Ovarian Cancer: Chemotherapy

What is chemotherapy?

Chemotherapy (chemo) uses strong medicines to kill cancer cells. The medicines attack and kill cells that grow quickly, like cancer cells. Some normal cells also grow quickly. These cells can also be damaged by chemo. This can cause side effects.

When might chemo be used for ovarian cancer?

Chemo is one of the main ways to treat ovarian cancer. The medicines are often put right into your blood through a vein (given by IV). Chemo kills or slows the growth of cancer. Most people get both chemo and surgery to treat ovarian cancer, even early stage disease (cancer that's small and hasn't spread).

The healthcare providers who treat you with chemo are called a gynecologic oncologist or a medical oncologist. Gynecologic oncologists are specialists with advanced training in the diagnosis and treatment of female cancers. Medical oncologists are specialists with advanced training in diagnosing and treating cancer with medicines like chemotherapy.

In most cases, more than one chemo medicine is used to treat ovarian cancer. Your healthcare provider can give you details about the medicines you're getting. You may also want to ask about common side effects you should watch for. Ask your healthcare provider to go over this information with you. Also ask about websites and other resources you can use to learn more.

What happens during chemo?

Chemo may be given before or after surgery. You'll likely start chemo a few weeks after surgery, after you've healed and recovered.

How often you get treatment will depend on the type of chemo you receive. Chemo plans vary depending on the stage of the cancer and the medicines chosen to be given to you Your plan will also depend on the amount of residual cancer left after cytoreductive (tumor debulking) surgery. You may get chemo every day, every week, every few weeks, or even once a month.

How is chemo given for ovarian cancer?

You will likely get chemo through an IV. This is called systemic therapy. The medicines go right into your bloodstream and reach all parts of your body. This treatment works well if the cancer has spread beyond your ovaries.

Another way you may get chemo is by putting it right into your belly (abdomen). This is called intraperitoneal (IP) chemo. A small drum-like port is put under your skin during surgery. It's attached to a soft catheter that ends in your abdomen. A needle is put through your skin and into the drum to put in the chemo. Clinical trials show that in certain cases getting chemo both ways helps people with advanced ovarian cancer live longer.

In some cases, you may get chemo medicines that you take by mouth.

Most chemo is given in a healthcare provider’s office or in an outpatient infusion center. This means you go home the same day. Each treatment can last several hours.

What types of chemo medicines are used to treat ovarian cancer?

There are many different chemo medicines your healthcare provider may choose from. You may get more than one medicine at the same time. This is called combination chemo. Many times it works better than getting just one medicine.

These are the chemo medicines commonly used to treat ovarian cancer:

• Platinum agents, such as carboplatin and cisplatin. These are the chemo medicines (along with a taxane) that are most often used to treat ovarian cancer. T

• Taxanes, such as paclitaxel and docetaxel. This class of medicines is used with cisplatin or carboplatin.

• Anthracyclines, such as doxorubicin and liposomal doxorubicin. These are often used if cancer comes back.

• Gemcitabine. This is most often used if ovarian cancer returns after the first chemo treatment.

• Topotecan. This medicine is most often used if other treatments fail.

What are common side effects of chemo?

Side effects depend on which chemo medicines you get. They also depend on the dose. Your overall health and other medicines you may be taking can also impact treatment side effects. There are often ways to prevent or control chemo side effects.

Common side effects include:

• Low blood cell counts. Chemo can affect your blood cells. This can make you more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your blood counts will be checked regularly. There are medicines that can be used to help your body make new blood cells and recover sooner. Your dose might be lowered or treatment might be held if your blood counts become too low. If counts get very low, you may need a blood transfusion.

• Hair loss. Some medicines can cause you to lose the hair on your head as well as the rest of your body, including eyelashes and pubic hair. Your hair will grow back, but it may be a different color , texture, or both.

• Eating problems. Certain medicines can make you not feel like eating. Some cause nausea and vomiting, diarrhea, or mouth and lip sores. Tell your healthcare team if you have these problems.

• Nerve damage. Certain medicines can damage nerves. This is called peripheral neuropathy. This can cause pain, numbness, and tingling in your hands and feet that may get worse over time if it's not treated. You may lose your hearing if nerves in your ears are damaged.

Some chemo medicines can have long-term or permanent side effects. Cisplatin may cause kidney damage. Your healthcare team will keep track of your kidney function closely and may give you extra fluids. Peripheral neuropathy from medicines like cisplatin and taxane medicines can be long-lasting. Cisplatin can also cause hearing loss.

If you notice side effects, tell your healthcare provider right away. Many side effects go away after treatment ends. Some may last longer or be permanent. Most can be treated, and there may be things you can do to keep them from getting worse or even help prevent them.

Working with your healthcare provider

It's important to know which medicines you're taking. Write down the names of all your medicines. Ask your healthcare team how they work and what side effects they might cause.

Talk with your healthcare providers about what changes you should look for and when to call them. For instance, chemo can make you more likely to get infections. You may need to call if you have a fever, rash, or other sign of infection. Make sure you know what number to call with questions or problems. Is there a different number for evenings, holidays, and weekends?

It may be helpful to keep a diary of your side effects. Write down physical, thinking, and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.