Managing side effects of ovarian cancer treatment

Having surgery or radiation therapy for ovarian cancer may mean you will be unable to conceive a child. This is known as infertility.If you have stage 1 ovarian cancer and have not yet reached menopause, it may be possible to leave the uterus and one ovary in place (unilateral salpingo-oophorectomy). Talk to your doctor or a fertility specialist about what options are available to you.

Being told that your reproductive organs will be removed or will no longer work and that you won’t be able to have children can be devastating. Even if your family is complete or you do not want children, you may still feel a sense of loss and grief.

Speaking to a counsellor or gynaecological oncology nurse about your feelings can be helpful.

If you were still having periods (menstruating) before surgery, having your ovaries removed will mean your periods will stop. This is called menopause. When menopause occurs naturally, it is a gradual process that usually starts between the ages of 45 and 55, but menopause after surgery is sudden.

Symptoms of menopause can include hot flushes, dry or itchy skin, mood swings, trouble sleeping (insomnia), tiredness and vaginal dryness. These symptoms are usually more intense after surgery than during a natural menopause, because the body hasn’t had time toget used to the gradual decrease in hormone levels. If symptoms are causing problems for you, speak to your treatment team or doctor.

Managing the symptoms of menopause

Check your cholesterol levels

Cholesterol levels can change after menopause, which can lead to heart disease. You can manage cholesterol levels with regular exercise and a balanced diet. Ask your doctor about cholesterol-lowering drugs.

Use a vaginal moisturiser

This will help with vaginal discomfort and dryness. You can buy a vaginal moisturiser over the counter from chemists.

Ask about menopausal hormone therapy (MHT)

Previously called hormone replacement therapy (HRT), there are benefits and risks to managing menopause with MHT. Ask your oncologist if MHT is safe for you to use after treatment for ovarian cancer.

Learn meditation and relaxation techniques

These may help reduce stress and lessen symptoms.

Have your bone density checked

Menopause can increase your risk of developing thinning of the bones (osteoporosis). Talk to your doctor about having a bone density test or taking medicines to prevent your bones becoming weak. Regular exercise will help keep your bones strong. For more information, call Healthy Bones Australia on 1800 242 141.

After surgery or during chemotherapy or radiation therapy, some people notice changes in how their bowel works. You may have diarrhoea, constipation or stomach cramps. Pain medicines may also make you feel constipated. Diarrhoea and constipation can occur for some time but usually temporary.

Sometimes tissues in the pelvis stick together after surgery. This is called a pelvic adhesion, and it can be painful and cause ongoing bowel problems such as constipation. In rare cases, it may need further surgery.

To help manage bowel changes, ask your doctor, nurse or dietitian for advice about eating and drinking, and see the tips below.

Tips for managing bowel changes

• Drink plenty of liquids to replace fluids lost through diarrhoea or to help soften faeces (poo) if you are constipated. Avoid alcohol, caffeinated drinks and very hot or very cold liquids.
• Avoid fried, spicy or greasy foods, which can cause pain and make diarrhoea and constipation worse.
• If you have diarrhoea, rest as much as possible. Diarrhoea can make you feel very tired.
• Ask your pharmacist or doctor about suitable medicines to relieve symptoms of diarrhoea or constipation.
• Eat small, frequent meals instead of 3 big ones.
• Drink peppermint or chamomile tea to reduce stomach or wind pain.
• If you are constipated, consider taking laxatives and do some gentle exercise, such as walking.

When food can’t pass through the bowel it can become blocked. This is known as a bowel obstruction. Causes may include surgery or radiation therapy, or the cancer coming back. Symptoms may include feeling sick, vomiting, or a swollen and painful stomach. Bowel obstruction can be serious. How it is treated will depend on its cause, where it is in the bowel, and your general health.

Options may include:

Resting the bowel – A bowel obstruction can sometimes be treated by resting the bowel, which means not eating or drinking and having fluid through an intravenous drip until the blockage clears.

Taking medicines – Your doctor may prescribe an anti-inflammatory medicine to reduce the swelling around the obstruction.

Inserting a stent – Surgery may help clear some bowel obstructions. If only one area is blocked, you may have a small tube (stent) put in to help keep the bowel open and relieve symptoms. The stent may be inserted through the rectum using a flexible tube called an endoscope.

Creating a stoma – If the bowel is blocked in more than one spot, you may have a stoma. This is a surgically created opening in the abdomen that allows waste matter to leave the body. A stoma may be a colostomy (made from the colon in the large bowel) or an ileostomy (made from the ileum in the small bowel). A small bag called a stoma bag or appliance is worn on the outside of the body to collect the waste. The stoma may be reversed when the blockage is cleared, or it may be permanent.

For more information on caring for a stoma, visit the Australian Association of Stomal Therapy Nurses or the Australian Council of Stoma Associations.

It is common to feel very tired and lack energy during or after treatment. Fatigue for people with cancer is different from tiredness as it doesn’t always go away with rest or sleep. Most people who have chemotherapy will start treatment before they have had time to fully recover from their operation. Fatigue may continue for a while after chemotherapy has finished, but it is likely to gradually improve over time. In some cases, it may take 1–2 years to feel well again.

