Ovarian Cancer: Chemotherapy

What is chemotherapy?

Chemotherapy (chemo) uses anticancer medicines to kill cancer cells. The medicines are made to attack and kill cancer cells that grow quickly. Some normal cells also grow quickly. Because of this, chemo can also harm those cells. This can cause side effects.

When might chemo be used for ovarian cancer?

Chemo is one of the main ways to treat ovarian cancer. It uses anticancer medicines. These are normally given intravenously (IV or into a vein). The medicines kill or slow the growth of the cancer. You’ll almost always have both chemo and surgery to treat ovarian cancer, even with early stage disease.

The healthcare provider who treats you with chemo is called a gynecologic oncologist or a medical oncologist. Gynecologic oncologists are specialists with advanced training in the diagnosis, treatment, and surveillance of female cancers. These include ovarian cancer.

Chemo for ovarian cancer tends to involves more than one medicine. You may want to know details about the medicines you're taking. You may also want to know about their common side effects. Ask your healthcare provider to go over this information with you.

What happens during chemo?

About 1–4 weeks after surgery to remove ovarian tumors. You’ll likely start chemo. You’ll most likely have it for about 6 months.

How often you get treatment will depend on the type of chemo you receive. The chemo regimen will vary depending on the stage of your cancer. It also depends on the amount of residual cancer left after cytoreductive (tumor debulking) surgery. You may have chemo every day, every week, every few weeks, or even once a month.

How is chemo given for ovarian cancer?

You may receive the medicine through an IV. This is known as systemic therapy. The medicines enter your bloodstream and reach all areas of your body. This makes the treatment effective if your cancer has spread beyond the ovaries.

Another way you may receive the medicine is by injection right into your abdomen. This is called intraperitoneal chemo. Clinical trials show that using both delivery methods (intravenous and intraperitoneal) extends the survival of women with advanced ovarian cancer.

In some cases, you make receive chemo medicines by mouth.

Most chemo is given in a healthcare provider’s office or in the outpatient part of the hospital. The treatments can last several hours each.

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

There are several medicines your healthcare provider may choose from. You may need to take more than one medicine at the same time. This is called combination chemo. Sometimes this works better. These are the chemo medicines typically used to treat ovarian cancer:

• Platinum agents, such as carboplatin and cisplatin. These are the medicines (with a taxane) that healthcare providers most often use to treat ovarian cancer. They work by creating breaks in the genetic material inside each cancer cell called DNA. This leads to cell death.

• Taxanes, such as paclitaxel and docetaxel. These keep cells from dividing. This class of medicines is used with cisplatin or carboplatin.

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

• Gemcitabine

• Topotecan

• Bevacizumab. This blocks tumors from growing new blood vessels. It can be used as a combination or single treatment.

What are common side effects of chemo?

The side effects of chemo depend on which medicines you receive. They also depend on your dose. You may or may not have a particular side effect. This depends on your overall health and other medicines you may be taking. There may be ways to prevent or control these side effects:

• Low blood cell counts. When medicines affect your blood cells, you may be more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your healthcare provider or nurse will check your blood counts regularly. They may suggest medicines that can help your body make new blood cells and recover sooner. They may also reduce your dose or postpone a treatment if your blood counts become too low. If counts get too low, you may need a blood transfusion.

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

• Eating problems. Certain medicines can cause poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Tell your healthcare team if you have these problems.

Some people may have hearing loss, joint pain, and tingling or numbness in your hands or feet. These side effects often go away after treatment ends. If they don’t, tell your healthcare provider. Almost all side effects can and should be treated.

Working with your healthcare provider

It's important to know which medicines you're taking. Write your medicines down, and ask your healthcare team how they work and what side effects they might have.

Talk with your healthcare providers about what signs to look for and when to call them. For instance, chemo can make you more likely to get infections. Make sure you know what number to call with questions or problems. Is there a different number for evenings 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.