Treatment

Navigating and understanding treatment options are critical for an ovarian cancer patient’s survival. All treatment decisions should be made by a patient in consultation with her medical professional.

Surgery

During surgery, doctors attempt to remove all visible tumors (tumor debulking). The five-year survival rate and disease-free intervals of patients whose surgeon was a gynecologic oncologist far surpass those of patients whose surgeons were not oncologists.

Chemotherapy

Patients undergo chemotherapy in an effort to kill any cancer cells that remain in the body after surgery.

Intraperitoneal Chemotherapy

This therapy places the medicine directly into the peritoneal area through a surgically implanted port and catheter. While intraperitoneal (IP) therapy has been in use since the 1950s, new advances have combined it with intravenous (IV) therapy, using chemotherapy agents that work best for treating ovarian cancer. The National Cancer Institute recommends that, for select ovarian cancer patients, chemotherapy be given by both IV and IP. This combination has been found to increase survival for women with advanced stage ovarian cancer.

Neoadjuvant Chemotherapy

Some patients may receive chemotherapy before having surgery to remove their tumors. This is known as neoadjuvant chemotherapy.

Other Drugs

Other drugs, including angiogenesis inhibitors and targeted therapies, may be recommended either in conjunction with chemotherapy or as single agents. These drugs may have very different side-effects than chemotherapies and may be useful only for specific populations.

Radiation Therapy or Radiotherapeutic Procedures

These procedures may be used to kill cancer cells that remain in the pelvic area.

Clinical Trials

Researchers carry out ovarian cancer clinical trials to find ways of improving medical care and treatment for women with this disease. A woman is eligible to participate in a clinical trial at any point in her experience with ovarian cancer: before, during or after treatment. Many women think of clinical trials as an option only after other treatments have failed. Clinical trials exist for women in this situation, but many equally important trials are available for women earlier in their fight against ovarian cancer.

Side Effects

The goal of chemotherapy is to eliminate rapidly growing cancerous cells; however, some drugs are unable to differentiate between cancerous cells and other frequently dividing cells. As a result, the drugs can kill cells found in the bone marrow, digestive tract, hair follicles, and reproductive organs. Every woman experiences different side effects depending on the type and dosage of her chemotherapy treatments. Women undergoing treatment should talk to their medical professionals about the best way to address their side effects.

Hair Loss

Some chemotherapy drugs damage hair follicles, causing loss of body hair. Hair loss typically begins two to three weeks after the first treatment and may affect not only the hair on a woman’s head but also her eyebrows, eyelashes, facial hair, pubic hair, underarm hair and leg hair. While hair loss can be extensive, it is almost always temporary. Women’s hair usually grows back once treatment ends. Some women cope with hair loss by cutting their hair or shopping for a wig before losing any hair.

Nausea and Vomiting

Since nausea is such a common side effect of chemotherapy, doctors will often prescribe antiemetics to minimize suffering. Antiemetics work by blocking signals between the brain and stomach to stop vomiting. These side effects must be managed during chemotherapy treatments because uncontrolled vomiting and nausea can interfere with the patient’s ability to receive treatments. Complementary therapies, such as ginger, exist and are proven to reduce nausea.

Fatigue

Cancer patients experience fatigue for many reasons—not all of which are known. Both cancer and cancer treatments can cause fatigue. Fatigue is a common side effect following radiation and chemotherapy. Medication used to treat pain, depression, vomiting, seizures, and other side effects may cause fatigue. Fatigue usually lessens after treatment ceases, but sometimes people never regain their full energy.

Diarrhea and Constipation

Diarrhea is a common side effect of chemotherapy that usually occurs in the days immediately following a chemotherapy treatment. Patients with diarrhea need to remember that they can become dehydrated quickly and should be sure to hydrate themselves. Some patients may experience constipation due to chemotherapy, the after effects of surgery, or anti-nausea drugs. Doctors often tell patients who experience constipation to take a mild laxative or stool softener. Patients experiencing constipation should drink plenty of liquids.

Nerve Problems

Certain chemotherapy drugs can cause peripheral neuropathy, an increase in numbness caused by damage to the nerves that transmit signals between extremities and the central nervous system. This damage to the nerves often causes a tingling sensation or loss of control in the hands or feet. Acupuncture or massage and physical therapy may lessen these side effects, which are usually temporary and improve or resolve when chemotherapy treatment stops.

