Women treated for vulval cancer may experience a range of physical changes and symptoms.

Physical changes associated with vulval cancer can be due to the cancer itself or to treatment side effects. Not all women will experience these symptoms. Your doctor should tell you about any side effects of drugs or other treatments that are recommended.

Follow-up visits are a good opportunity to discuss any symptoms or side effects of treatment. Regardless of whether a woman is having regular follow-up visits, she should talk to a health professional about any symptoms or side effects that are concerning her.

This section describes some of the symptoms reported by women with vulval cancer and what can be done to manage them.

• Fatigue
• Sleep problems
• Eating problems
• Nausea and vomiting
• Mouth sores
• Bladder problems
• Bowel problems
• Pain

Lymphoedema

Lymphoedema is swelling of part of the body, usually the legs or the arms. It may occur after treatment for vulval cancer if you have had the lymph nodes in your abdomen removed (lymphadenectomy). Women who have had surgery followed by radiotherapy are particularly at risk.

Removal of the nodes may prevent normal draining of the lymph fluid from the legs. As a result, fluid can build up in one or both legs causing swelling. This usually doesn’t occur until some time after treatment.

If you have problems, seek immediate help as symptoms are better managed if treated early. Seek advice from your specialist or nurse.

Some hospitals have specialist physiotherapists who can help reduce your risk of developing lymphoedema.

Tips:

• Gently massage the swollen leg towards your heart to move the fluid out to other lymph channels
• Wear special bandages, stockings or a compression garment to help remove fluid
• Avoid infection by caring for your skin and nails
• Exercise the leg to help move fluid out of the area and into other lymph channels
• Avoid injections in your legs
• Keep the leg raised higher than the heart when you can.

Fertility problems

Although the vulva is a part of the female sex organs, in most cases fertility will not be affected by treatment for vulval cancer. Your doctor can advise you if you have any concerns about fertility or sexual problems.

Menopause

If you’ve had chemotherapy or full pelvic radiotherapy, your periods may stop, either temporarily or permanently.

The usual age for menopause is between 45 and 55. The loss of menstruation and fertility at a younger age can lead to feelings of sadness, grief and low self-esteem. You may feel old before your time or less feminine.

When menopause is brought on by cancer treatment, the symptoms are usually more severe than a natural menopause because the body hasn’t had time to get used to the gradual decrease in hormone levels. You may experience hot flushes, mood swings, trouble sleeping and tiredness. The vagina can also lose elasticity and become dry, because it needs oestrogen to stay moist.

You can manage menopausal symptoms in several ways:

• Hormone replacement therapy (HRT) can help reduce your symptoms. Using HRT for more than five years increases the risk of some diseases including breast cancer, but it also decreases the risk of other diseases. You will need to talk to your gynaecologic oncologist about the benefits and risks of HRT. If you were already on HRT when your cancer was diagnosed, you will need to weigh up the risks of continuing it. Because vulval cancer can be hormone-sensitive, HRT may not be suitable for some women.
• Locally applied oestrogen, contained in creams or pessaries, can be inserted into the vagina to relieve dryness. Vaginal moisturisers without oestrogen can also be used.
• To relieve hot flushes, try wearing cotton clothing and using cotton sheets, and dressing in layers that you can take off if you get warm. Sleep in a cool room to avoid being awakened by a hot flush. Limit your intake of alcohol, caffeine and spicy foods.
• There are a number of dietary, herbal and alternative approaches to managing menopausal symptoms, such as herbal remedies and changes to your diet. Talk to your doctor or health care team for more information.

No matter what you decide to do, you should advise your doctors about how you are managing your menopausal symptoms.

Osteoporosis

Menopause may cause bones to weaken and break more easily. This is called osteoporosis.

You may be able to prevent osteoporosis by:

• getting your daily recommended amounts of calcium and vitamin D
• engaging in regular weight-bearing exercise
• avoiding smoking and excessive alcohol.

Talk to your health-care provider about osteoporosis. You may have a bone density test or be prescribed medication to prevent your bones from becoming weak and brittle. You can also call Osteoporosis Australia on (02) 9518 8140 or visit their website.

Cardiovascular effects

After menopause, changes in your cholesterol balance increase your risk of hardening and blockage of the arteries.

If you smoke, quitting is probably the most important thing you can do to either prevent heart disease or prevent further problems if you already have heart disease.

There are many other positive lifestyle changes you can make at menopause that will reduce your risk of heart disease and stroke. You can try to maintain a healthy weight by eating a balanced diet with lower fat levels, exercising regularly and reducing your stress levels. If necessary, your doctor may prescribe medications to reduce your risk, such as cholesterol-lowering drugs.