Do What You Can to Ease Side Effects of Treatment for Vaginal Cancer

Anemia (low red blood cell levels)

Your doctor will take blood samples for blood tests throughout your treatment. One thing he or she is checking for is your red blood cell count. Red blood cells carry oxygen throughout the body. If your body doesn't have enough oxygen, you may feel tired. Decreased red blood cell counts can be caused by small amounts of blood loss due to bleeding, chemotherapy, radiation, or by the cancer itself.

If your doctor tells you that you have anemia, take these actions to feel better:

• Take short rests when you're 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.

• Balance activity with rest. Save your energy for important tasks.

• Drink plenty of water. Dehydration adds to fatigue.

• Talk with your doctor about medications or treatments that may help manage your anemia.

Anxiety and depression

Many people may 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.

• Ask your doctor about medications for depression and anxiety.

Appetite changes

People who eat well during cancer treatment are more likely to maintain their strength, are more active, and are better able to fight 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 getting a balanced diet and increasing 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 keep your bowels moving. In addition to water, fruit juices, and other liquids, try gelatin, pudding, soups, fruit bars, and ice cream.

• Eat small 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 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.

Constipation

This may be a side effect of chemotherapy or some pain medicines. Constipation may include difficult or infrequent bowel movements. It can range from mildly uncomfortable to very painful. Taking pain medications can lead to constipation, so it's wise to take these preventive actions before you have problems. These same steps will give you relief if you are already constipated:

• Drink plenty of fluids, especially water and prune juice.

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

• Exercise.

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

Diarrhea

This is one of the most common side effects of chemotherapy. Diarrhea, which includes loose or frequent bowel movements, or both, may lead to dehydration if you don't take these precautions. Many drugs can cause bowel changes:

• 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 included in the BRAT diet (bananas, rice, applesauce, and toast).

• Drink more fluids, such as water and broth, to prevent dehydration.

• Ask your doctor about medications that may help.

Dry or irritated skin

This may be a side effect of radiation therapy:

• Protect your skin from sun exposure by wearing sunscreen of at least 15 SPF (sun protection factor). However, check with your doctor or nurse before applying sunscreen to make sure it's okay.

• Ask your doctor or nurse what kind of lotion you can use to moisturize and soothe your skin. Don't use any lotion, soap, deodorant, sun block, cologne, cosmetics, or powder on your skin within two hours before or after radiation treatment because they may cause more irritation.

• Wear loose, soft clothing over the treated area. Cotton underwear can help prevent further irritation.

• Don't scratch, rub, or scrub treated skin. After washing, gently blot dry.

• Don't bandage skin with tape. If you must bandage it, use paper tape, and ask your nurse to help you place the dressings so that you can avoid irritation.

• Don't apply heat or cold to the treated area. Bathe only with lukewarm water because it's less dehydrating.

• If you must shave the treated area, use only an electric shaver because it is less irritating to the skin. Don't use lotion before shaving and don't use hair-removal products. Both can irritate your skin.

• Keep your nails well trimmed and clean so you don't accidentally scratch yourself.

Hair loss

Losing your hair (called alopecia) can be upsetting because baldness is a visible reminder that you are being treated for cancer. Chemotherapy can cause hair loss. Keep in mind that your hair will most likely grow back after treatment (though it may look different than it did before). 

Try these coping tips:

• Consider cutting your hair 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 to the face, neck, upper chest, and back--with or without sweating. 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.

Infections

Your doctor will take blood samples for blood tests throughout your treatment. One thing he or she is checking for is your white blood cell count. Many types of chemotherapy can cause low white blood cell counts. A decrease in your white cell count is called leukopenia. Neutrophils are a special subtype of white blood cells that help stave off infection. If your neutrophil levels are low, you are neutropenic. Without enough white blood cells, including neutrophils, your body may not be able to fight infections. 

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 or use hand sanitizer throughout the day to kill germs.

• Call your doctor right away if you have any of these signs of infection: a temperature of 100.5 degrees F (38 degrees C) 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 using 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 they can interfere with your ability to fall asleep at night.

Menopausal symptoms

Some types of chemotherapy can damage a woman's ovaries. Or it may cause menopausal symptoms in women who've not yet reached menopause. These symptoms include hot flashes, vaginal dryness, mood swings, and weight changes. Periods may become irregular or may stop, and you may not be able to get pregnant. For some women, the loss of a menstrual period is permanent:

• 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 hot flashes, vaginal dryness, and weight changes.

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 try these tips:

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

• Remember that exercise, sleeping, and eating well can greatly improve your moods.

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

• Join a cancer support group.

Mouth sores (mucositis)

Some types of chemotherapy may cause mouth sores. These may hurt and make it hard to eat.

To prevent sores in your mouth, take these actions:

• Brush your teeth after meals and before bedtime; floss every day.

• Keep your mouth and lips clean and moist.

• Use sugar-free candies or gums to increase moisture in your mouth.

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 the sores. Smoking can also make you more susceptible to sores.

• Ask your doctor about topical mouth medications.

• Take over-the-counter pain medication, such as Tylenol (acetaminophen), if necessary.

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

Nausea or vomiting

Nausea or vomiting as a result of chemotherapy or radiation treatment for 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 five to six 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 is 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 occurs despite treatment to prevent it. It requires additional treatment.

• Refractory vomiting occurs after taking one or more antinausea medications--essentially, you're no longer responding to antinausea treatments.

