects.

Long-term side effects of chemotherapy can include:

Menstrual changes: If you are younger and and have not had your uterus removed as a part of treatment, changes in menstrual periods are a common side effect of chemo. But even if your periods stop while you are on chemo, you might still be able to get pregnant. Getting pregnant while receiving chemo is not safe, as it could lead to birth defects and interfere with treatment. This is why it’s important to discuss your options for birth control with your doctor if you are pre-menopausal before treatment and are sexually active. Patients who have finished treatment (like chemo) can often go on to have children, but it's important to talk to your doctor about when it is safe to do so.

Premature menopause (not having any more menstrual periods) and infertility (not being able to become pregnant) may occur and may be permanent. Some chemo drugs are more likely to cause this than others. The older you are when you get chemo, the more likely it is that you will become infertile or go through menopause as a result. If this happens, there is an increased risk of bone loss and osteoporosis. Medicines that can treat or help prevent bone loss are available.

Neuropathy: Some drugs used to treat vaginal cancer, including paclitaxel and cisplatin, can damage nerves outside of the brain and spinal cord. The injury can sometimes lead to symptoms like numbness, pain, burning or tingling sensations, sensitivity to cold or heat, or weakness, mainly in the hands and feet. This is called peripheral neuropathy. In most cases it gets better or even goes away once treatment stops, but it might last a long time in some people.

Nephrotoxicity: Cisplatin, the main chemo drug used to treat vaginal cancer, can damage the kidneys (called nephrotoxicity). Many times the damage is preventable and reversible, but sometimes the damage may be long-lasting. Often, there are no symptoms, but the damage can be seen on bloodwork done routinely while chemo is given. If the kidneys show damage, the cisplatin is usually stopped and carboplatin may be used instead.

Other side effects are also possible. Ask your cancer care team about the chemo drugs you will receive and what side effects you can expect.