Mouth Issues

Chemotherapy can kill the cells lining the mouth, throat, and gastrointestinal tract, causing mouth sores. Mouth issues are particularly bad for patients who receive high doses of chemotherapy, have poor oral and dental health prior to treatment, or have kidney or concomitant disease. Smoking, using tobacco, and consuming harsh foods or alcohol increase the severity of these side effects. Some chemotherapy drugs create taste changes in patients. Food may taste salty or bitter but usually tastes normal again once treatment is over. Non-alcoholic mouthwash and other products can decrease dryness of the mouth.

Sexuality and Intimacy Issues

Interest in sexual intimacy often decreases for chemotherapy patients for many reasons, including additional stress and the side effects of treatment. Patients need to maintain a positive self image during this time and sustain open communication with their partners. When a patient is ready to engage in sexual activity, she should consider taking the following actions:

  • Make time for rest before and after sexual activity to preserve energy.
  • Use water-soluble lubricants as her vagina may be drier than usual due to hormonal changes.
  • Experiment to find comfortable positions and avoid those that will tire her quickly.

“Chemobrain”

Many women experience forgetfulness and have trouble with concentration after receiving chemotherapy. This absentmindedness is often temporary; however, about 15 percent of chemo patients experience permanent problems. Since the cause is unknown, no treatment exists for this side effect. Women who have experienced this side effect offer several suggestions for dealing with it:

  • Minimize distractions while performing important tasks.
  • Keep a daily organizer/journal to keep track of appointments.
  • Use the calendar on your computer and voicemail messages to remind yourself of meetings.

After Treatment

Follow-up Plan

After the initial treatment is over, a woman should have follow-up treatments with her doctor. During follow-ups, doctors do thorough physical exams and may also monitor a patient’s blood for an elevated CA-125 level. Some patients have a sensitive CA-125 that will rise before their CT scan shows evidence of recurrent disease; a recent study suggests that it may be more useful to wait until a woman experiences symptoms of ovarian cancer before starting treatment. Others will have evidence of the disease before their CA-125 rises. Doctors often use a combination of tests to monitor a patient because recurrent ovarian cancer has a wide spectrum of behavior making it difficult to monitor. In addition to physical exams and a CA-125 test, doctors may request CT and/or PET scans to look for tumor growth.

A patient should discuss a follow-up plan and survivorship plan with her physician, clearly outlining a plan of action post treatment. A survivorship plan that addresses long-term issues is critical for a woman to have and discuss with her regular internist and other health care professionals outside of her cancer treatment.

CA-125 plus HE4 have been approved by the Food and Drug Administration (FDA) for monitoring.

Recurrence

When cancer returns after a period of remission, it is considered a recurrence. A cancer recurrence happens because some cancer cells were left behind and eventually grow and become apparent. The cancer may come back to the same place as the original tumor or to another place in the body. Around 70 percent of patients diagnosed with ovarian cancer will have a recurrence.

One of the factors in determining a patient’s risk of recurrence is the stage of the cancer at diagnosis:

  • Patients diagnosed in stage I have a 10 percent chance of recurrence.
  • Patients diagnosed in stage II have a 30 percent chance of recurrence.
  • Patients diagnosed in stage III have a 70 to 90 percent chance of recurrence.
  • Patients diagnosed in stage IV have a 90 to 95 percent chance of recurrence.

Recurrent ovarian cancer is treatable but rarely curable. Women with recurrent ovarian cancer may have to undergo another surgery. Because many women with recurrent ovarian cancer receive chemotherapy for a prolonged period of time, sometimes continuously, the toxicities of therapy are a major factor in treatment decisions.

The effectiveness and type of treatment for recurrent ovarian cancer depends on what kind of chemotherapy the patient received in the past, the side effects associated with previous treatments, the length of time since finishing the previous treatment, and the extent of the recurrent cancer. Chemotherapy is used to stop the progression of cancer and prolong the patient’s survival. Sometimes, surgery is used to relieve symptoms, such as a blocked bowel caused by the recurrence.

A woman, in consultation with her doctor, should set realistic goals for what to expect from treatment. This may mean weighing the possible positive outcomes of a new treatment against the possible negative ones. At some point, a woman may decide that continuing treatment is unlikely to improve her health or survival. A woman must be certain that she is comfortable with her decision whatever it is.