The initial treatment for ovarian cancer usually consists of a combination of chemotherapy (a type of drug given to kill cancer cells) and surgery (a procedure to remove as much of the affected areas as possible).
Your medical team will have a detailed discussion with you about your treatment options and the risks involved, including options to preserve fertility where possible. You should raise any specific concerns you may have with them.
For many women with ovarian cancer, surgery normally includes removing:
- the uterus (womb) and cervix
- both ovaries and fallopian tubes (salpingo-oophorectomy)
- the omentum – a layer of fatty tissue that extends downwards from the stomach in front of the abdominal organs to protect them.
It may also involve the removal of any enlarged lymph nodes or cancer lumps from the peritoneum (the lining that covers the organs inside your abdomen) or other abdominal organs that appear to be affected. Removal of these organs does have side effects. For example, if your surgery has involved removing sections of the lymphatic system (like lymph nodes) you may be at risk of lymphoedema. If possible, your surgeon will discuss these with you beforehand.
In some cases of ovarian cancer, particularly with germ cell tumours, it may be possible just to remove the affected ovary and fallopian tube, leaving behind the other organs, or to make a diagnosis first by removing the affected ovary and only then removing the other organs if this is necessary.
Chemotherapy for ovarian cancer is given to kill any cancer cells that may remain after surgery, or to shrink the tumour to make it easier to operate. The drugs are given through a drip into a vein and the treatment will be given over several hours.
Usually you will be offered a combination of carboplatin (a platinum-based chemotherapy) and paclitaxel (a taxane, a type of drug which blocks cancer growth). Sometimes carboplatin will be recommended on its own.
How will chemotherapy affect me?
Chemotherapy affects people in different ways and some people will experience more side effects than others. There are many different medications for any side effects you may experience so do ask your chemotherapy team if you need help.
Possible side effects
- Your wellbeing: You may find that you tire more easily and you may need to make adjustments to your daily routine to cope with this. It's important to maintain a healthy lifestyle. Eat well and take regular exercise, as this will help you feel better and cope with the side effects of treatment.
- Feeling or being sick: You will be given anti-sickness medication to take home. If you do vomit you need to contact your chemotherapy team and they will change your prescription.
- Fertility and early menopause: Depending on your treatment, there is some risk of impaired fertility and early menopause even if your surgery is 'fertility-sparing'.
- Losing your hair: Chemotherapy can cause you to lose your hair. Hair loss can sometimes be reduced by the use of a cold cap. Ask your medical team if this is appropriate for you or speak to them about a referral for a wig if this is something that worries you.
- Memory loss or 'chemo brain': This is quite common after cancer treatment and includes changes in memory, concentration and thinking. It can be very frustrating, but for most people it will improve with time.
- Tiredness and fatigue: Most women feel very tired during chemotherapy so it's important to plan time to recover your energy.
- Changes to your body: Many women experience weight loss as appetite can be affected by treatment. Weight gain can also occur as a side effect of anti-sickness drugs (steroids) given with chemotherapy, as these can stimulate appetite and cause fluid retention. Your clinical nurse specialist (CNS) and local cancer centres can give advice to help you maintain good nutrition during chemotherapy.
Hormone replacement therapy (HRT)
Women who go through menopause before the age of 45 years are often offered HRT. HRT can relieve symptoms and benefit long-term health by replacing some hormones. It may not be suitable for all women so should be discussed with your medical team. HRT is thought to:
- prevent loss of bone strength
- maintain a healthy heart
- prevent cognitive decline in later life (eg memory).
After surgical menopause HRT is mostly given as one hormone (oestrogen therapy). However, women who still have a womb will need two hormones: oestrogen and progestogen. Both can be given via tablets, patches and gels.
What are the side effects?
You may not experience any, but side effects of HRT may occur in some women and can include breast tenderness, headaches and leg cramps. They usually improve with time. Occasionally a change in dose or type of oestrogen will be necessary and your doctor will work with you to find the most appropriate dose and type. You may need to try a couple before finding one that suits you.
What are the risks?
There has been a lot of research into HRT and its safety in general but not so much is known about the risks and the benefits after surgery for ovarian cancer. It's important to discuss the matter with your doctor and, if possible, get a referral to someone who specialises in dealing with women who are experiencing the menopause because of cancer treatment.
Depending on your situation, you may decide to use HRT on a short-term basis for symptoms relief, on a longer-term basis for its health benefits, or not at all.
Thinking about HRT – questions to discuss with your doctor
- Which of my symptoms will HRT help?
- What are the risks associated with using HRT?
- Should I have a tablet, patch or gel?
- How long will I need it for?
- Is there anything else I might use instead?
- What will happen if I choose not to use it?
Vaginal oestrogen is given to treat vaginal changes after a surgical menopause and can be used alone or alongside conventional HRT. Vaginal oestrogen will not help other menopausal symptoms but is associated with fewer side effects and risks. It can be given via creams, vaginal tablets or vaginal rings, all of which are effective at reducing vaginal dryness and sexual discomfort.