See Fatigue and cancer and listen to Cancer Council's podcast episode on fatigue.

Tips for managing fatigue

• Plan your day. Set small, manageable goals and rest before you get too tired.
• Ask for and accept offers of help with tasks such as cleaning and shopping.
• Eat healthy, well-balanced meals to keep energy levels up.
• Do some light exercise. This has been shown to boost energy levels and make you feel less tired.
• Talk to your doctor about what type of exercise would be suitable for you.

The way ovarian cancer affects sex and intimacy depends on many factors, such as treatment and side effects, your self-confidence, and whether you have a partner. It is natural to experience changes in your desire to have sex.

It is important that your sexuality is respected and you feel comfortable when discussing how cancer treatment will affect you. Whatever your gender identity or sexual orientation, your medical team should be able to discuss your needs and support you through treatment.

Physical changes – Treatment can cause dryness and scarring of the vagina, and internal scar tissue. These side effects can make sexual penetration painful, and you may have to find different ways to orgasm. Removal of the uterus, cervix and ovaries can change how you experience sexual pleasure. The experience of having cancer may mean you lose interest in intimacy and sex (low libido).

Emotional changes – For most people, sex is more than arousal, intercourse and orgasms. It involves feelings of intimacy and acceptance, as well as being able to give and receive love. Although sexual intercourse may not always be possible, closeness and sharing can still be part of your relationship.

Changes to your body can affect the way you feel about yourself (your self-esteem) and make you feel self-conscious. You may feel less confident about who you are and what you can do. Give yourself time to get used to any changes. You may benefit from talking to a professional such as a psychologist or sexual therapist. Your doctor will be able to help with a referral.

Tips for managing sexual changes

• Enjoy physical touch with your partner without having sexual intercourse to maintain intimacy.
• Try touching, hugging, massaging, holding hands and having a bath together.
• Let your partner know if you don’t feel like having sex, or if you find penetration uncomfortable.
• Talk to your doctor about ways to manage side effects that change your sex life. These may include using vaginal dilators, lubricants and moisturisers.
• If you find that vaginal dryness is a problem, take more time before and during sex to help the vagina relax and become well aroused.
• Lubricant helps with vaginal dryness. A water-based or silicone-based gel with no added perfumes or colouring is best.
• Try different positions during sex to work out which position is the most comfortable for you.
• Spend more time on foreplay and try different ways to become aroused.
• If you can’t enjoy penetrative sex, explore other ways, such as oral and manual stimulation.
• Talk about how you’re feeling with your sexual partner or doctor, or ask your treatment team for a referral to a sexual therapist or psychologist.
• Do some regular physical activity to boost your energy and mood.
• Talk to your GP about managing any depression as it may be affecting your libido and desire for intimacy.
• For ideas on how to talk to your treatment team about sexual changes, visit Cancer Australia and search for their online resource Intimacy and sexuality for women with gynaecological cancer – starting a conversation.

Sometimes ovarian cancer can cause fluid to build up in different parts of the body.

Ascites

This is when fluid collects in the abdomen. It causes swelling and pressure, which can be uncomfortable and make you feel breathless.

If you have ascites, your doctor may inject a local anaesthetic into the abdomen and then insert a needle to take a sample of the fluid. This is called a paracentesis or ascitic tap. The fluid sample is sent to a laboratory to be examined under a microscope for cancer cells.

Sometimes, to make you feel more comfortable, the doctor will remove all the remaining fluid from your abdomen. If there is a lot of fluid, it may take a few hours for the fluid to drain into a drainage bag, and then the tube will be removed from your abdomen.

Pleural effusion

If the cancer has spread to the lungs, fluid builds up in the area between the lung and the chest wall (pleural space). It can cause pain and breathlessness. The fluid can be drained using a procedure called a thoracentesis or pleural tap. Your doctor will inject a local anaesthetic into the chest area, and then insert a needle into the pleural space to drain the fluid.

If you have lymph nodes removed from the pelvis as part of surgery (a lymphadenectomy), you may find that one or both legs become swollen. This is known as lymphoedema. It can happen if lymph fluid doesn’t circulate properly and builds up in the legs. Radiation therapy in the pelvic area may also cause lymphoedema.

Lymphoedema can make movement and some types of activities difficult. The swelling may appear at the time of treatment or months or years later. It is important to seek help with lymphoedema symptoms as soon as possible because early diagnosis and treatment lead to better outcomes.

Tips for managing lymphoedema

• Manage and reduce the swelling of lymphoedema with gentle exercise, compression stockings and a type of massage called manual lymphatic drainage.
• Keep your skin clean and apply moisturiser every day.
• Protect your skin from cuts, scratches, bites and burns to reduce the risk of infection.
• See a trained lymphoedema practitioner for a treatment plan and ongoing care. Visit the Australasian Lymphology Association.
• All states and territories have a compression garment scheme. These schemes cover some, or all, of the cost of a compression garment. For more information, visit the Australasian Lymphology Association.
• Talk to your GP about how a chronic disease management plan can help you manage the condition.