Chemotherapy for ovarian cancer

Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs. The aim is to destroy cancer cells while causing the least possible damage to normal, healthy cells.

When is chemotherapy used?

When you have chemotherapy depends on the stage of the cancer. It may be used at different times:

Before surgery – People with advanced ovarian cancer (stages 3 or 4) will often have chemotherapy before surgery. This is called neoadjuvant chemotherapy, and it is done to shrink the cancer and make surgery safer.

After 3–4 cycles of chemotherapy, you will have a CT scan to check how the tumour has responded to the chemotherapy. Your doctor or multidisciplinary team will then decide whether to recommend an operation. If you have surgery, you will have another 2–3 cycles of chemotherapy afterwards. If you do not have surgery, you will usuallycontinue with a further 3 cycles of chemotherapy.

After surgery – Chemotherapy given after surgery is called adjuvant chemotherapy. It usually starts 2–4 weeks after the surgery to destroy cancer cells still in the body. For ovarian cancer, the chemotherapy drugs are usually given in repeating cycles spread over 4–5 months, but this can vary depending on the stage of the cancer and your general health. Your treatment team will talk to you about the best schedule for you. Some people may have chemotherapy and a targeted therapy drug.

Main treatment – Chemotherapy may be recommended as the main treatment if you are not well enough for a major operation or when the cancer cannot be surgically removed.

Having chemotherapy

Chemotherapy is usually given as a combination of 2 or more drugs, or sometimes as a single drug.

In most cases, the drugs are injected into a vein (intravenously). To reduce the need for repeated needles, you may receive chemotherapy through a small medical appliance or tube inserted beneath your skin. This may be called a port-a-cath or a peripherally inserted central catheter (PICC), or it may have another name.

You will usually have chemotherapy as an outpatient (also called a day patient), but some people need to stay in hospital overnight.

Intraperitoneal chemotherapy

Occasionally, chemotherapy is given directly into the abdominal cavity (the space between organs in the abdomen and the walls of the abdomen). This is known as intraperitoneal chemotherapy.

In this method, the drugs are delivered through a tube (catheter) that is put in place during surgery and removed once the course of chemotherapy is over.

Intraperitoneal chemotherapy is used only in specialised units in Australia. It may be offered for stage 3 cancer with less than 1 cm of tumour remaining after surgery. Some studies have shown it may be more effective than giving chemotherapy through an intravenous drip.

There are other studies looking at giving heated intraperitoneal chemotherapy (HIPEC) at the time of surgery.

Ask your medical oncologist for more information about this type of chemotherapy, its benefits and risks, and if it is suitable for you.

Blood tests during chemotherapy

You will have blood tests before each chemotherapy cycle, to check that your body’s healthy cells have had time to recover. If your blood count has not recovered, which can be common, there may be a delay before your next treatment.

If you had raised CA125 levels when you were diagnosed, you may also have blood tests during treatment to check what is happening to these levels. 

The blood tests will check if:

• CA125 levels fall during treatment – this can mean the chemotherapy is destroying the cancer cells
• CA125 levels stay the same or rise during treatment – this may mean the cancer is not responding to chemotherapy.

Side effects of chemotherapy

Chemotherapy can affect healthy cells in the body, which may cause side effects. Not everyone will have side effects, and they will vary according to the drugs you are given. Your treatment team will talk to you about what to expect and how to manage any side effects.

Fatigue

This is very common during and after cancer treatment, but can also be caused by other factors. Your red blood cell level may drop (anaemia), which can cause you to feel tired and short of breath.

Nausea and vomiting

Some types of chemotherapy drugs may make you feel sick (nauseous) or vomit. You will probably be given anti-nausea medicines with each chemotherapy session to help prevent or reduce nausea and vomiting. Whether or not you feel sick is not a sign of how well the treatment is working.

Changed bowel habits

Some chemotherapy drugs, pain medicines and anti-nausea drugs can cause constipation or diarrhoea. Ensure you tell your doctor or nurse if your bowel habits have changed.

Joint and muscle pain

This may occur after your treatment session. It may feel like you have the flu, but the symptoms should disappear within a few days. Ask your doctor if taking a mild pain medicine such as paracetamol may help.

Risk of infections

Chemotherapy reduces your white blood cell level, making it harder for your body to fight infections. Colds, flu and viruses may be easier to catch and harder to shake off, and scratches orcuts may get infected more easily. You may also be more likely to catch a serious infection and need to be admitted to hospital. 

Contact your doctor or go to the nearest hospital immediately if you have one or more symptoms of an infection, such as:

• temperature of 38°C or above
• chills or shivering
• burning or stinging feeling when urinating
• a severe cough or sore throat
• severe abdominal pain, constipation or diarrhoea
• any sudden decline in your health.

Hair loss

Depending on the chemotherapy drug you receive, you will probably lose your head and body hair. Some treatment centres offer cold caps for your head, which may reduce the amount of hair loss.

The hair will grow back after treatment ends, but the colour and texture may be different for a while. If you choose to wear a wig until your hair grows back, call Cancer Connect on 13 11 20 to find out about wig services in your area. If you have private health insurance, check whether they’ll cover the cost of a wig because of hair loss related to chemotherapy.

Numbness or tingling in your hands and feet

This is known as peripheral neuropathy, and it can be a side effect of certain chemotherapy drugs. Let your doctor know if this happens, as your dose of chemotherapy may need to be adjusted.

I kept a notebook to record my chemotherapy symptoms and any questions I had to ask my oncologist at each appointment.

Ann