Alternatives to HRT
If you choose not to use HRT or have a medical reason not to, other medications can be prescribed. Citalopram, paroxetine and venlafaxine are classed as antidepressant medicines but they have been found to help menopausal flushes and sweats when used at low doses. Clonidine is a blood pressure medicine that may help flushes. If later in life you experience bone density loss, you may be prescribed drugs to treat osteoporosis.
Cognitive behavioural therapy (CBT) has been proven to be a safe and effective treatment for women who experience menopausal symptoms such as hot flushes and night sweats with additional benefits to mood, sleep and quality of life. The CBT Register UK allows you to search for a therapist in your area or you can ask your GP for a referral.
There are lots of herbal and dietary supplements aimed at helping with the menopause. The evidence is inconsistent so you may wish to ask a pharmacist for advice as these can interfere with other medicines. These remedies may also contain oestrogen.
The menopause usually happens naturally between the ages of 45–55 when levels of oestrogen gradually decline and periods stop.
If you have surgery to remove your ovaries, these hormonal changes will happen straight away. This is known as surgical menopause. Surgical menopause can be overwhelming. If possible, discuss how best to manage this with your medical team beforehand. You can ask to be referred to a menopause specialist, who may be part of a gynaecology or sexual health team.
What to expect from early menopause
Some women experience symptoms more intensely after a surgical menopause because of the abrupt onset of hormonal changes. Some women will not experience any of these symptoms, some will experience a few, and some will experience all.
- Hot flushes can vary from occasional to very frequent, day and night. They don't usually last long, but can leave you feeling tired, anxious, frustrated, sweaty and hot, and they can be accompanied by palpitations.
- Emotional symptoms can include irritability, poor concentration and poor memory. Sometimes addressing the hot flushes can improve these symptoms because it means you can get more sleep.
- Vaginal discomfort and dryness, which can lead to painful sex.
- Bladder symptoms can include increased urinary frequency and urgency. These symptoms tend to worsen with time, so seek help sooner rather than later.
- Other bodily changes can include brittle nails, thinning of the skin, hair loss and aches and pains.
In many cases, these symptoms will get better on their own, although it's difficult to predict how long you may have them for. If symptoms are causing problems in your life, you should discuss treatment options – including hormone replacement therapy (HRT) – with your CNS or GP.
A surgical menopause changes your hormone levels, which can affect how you feel. This is on top of the emotions that you may already be feeling relating to your diagnosis and treatment. You may feel:
- too young to be going through the menopause
- worried about your options to have a baby
- less feminine
- worried about the future.
If this sounds familiar you may benefit from talking to your family and friends about how your feelings are affecting you and your relationships. It may also help to speak to a counsellor or with other women who have experienced the same.
Our information on body image and sexuality offers more advice on how to deal with these emotions.
Your long-term health
After a surgical menopause you will be advised to take measures to ensure that you stay healthy in the years ahead. This will include protecting your bones from osteoporosis and maintaining a healthy heart.
Early menopause can increase the likelihood of developing osteoporosis or loss in bone density which, for some women, may lead to an increased risk of fractures. You should be offered a DEXA scan (an x-ray which measures bone density) to assess the density or strength of your bones, which will help to predict your future risk of fracture. What can help:
Hormone replacement therapy (HRT) can help prevent loss of bone density.
A healthy balanced diet that includes around 700mg calcium a day – calcium can be found in dairy, and also in food such as sardines, chocolate, almonds and oranges.
Taking moderate exercise, both weight-bearing (any exercise where you support your weight by standing or through your hands and arms) and aerobic (any exercise which makes you breathe faster), 3–5 times a week is important for bone and heart health.
Giving up smoking, drinking alcohol in moderation and maintaining a healthy weight will also help.
You might want to use complementary therapies alongside your hospital treatments, to help you relax or to ease symptoms and side effects. Some complementary therapies are common, like massage and acupuncture, and some you may not have heard of before. All of these therapies can help improve your mood and deal with problems like sickness or pain.
None of these therapies should replace your actual treatment, but they may give you an extra boost. As cancer is a complex condition, it's important to use a registered therapist and always keep your clinical nurse specialist and oncologist aware.
Our expert mini guide can answer your questions about the use of complementary therapies after an ovarian cancer diagnosis, including what complementary therapies are, the difference between complementary and alternative therapies, and how and where you can find out more. Read 'Ovarian cancer and complementary therapies' [PDF]or order a copy.
Most hospitals have links with a local cancer support centre, which might offer a range of therapies on site for free.
Cancer Research UK has detailed information about each therapy on its website.
Therapy Directory connects you with a qualified therapist most suited to your needs. All the therapists on the website have shown proof of qualifications and/or membership with a professional body. They list many therapies from aromatherapy to reflexology.
This information is reviewed regularly and is in line with accepted national and international guidelines. All of our publications undergo an expert peer review and are reviewed by women with ovarian cancer to ensure that we provide accurate and high-quality information. To find out more take a look at our information standards.