Choosing the best options - knowing the side effects
Ovarian Cancer Treatments
Navigating and understanding treatment options are critical for an ovarian cancer patient’s survival. All treatment decisions should be made by a patient in consultation with her medical professional.
During surgery, doctors attempt to remove all visible tumors (tumor debulking). The five-year survival rate and disease-free intervals of patients whose surgeon was a gynecologic oncologist far surpass those of patients whose surgeons were not oncologists.
Patients undergo chemotherapy in an effort to kill any cancer cells that remain in the body after surgery.
This therapy places the medicine directly into the peritoneal area through a surgically implanted port and catheter. While intraperitoneal (IP) therapy has been in use since the 1950s, new advances have combined it with intravenous (IV) therapy, using chemotherapy agents that work best for treating ovarian cancer. The National Cancer Institute recommends that, for select ovarian cancer patients, chemotherapy be given by both IV and IP. This combination has been found to increase survival for women with advanced stage ovarian cancer.
Some patients may receive chemotherapy before having surgery to remove their tumors. This is known as neoadjuvant chemotherapy.
Other drugs, including angiogenesis inhibitors and targeted therapies, may be recommended either in conjunction with chemotherapy or as single agents. These drugs may have very different side-effects than chemotherapies and may be useful only for specific populations.
PARP Inhibitors (Poly(ADP-ribose) polymerase (PARP) inhibitors) are offering real hope to many in our community. PARP inhibitors can extend progression free survival significantly. In order for you to know whether you are a candidate for a PARP inhibitor, you need genetic testing (ASAP) and counseling, and also to have your tumors itself tested for genetic mutations. PARP inhibitors work best for women with genetic mutations, which many women with ovarian cancer do have.
Radiation Therapy or Radiotherapeutic Procedures
These procedures may be used to kill cancer cells that remain in the pelvic area.
Researchers carry out ovarian cancer clinical trials to find ways of improving medical care and treatment for women with this disease. A woman is eligible to participate in a clinical trial at any point in her experience with ovarian cancer: before, during or after treatment. Many women think of clinical trials as an option only after other treatments have failed. In reality, many equally important trials are available for women earlier in their fight against ovarian cancer. For more information about the clinical trial process, click here.
Treatment Side Effects
The goal of chemotherapy is to eliminate rapidly growing cancerous cells; however, some drugs are unable to differentiate between cancerous cells and other frequently dividing cells. As a result, the drugs can kill cells found in the bone marrow, digestive tract, hair follicles, and reproductive organs. Every woman experiences different side effects depending on the type and dosage of her chemotherapy treatments. Women undergoing treatment should talk to their medical professionals about the best way to address their side effects, and also ask about working with a palliative care team. Palliative care teams are being re-branded as "supportive care," as many still mistakenly believe they are only for end of life care. In fact, they are experts in reducing side effects and reducing discomfort for those suffering from chemotherapy treatment. We encourage you to use all the health care you are entitled to and may need by asking your doctore about these services.
Some chemotherapy drugs damage hair follicles, causing loss of body hair. Hair loss typically begins two to three weeks after the first treatment and may affect not only the hair on a woman’s head but also her eyebrows, eyelashes, facial hair, pubic hair, underarm hair and leg hair. While hair loss can be extensive, it is almost always temporary. Women’s hair usually grows back once treatment ends. Some women cope with hair loss by cutting their hair or shopping for a wig before losing any hair. Hair loss can be preventable with products like "cold caps." They may cost you out of pocket to rent, but more information on this option is available online. not have
Nausea and Vomiting
Since nausea is such a common side effect of chemotherapy, doctors will often prescribe antiemetics (anti-nausea medicine) to minimize suffering. Antiemetics work by blocking signals between the brain and stomach to stop vomiting. These side effects must be managed during chemotherapy treatments because uncontrolled vomiting and nausea can interfere with the patient’s ability to receive treatments. Complementary therapies, such as ginger, exist and are proven to reduce nausea.
Cancer patients experience fatigue for many reasons—not all of which are known. Both cancer and cancer treatments can cause fatigue. Fatigue is a common side effect following radiation and chemotherapy. Medication used to treat pain, depression, vomiting, seizures, and other side effects may cause fatigue. Fatigue usually lessens after treatment ceases, but sometimes people never regain their full energy.
Diarrhea and Constipation
Diarrhea is a common side effect of chemotherapy that usually occurs in the days immediately following a chemotherapy treatment. Patients with diarrhea need to remember that they can become dehydrated quickly and should be sure to hydrate themselves. Once you are aware that this is a side effect you suffer from, you may want to talk to your doctor about taking some medicines prophylactically (ahead of time) like Immodium. Some patients may experience constipation due to chemotherapy, the after effects of surgery, or anti-nausea drugs. Doctors often tell patients who experience constipation to take a mild laxative or stool softener. Patients experiencing constipation should drink plenty of liquids.