To help 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 can be changed.

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've had the flu or were nauseated from stress. These might be bland foods, sour candy, pickles, dry crackers, ginger ale, flat soda, or others.

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

• Eat room temperature or cold foods. 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 to decrease your nausea.

Numbness, tingling, or muscle weakness in your hands or feet (peripheral neuropathy)

If you have numbness, tingling, or weakness in your hands and feet, you may have nerve damage called peripheral neuropathy. This can be a side effect of chemotherapy. Other signs of this problem are ringing in your ears or trouble feeling hot or cold. If you have symptoms such as these, your doctor may adjust the dose of your chemotherapy. Or your doctor may prescribe medicine or certain vitamins that may help relieve your symptoms. You should also take these precautions to protect yourself:

• Take extra care walking and moving so that you don't fall. Wear only well-fitting shoes that help you maintain your balance.

• Use warm, not hot, water for bathing to prevent burns. Consider using a shower chair or railing to improve your stability.

• If your daily activities become too difficult, ask your doctor for a referral to an occupational therapist or a physical therapist. They can help teach you new ways of doing things so that you can stay as active as possible.

• Take extra care when driving (you may have trouble feeling the gas and brake pedals). Ask friends and family to drive you places.

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; 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--either may help.

• 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.

• Talk to your doctor about your pain and get help. Do not accept pain as a normal part of having cancer.

Sexual changes

Having vaginal cancer affects a woman's sexuality. The vagina often becomes less elastic following radiation, making intercourse painful. Surgery (partial vaginectomy) may change the size and shape of the vagina, making intercourse uncomfortable. If you have scars, it might affect how you feel about yourself or about how you experience sexual pleasure. If you have a partner, you might be afraid of how your partner will react to these changes. Talk to your partner and doctor or nurse about your concerns.

Whether the changes are short term or long lasting, you can find ways to feel good about yourself and to be intimate with a partner. Remember to be patient and give yourself time. Be creative. Below are some ideas on how to cope with these changes:

• Focus on physical recovery, including diet and physical activities.

• Ask your doctor or nurse about maintaining or resuming sexual activity. Include your partner in discussions.

• Use a water-soluble lubricant (Astroglide, K-Y Jelly, Lubrin) if needed. Make sure you use enough of it.

• Report vaginal discharge or bleeding, fever, or pain to your doctor.

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

• Create a romantic mood.

• Try different positions until you find one that is more comfortable and less tiring for you.

• Use pain medications, if needed.

• Remember that cancer is not contagious.

• Remember that being intimate will not make the cancer come back or grow.

• Talk about your feelings and fears with your partner. Listen to your partner's concerns, too.

• Explore different ways of showing love, such as hugging and holding, stroking and caressing, or talking.

• Consider alternate forms of sexual intercourse, such as oral sex.

Swelling (lymphedema)

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

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

• Wear support stockings or special compression devices.

• Clean the skin of your leg daily and use moisturizing lotion. This helps prevent cracks in skin that could lead to infection.

• Do not use elastic bandages with tight bands.

• To increase circulation and reduce fluid buildup, 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.

• Use the force of gravity to avoid or reduce swelling: Do not stand for long periods of time. Elevate your legs while sitting or lying down.

• Keep regular follow-up appointments with your doctor.

To avoid injury and infection in your leg or vagina, take these precautions:

• Try not to cut or tear toenail cuticles because even small wounds may let in germs that cause infection.

• 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 to avoid damage to your skin.

Thinking and memory problems

You may have mild problems with concentration and memory during and after systemic chemotherapy. Being tired can make this 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.

Tiredness

Tiredness is a very common symptom and side effect from chemotherapy and radiation treatments. You may feel only slightly tired or you may suffer from extreme fatigue.

Taking these actions may help increase your energy level. Fatigue can last for months after treatment ends:

• Save your energy for important tasks.

• 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.

• Follow the tips under anemia.

• Talk to your doctor about how the fatigue is affecting you. There may be a medical reason for why you are feeling tired and it may be something that can be treated.

Urination problems

You may have problems with urination following radiation therapy. This could lead to bladder spasms and frequent, urgent, or burning urination. Trouble controlling the flow of urine is called incontinence:

• Keep track of your symptoms so you can report them to your doctor. This might include how frequently you urinate, how many incontinence pads you use, and the kind of activity that leads to incontinence.

• Ask your doctor about medications, exercises, or other options to prevent spasms or incontinence.

• Try to urinate regularly--about every three hours.

• Avoid drinking caffeinated beverages because caffeine causes the kidneys to make more urine and irritates the bladder. Spicy or acidic foods, such as orange juice, may also irritate the bladder so try to avoid them.

Vaginal dryness and other vaginal problems

Vaginal dryness and discharge can result from having a hysterectomy, which leads to menopause. In addition to vaginal dryness, lowered estrogen levels may cause women to have vaginal thinning and difficult or painful intercourse. 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 unusual vaginal discharge or other symptoms that do not go away. 

Weight gain

Weight gain may partly be a result of going into early menopause following treatment with chemotherapy or removal of ovaries. Take these actions to help manage your weight:

• Increase the amount of your daily exercise. Strive to be active every day.

• Eat a balanced, low-calorie diet.

• Increase the amount of fruits and vegetables you eat. Drink more water. These can help fill you up--and are good for you--without adding a lot of calories.