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Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. The drugs work by disrupting the growth of cancer cells. Ovarian cancer is usually very sensitive to chemotherapy and in most women the tumours will become smaller or disappear.
Chemotherapy drugs are sometimes given as tablets (orally) or, more usually, by injection into a vein (intravenously).
Women with borderline tumours, or those with low-grade or stage 1a ovarian cancer may not need chemotherapy after their surgery.
Chemotherapy is often recommended after surgery for women with moderate or high-grade ovarian cancer or those with stage 1b or 1c cancer. Giving chemotherapy after surgery is known as adjuvant chemotherapy. Generally six sessions of chemotherapy are given, over 5–6 months.
Chemotherapy is sometimes given before surgery (neo-adjuvant chemotherapy), or if you are too unwell for a major operation. It is also often used after surgery to try to shrink any remaining tumours.
If the cancer has spread to the liver, or beyond the abdomen, it may not be possible to remove it and so chemotherapy is the main treatment used. Chemotherapy is also used if the cancer comes back after surgery.
After surgery, the most commonly used drug to treat ovarian cancer is carboplatin, which may be given with paclitaxel (Taxol®).
Other drugs that are less commonly used, or may be used if the cancer comes back, are topotecan (Hycamtin®), doxorubicin, liposomal doxorubicin (Caelyx®, Myocet®) and cisplatin.
Intravenous chemotherapy is given as a session of treatment, usually over several hours. This is followed by a rest period of a few weeks, which allows your body to recover from any side effects of the treatment. Together, the treatment and the rest period is known as a cycle of chemotherapy. Most women have six cycles of chemotherapy. Women who are given neo-adjuvant chemotherapy generally have three cycles of chemotherapy before the operation, followed by three further cycles.
Chemotherapy is usually given to you as an outpatient, but sometimes it will be given as an inpatient, which will mean spending a few days in hospital.
Chemotherapy can also be given directly into the abdomen through a small tube. This is known as intraperitoneal chemotherapy. Research has shown that intraperitoneal chemotherapy, given alongside intravenous chemotherapy, can help to improve survival for a small number of women. However, it can also cause unpleasant side effects, such as pain, infection and digestive problems. As a result this way of giving chemotherapy isn’t commonly used in the UK.
Your doctor can discuss whether intraperitoneal chemotherapy is an appropriate treatment for you.
Our section on chemotherapy discusses the treatment and its side effects in more detail. Information about individual drugs and their particular side effects are also available.
Chemotherapy can cause unpleasant side effects, but any that occur can often be well controlled with medicines.
Chemotherapy can reduce the production of white blood cells by the bone marrow, making you more prone to infection. Contact your doctor or the hospital straightaway if:
You will have a blood test before having more chemotherapy, to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if your blood count is still low.
Chemotherapy can reduce the production of platelets, which help the blood to clot. Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.
You may become anaemic. This may make you feel tired and breathless.
Some of the chemotherapy drugs used to treat cancer of the ovary may cause nausea and vomiting. There are very effective anti-sickness drugs (anti-emetics) to prevent or reduce nausea and vomiting. Your doctor will prescribe these for you.
Some chemotherapy drugs can make your mouth sore and cause small mouth ulcers. Regular mouthwashes are important and your nurse will show you how to do these properly. If you don’t feel like eating during treatment, you could try replacing some meals with nutritious drinks or a soft diet.
Unfortunately, some chemotherapy drugs used to treat ovarian cancer can make your hair fall out. You can ask your doctor if the drugs you are having are likely to cause hair loss. Most patients are entitled to a free wig from the NHS. Your doctor or nurse will be able to arrange for you to see a wig specialist. You may prefer to wear a bandana, hat or scarf.
If your hair does fall out, it will grow back over a period of 3–6 months once the chemotherapy has finished.
This is due to the effect of some chemotherapy drugs on nerves and is known as peripheral neuropathy. Tell your doctor if you notice these symptoms. The problem usually improves slowly a few months after treatment is over, but for some people it can be permanent.
Chemotherapy affects people in different ways. Some people find they are able to lead a fairly normal life during their treatment, but many find they become very tired and have to take things much more slowly. Just do as much as you feel like and try not to overdo it.
Although they may be difficult to cope with, most of these side effects will disappear once your treatment is over.
Many women are nervous of having chemotherapy, because of the possible side effects, and ask what would happen if they did not have it.
In women with early-stage ovarian cancer, if chemotherapy is given after surgery, it is given to reduce the chance of the cancer coming back. It does this by killing any tiny groups of cancer cells that may be left behind after an operation.
Chemotherapy can’t guarantee that the cancer will not come back, but it can reduce the chance that it will. The risk of the cancer coming back varies according to each woman’s situation. Your doctor can usually give you an idea of whether your cancer is likely to come back or not. They can also give you information about the likely side effects of chemotherapy for you.
If the chance of your cancer coming back is small, chemotherapy may only slightly reduce the risk of the cancer coming back. The additional benefit of the chemotherapy would be small and the chance of doing well without it would still be good. However, if the risk of the cancer coming back is higher, chemotherapy may greatly reduce the chance of recurrence, and increase the chance of cure.
It is important to talk to your specialist about:
This information can help you decide whether the benefit of the chemotherapy is worth the side effects of the treatment.
When the cancer has spread to other parts of the body, such as the abdomen or pelvis, the aim of chemotherapy is to try and shrink the cancer. This can reduce symptoms, maintain a good quality of life and help you live longer. For many women the chemotherapy will shrink the cancer. However, for some women the chemotherapy will have little or no effect on the cancer and they will have the side effects of the treatment with little benefit. The fitter you are the more likely you are to benefit and the less likely to have side effects.
Making decisions about treatment in these circumstances is always difficult, and you may need to discuss in detail with your doctor whether you want to have chemotherapy. If you choose not to have chemotherapy, you can still be given medicines to control any symptoms that you have. This is known as supportive care (or palliative care).
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