Certain chemotherapy drugs can cause peripheral neuropathy, an increase in numbness caused by damage to the nerves that transmit signals between extremities and the central nervous system. This damage to the nerves often causes a tingling sensation or loss of control in the hands or feet. Acupuncture or massage and physical therapy may lessen these side effects, which are usually temporary and improve or resolve when chemotherapy treatment stops.
Chemotherapy can kill the cells lining the mouth, throat, and gastrointestinal tract, causing mouth sores. Mouth issues are particularly bad for patients who receive high doses of chemotherapy, have poor oral and dental health prior to treatment, or have kidney or concomitant disease. Smoking, using tobacco, and consuming harsh foods or alcohol increase the severity of these side effects. Some chemotherapy drugs create taste changes in patients. Food may taste salty or bitter but usually tastes normal again once treatment is over. For those experiencing a metal taste, consider using plasticware. Non-alcoholic mouthwash and other products can decrease dryness of the mouth.
Sexuality and Intimacy Issues
Interest in sexual intimacy often decreases for chemotherapy patients for many reasons, including additional stress and the side effects of treatment. Patients need to maintain a positive self image during this time and sustain open communication with their partners. When a patient is ready to engage in sexual activity, she should consider taking the following actions:
Make time for rest before and after sexual activity to preserve energy.
Use water-soluble lubricants as her vagina may be drier than usual due to hormonal changes.
Experiment to find comfortable positions and avoid those that will tire one quickly.
Proactively ask your doctor about your pelvic floor rehabilitation options. This is an underused resource! See COCA's video resources for some information on pelvic floor rehabilitation..
Former COCA Board member and Director of University of Colorado Gynecologic Oncology Department Dr. Saketh Guntapalli has written a book entitled "Sex and Cancer: Intimacy, Romance, and Love After Diagnosis and Treatment." You can purchase the book on Amazon: Sex and Cancer
Many women experience forgetfulness and have trouble with concentration after receiving chemotherapy. This absentmindedness is most often temporary; however, about 15 percent of chemo patients experience some permanent problems. Since the cause is unknown, no treatment exists for this side effect. Women who have experienced this side effect offer several suggestions for dealing with it:
Minimize distractions while performing important tasks.
Keep a daily organizer/journal to keep track of appointments.
Use the calendar on your computer and voicemail messages to remind yourself of meetings.
After her initial treatment is over, a woman should have follow-up treatments with her doctor. During follow-ups, doctors do thorough physical exams and may also monitor a patient’s blood for an elevated CA-125 level. Some patients have a sensitive CA-125 that will rise before their CT scan shows evidence of recurrent disease; a recent study suggests that it may be more useful to wait until a woman experiences symptoms of ovarian cancer before starting treatment.
Others will have evidence of the disease before their CA-125 rises. Doctors often use a combination of tests to monitor a patient because recurrent ovarian cancer has a wide spectrum of behavior making it difficult to monitor. In addition to physical exams and a CA-125 test, doctors may request CT and/or PET scans to look for tumor growth.
A patient should discuss a follow-up plan and survivorship plan with her physician, clearly outlining a plan of action post-treatment. A survivorship plan that addresses long-term issues is critical for a woman to have and discuss with her regular internist and other health care professionals outside of her cancer treatment. CA-125 plus HE4 have been approved by the Food and Drug Administration (FDA) for monitoring.
Emotional Health Post-Treatment
Many women report mixed emotions following treatment for ovarian cancer. While they are excited to have no evidence of disease, fears of recurrence are common. Often the hardest part of treatment for a woman with ovarian cancer is when chemotherapy is finished and she goes on with life. When she had surgery and chemotherapy she was in battle mode, fighting the cancer and taking active steps in her treatment. But the uncertainty about whether the cancer will return and concerns that every little sign or symptom may indicate a recurrence can be very anxiety-producing for many women. Support from family and friends is critical at this time.
Many women begin attending a support group after treatment, to talk with others and manage fears after treatment ends. Click below for a list of support groups and resources from our Colorado Ovarian Cancer Resource Guide.
COCA's Support Programs
We also suggest you take advantage of COCA's support programs. Order a Comfort Kit to take to chemo with you during ovarian cancer treatments. Download our Colorado Ovarian Cancer Resource Guide to find valuable and relevant resources for the journey. Join us at a Nicki's Circle support group to meet other women, and apply to the COCA.Cares Financial Assistance program if you find yourself in a situation of need. And reach out to our Carol's Wish Financial and Insurance Navigation experts for assistance. We're here to help through all stages of ovarian cancer.
We're Here For You
You're never on this journey alone. Contact Jeanice Hansen, COCA's Support Services Program Director, for more information or before coming to support group for the first time. Reach Katlyn at 720-519-3122, or Jeanice@colo-ovariancancer.org.