Chemotherapy for ovarian cancer

After surgery – Most women will have chemotherapy after surgery (adjuvant chemotherapy) as there may be some cancer cells still in the body. Chemotherapy usually starts 2–4 weeks after surgery. The drugs you receive will depend on the stage of the cancer and your general health. For ovarian cancer, a combination of several drugs is usually given in repeating cycles spread over 4–5 months. Your treatment team will provide details about your specific schedule.

Before surgery – Some women with stage III or stage IV ovarian cancer have chemotherapy before surgery (neoadjuvant chemotherapy). The aim is to shrink the tumours to make them easier to remove. This usually involves three cycles of chemotherapy, followed by surgery, and then another three cycles.

Primary 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.

Chemotherapy is usually given as a combination of two drugs, or sometimes as a single drug. It’s delivered as a liquid drip into a vein (intravenous drip). To reduce the need for repeated needles, some women have a small medical appliance or tube placed beneath their skin through which they receive chemotherapy. This may be a port-a-cath, a peripherally inserted central catheter (PICC), or another type of catheter.

You will usually have chemotherapy as an outpatient (also called a day patient), but some women need to stay in hospital overnight. Let your oncologist know if you are taking nutritional or herbal supplements as these can interact with chemotherapy and may lessen the effect.

For more information, see Chemotherapy or call Cancer Council 13 11 20.

This is a way of giving chemotherapy directly into the abdominal cavity – the space between the abdominal organs and the abdominal wall.

The drugs are given through a tube (catheter) that is put in place during surgery and removed once the course of chemotherapy ends.

Intraperitoneal chemotherapy is used only in specialised units in Australia. It may be offered to women with stage III disease 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. Ask your doctor for more information about this type of treatment and the advantages and side effects.

Before each chemotherapy session, you will have blood tests to ensure your body’s healthy cells have had time to recover. If your blood count has not recovered, your doctor may delay treatment. Some women also have blood tests during treatment to check their tumour markers, such as CA125. If the CA125 level was high before chemotherapy, it can be monitored to see if the treatment is working.

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

Fatigue – Your red blood cell level (haemoglobin) may drop, which can cause you to feel tired and short of breath. Travelling to and from treatment can also be exhausting.

Nausea –  Some chemotherapy drugs may make you feel sick or vomit. You will generally 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 – Many women become constipated while on chemotherapy. This may be caused by anti-nausea drugs or because what you can eat changes. Your doctor will talk to you about taking laxatives. Diarrhoea (loose, watery bowel movements) is another possible side effect.

Hair loss – It is likely that you will lose your head and body hair, depending on the chemotherapy drug you receive. The hair will grow back after treatment is completed, but the colour and texture may change. For more details, see Hair loss or call Cancer Council 13 11 20 to ask about wig services in your area. If you have private health insurance, check with your provider whether you are entitled to a rebate on a wig purchased because of hair loss associated with chemotherapy.

Risk of infections – Chemotherapy reduces your white blood cell level, making it harder for your body to fight infection. Colds and flu may be easier to catch and harder to shake off, and scratches or cuts may get infected more easily. You may also be more likely to catch a more serious infection and need to be admitted to hospital. Contact your doctor or go the nearest hospital if you have a temperature of 38°C or over or other signs of infection.

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. Taking paracetamol may help.

Numbness or tingling in your hands and feet – This is called 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.

Watch this short video to learn more about chemotherapy.