What to expect during ovarian cancer treatment

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. Improving your understanding of the information your health care provider shares with you about treatment options, including potential side effects, 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.

Surgery

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 health care providers 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, surgeons will likely remove your ovaries, fallopian tubes, and uterus, along with the surrounding lymph nodes and any affected abdominal tissue. This more extensive surgery helps increase the chances of removing as much 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. Go easy on yourself. This type of major abdominal surgery isn’t easy. You can resume your normal activities once you’ve fully recovered.  

Chemotherapy

“Most ovarian cancers are at stage III at the time of diagnosis, which requires chemotherapy after surgery,” says Russell J. Schilder, M.D., director of gynecologic medical oncology at the Sidney Kimmel Cancer Center in Philadelphia. Occasionally, health care providers will recommend chemotherapy, sometimes called 'chemo', before surgery. Chemo treatment can shrink the tumors first to 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). 

You may get more than one drug during chemotherapy treatment. “The two most important drugs for ovarian cancer are carboplatin (Paraplatin) and paclitaxel (Taxol),” says Dr. Schilder. 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, health care providers 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,” a mixture of viscous lidocaine, Maalox, and Benadryl. It is important to clear as much time in your schedule as you need during treatment to take time to 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 reduce symptoms. It is important to inform you clinical care team of your symptoms and ask for recommendations, 

One nearly universal side effect of chemotherapy for ovarian cancer is hair loss. And for many women, this can feel like 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 seek advice on hair loss. 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.  

Targeted therapy

Targeted therapies are like guided missiles. They focus 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. 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. 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, and you may want to ask your doctor about the following options:

• Clinical trials. Some patients may have the option of enrolling in programs that test the efficacy of promising new treatments or procedures. You can find trials near you by searching clinicaltrials.gov. You can also 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, health care providers may recommend radiation to target a certain area.