CHEMOTHERAPY

What is chemotherapy for ovarian cancer and when is it given?

Chemotherapy works by using cytotoxic drugs to attack and kill cancer cells. It is one of the most commonly used treatments for ovarian cancer, along with surgery. 

Most women with ovarian cancer are offered chemotherapy at some point during their treatment. When it’s used will depend on the individual patient and the stage of their cancer. In fact you may not require this treatment at all if your cancer has been discovered at a very early stage. 

Your consultant and specialist nurse will explain if and how chemotherapy fits into your treatment pathway. Here are some examples about when and why chemotherapy might be appropriate. 

After surgery for ovarian cancer

If you are diagnosed with a borderline or early stage one ovarian cancer you may have chemotherapy after your surgery to ensure all the cancer has been removed and to help prevent the cancer from returning in the future.

If your ovarian cancer is found to have spread to a more advanced stage you may have de-bulking surgery (surgery to remove as much of the disease as possible). Chemotherapy can be used to eradicate any remaining signs of cancer after surgery. 

Chemotherapy which is administered after surgery is known as adjuvant chemotherapy.

Before surgery for ovarian cancer

If your ovarian cancer has been diagnosed at a later stage then it might not be possible to perform surgery initially. Chemotherapy will be given first to shrink as much of the ovarian cancer as possible and make any subsequent surgery safer and more effective.

Chemotherapy which is administered before surgery is known as neo-adjuvant chemotherapy.

Chemotherapy as the main treatment for ovarian cancer

Surgery may not be an option when treating very advanced ovarian cancer. In this case, chemotherapy can be used to reduce your symptoms and make you feel better for a longer period of time.

Types of chemotherapy for ovarian cancer

There are different chemotherapy drugs available. The type of chemotherapy you receive depends on the type of ovarian cancer you have.

• Epithelial ovarian cancer is commonly treated with a drug called carboplatin. This might be given on its own, or in combination with another drug called paclitaxel.
• Germ cell ovarian cancer is most commonly treated with a combination of drugs called bleomycin, etoposide and cisplatin (referred to as BEP). 
• Sex cord-stromal ovarian tumours are not usually treated with chemotherapy, but if it is required a combination of the drugs used for treating epithelial and germ cell ovarian cancer will be considered.

How is chemotherapy given?

The majority of ovarian cancer chemotherapy drugs are administered into the bloodstream by one of the following routes: 

• By cannula - a thin tube that can be inserted into either the arm or hand and directly into a vein
• By a central line – a very fine tube that is inserted under the skin of the chest and into a vein that feeds directly to the heart 
• By a PICC line – a thin, long tube that is inserted into the arm and up through to a large vein in the chest

Chemotherapy is usually given in cycles of treatment followed by a rest period that allows the normal cells in your body to recover from the effect of the drugs. Typically, you will have six initial rounds of chemotherapy, occurring in three- to four-weekly cycles.

Starting chemotherapy for ovarian cancer

Chemotherapy usually requires a day trip to your hospital’s specialist unit, although on some occasions you may be admitted to hospital as an inpatient. 

Before you begin treatment, you will be checked to see that you are fit enough to undergo treatment. A nurse will take your blood and ask some questions about your general wellbeing.

Your blood will be sent for tests and there will be a wait for your chemotherapy drugs to be ordered, then prepared. 

Once you have been given the all clear to have treatment, you will go to the chemotherapy unit. The nurse will administer some anti-sickness drugs through your line first, along with any other medications you have been advised to take.

The chemotherapy itself is given through your line in the form of a drip. The nurse will set the timing of your drip through a pump which will administer the drugs across a number of hours. 

Your nurse will check on you at regular intervals to monitor your temperature, heart rate and blood pressure. This is to ensure you are not having any reactions to the drugs.

Once all of the chemotherapy has been administered you will be given some anti-sickness drugs, along with a supply of any other medication to take in between cycles. You will then be discharged from the unit, returning for your next treatment three to four weeks later. 

What are the side effects of ovarian cancer chemotherapy drugs?

Everyone reacts differently to chemotherapy, particularly as some drugs carry specific side effects.

Typical side effects of ovarian cancer chemotherapy drugs include:

• Bruising and bleeding
• Anaemia
• Nausea
• Extreme tiredness
• Hair loss
• Diarrhoea
• Constipation
• Sore mouth
• Numb or tingling hands and feet (symptoms of neuropathy)
• Muscle and joint pain
• Low blood pressure
• Dry or itchy skin
• Brittle nails
• Headaches
• Impaired kidney function
• Increased risk of infection due to impaired immune system. Neutropenia happens when you have a low white blood cell count

It’s important to note that you are not definitely going to get all, or indeed any of these side effects. They are things that we know that women who have been through chemotherapy for ovarian cancer have suffered with, however.

There are ways to combat some of these things if you do suffer from them.  

What happens after chemotherapy?

When you’ve finished chemotherapy, you will have check-ups every three months, and then every six months if you’re still cancer free. If you are cancer free after ten years (or five years for early stage ovarian cancer), you’ll be considered to be in remission from ovarian cancer and you’ll no longer need regular check-ups.