What to expect during ovarian cancer treatment
There are more options for fighting ovarian cancer than ever before. Here’s what you need to know.
Your diagnosis has been confirmed. Your care team is in place. Now it’s time to work closely with your gynecologic oncologist to map out your ovarian cancer treatment plan. Learning more about your options, including any potential side effects they can bring, is the first step. The more you understand, the more prepared you’ll feel.
Here are some of the most common types of ovarian cancer treatment and what to expect each step of the way. Remember that not every woman has all of these treatments.
After receiving an ovarian cancer diagnosis, many patients have surgery. Sometimes a minimally invasive surgery called a laparoscopy happens as a first step. It lets doctors know how much of a tumor can be removed. A more invasive procedure, known as a laparotomy, will remove as much of the tumor(s) as possible. You might also hear this process called “debulking.”
In some early-stage cancers, it may be possible to remove only the affected ovary and fallopian tube, possibly preserving your fertility. The more advanced your cancer though, the more extensive the surgery will be. In these cases, doctors will likely remove your ovaries, fallopian tubes, and uterus, along with the surrounding lymph nodes and any affected abdominal tissue. We know that sounds like a lot — and it is. But this kind of surgery helps increase your chances of removing as much of the cancer as possible.
You should expect to be in the hospital for about three days to a week, and your recovery time at home will likely continue for about six weeks. Don’t push yourself during your recovery — this type of major abdominal surgery requires time to heal. You’ll be able to resume your normal activities once you’ve fully recovered.
“Most ovarian cancers are at stage III at the time of diagnosis, which requires chemotherapy (chemo) after surgery,” says Russell J. Schilder, M.D., chief of gynecologic medical oncology at the Sidney Kimmel Cancer Center in Philadelphia. Occasionally, doctors will recommend chemo before surgery. Shrinking the tumors first can help improve the chances they can be removed entirely later.
Chemotherapy medications can be injected into a vein, taken by mouth, or occasionally injected directly into the abdomen (known as intraperitoneal chemotherapy).
Usually, patients have six three-week cycles of chemo. “So, it’s about five months of therapy. If there’s a break in between to do surgery, the five months will go a little longer,” he says.
During chemo, doctors will monitor you closely and track your blood counts, electrolytes, and kidney and liver function, says Dr. Schilder. Once treatment is underway, you may experience nausea and vomiting. The silver lining: Today’s drugs are better at avoiding or controlling those symptoms, so you may just feel slightly queasy, says Dr. Schilder. Not perfect, of course, but a little easier to manage.
You may also experience fatigue, appetite loss, numbness and tingling or rashes on your hands and feet, and mouth sores.
Dealing with these symptoms may take a little trial and error: If mint or ginger tea settles your stomach, keep some on hand. Gargling with salt water may help with mouth sores. You can also ask your doctor to prescribe a bottle of “magic mouthwash,” which is basically a mixture of viscous lidocaine, Maalox, and Benadryl. And if possible, clear time in your schedule during treatment for plenty of rest.
For numbness and tingling in your hands and feet, there’s no one-size-fits-all way to ease that side effect. Warm clothes (such as socks and gloves) may help. If you get rashes, mild soaps, moisturizers, and lotions can lessen symptoms. Ask your doctor for recommendations.
One nearly universal side effect of chemotherapy for ovarian cancer is hair loss. For many women, this can be the most difficult one to deal with. The social workers at your hospital and the resources at the American Cancer Society are two good places to start if you need some advice on getting through this part. Dr. Schilder recommends having a plan in place by the beginning of your second treatment cycle.
“There’s a lot of information out there, and everybody makes their own choices. I would say most women do more than one thing, whether it’s a turban, wig, or cap, depending on the day,” says Dr. Schilder.
If you’re in a support group, reaching out to women who are further along in treatment or recovery can also be incredibly helpful.
If chemotherapy takes a carpet-bombing approach to fighting ovarian cancer, targeted therapies are like guided missiles. They home in on cancer cells without damaging healthy surrounding tissue. They tend to be less toxic, have fewer side effects, and can be particularly helpful in treating recurrent cancer. You and your care team will decide whether targeted therapy is right for you. Often, targeted therapy is given in addition to chemotherapy. Two common targeted therapies include:
• Bevacizumab (Avastin). This drug is a monoclonal antibody that helps prevent the growth of the blood vessels tumors need to grow. “It’s a nice partner to chemotherapy,” says Dr. Schilder, because it does not have the same side effects. “Most of the time the drug is very well tolerated,” he says. It can raise your blood pressure, though, so your doctor will need to monitor that.
• PARP inhibitors (Lynparza, Zejula). Short for poly (ADP)-ribose polymerase, PARP inhibitors target a mechanism that prompts cancer cells to die. According to Dr. Schilder, the main side effects of PARP inhibitors are fatigue, anemia, and mild gastrointestinal symptoms.
“The deeper patients go into their disease [treatment] course, the more likely they are to get both bevacizumab and the PARP inhibitor, which are two of the hotter and newer drugs used in cancer today and ovarian cancer specifically,” says Dr. Schilder.
Other treatments for ovarian cancer
Recent research has led to advancements and more options when it comes to ovarian cancer treatment. You may be wondering about immunotherapy. Unfortunately, it has not yet had the same success in treating ovarian cancer as it has with other types of cancer, says Dr. Schilder. For now, in addition to the treatments above, you may want to ask your doctor about the following options:
Clinical trials: Some patients may enroll in programs that test the efficacy of promising new treatments or procedures. You can find trials near you by searching clinicaltrials.gov or ask your care team about them.
Radiation: Ovarian cancer is a radiation-sensitive cancer, but because the whole abdominal cavity is at risk, the toxicity is substantial, says Dr. Schilder. However, if there’s a particular lesion that’s causing pain or bleeding, doctors can use radiation judiciously to target a certain area.
There is also a range of alternative or complementary therapies that you may want to explore. Unite for Her offers massage, reiki, acupuncture, and nutrition counseling that can help ease side effects or just make you more comfortable while you’re undergoing treatment.
Whatever course of treatment ahead of you on your cancer journey, understanding your options and knowing what to expect can help you through it.