Getting diagnosed with ovarian cancer is scary, but it is a treatable disease. However, there isn't a one-size-fits-all approach to ovarian cancer treatment. Talk to your oncologist to determine what will work best for you.
Because there is a lot of information to absorb, it may be overwhelming in the beginning. Write down your questions before your appointment (see our printable checklist) and ask the most pressing questions first so that you don't run out of time during your preliminary visit.
Covering the Basics of Chemotherapy
There are different ways to administer chemotherapy, such as by mouth or injections into the muscle. Chemotherapy for ovarian cancer is usually given intravenously (IV) -- into a vein -- or medications are injected through a catheter or port into your abdomen, called intraperitoneal chemotherapy (IP).
Ask your doctor whether you are a candidate for IP. Research shows that women who received both IV and IP chemotherapy are disease-free longer than women who received only IV chemotherapy (and have a higher survival rate), but they also experienced more severe side effects such as fatigue, pain, and low blood counts.
A central line, also called central venous catheter (CVC), may be administered prior to chemotherapy treatment. A CVC is a hollow tube that is placed in a large vein, and it can stay in the body for a much longer period of time. CVCs allow an easier route for IV medicines and require different levels of care. The type of CVC used is based on how long you will be getting treatment, how long it takes to infuse each dose of chemotherapy, your preferences, your doctor's preferences, the care required to maintain the CVC, and its cost. Talk to your doctor about the type of central line that they recommend for you.
Discussing Your Treatment Plan
You will likely receive a combination of chemotherapy drugs. Most oncologists in the U.S. consider combination chemotherapy more effective than a single drug in treating ovarian cancer.
The standard approach is to use a platinum compound, such as cisplatin or carboplatin, and a taxane, such as paclitaxel or docetaxel (Taxotere). For IV chemotherapy, most doctors favor carboplatin over cisplatin because it has fewer side effects and is just as effective. In addition, paclitaxel is often favored over Taxotere due to a greater experience with paclitaxel.
Other medications used for treatment include:
- altretamine (Hexalen)
- capecitabine (Xeloda)
- cyclophosphamide (Cytoxan)
- etoposide (Vepesid)
- gemcitabine (Gemzar)
- ifosfamide (Ifex)
- irinotecan (Camptosar)
- liposomal doxorubicin (Doxil)
- melphalan (Alkeran)
- paclitaxel-protein bound (Abraxane)
- pemetrexed (Alimta)
- topotecan (Hycamtin)
- vinorelbine (Navelbine)
Talk to your oncologist about the schedule that is most appropriate for your treatment. Different drugs have varying cycles, and the number of treatment cycles you have will depend on the stage of your disease. A cycle is a schedule that allows regular doses of a drug, followed by a rest period. For example, if you have advanced ovarian cancer, your oncologist may recommend a course of chemotherapy that involves six cycles, with each cycle given once every three weeks.
Let's Talk Side Effects
You are probably concerned about the side effects you could experience with chemotherapy. Fortunately, newer types of chemotherapy cause fewer and milder side effects.
It is difficult to predict which side effects you may experience, if any. Common temporary side effects may include hair loss, nausea, vomiting, fatigue, and muscle and joint pain. You may also be at increased risk for bruising, bleeding, infection, and anemia. Permanent side effects can include premature menopause, infertility, and numbness in your fingers and toes.
Raise any specific concerns about side effects with your oncologist. Your doctor may prescribe medications to prevent nausea and vomiting before chemotherapy. If you have pre-existing conditions like nerve or kidney issues, your doctor may need to tailor your treatment plan differently.
Research suggests that a drug combination with fewer side effects may help more women gain the full benefit of their cancer treatment. Talk to your doctor about your treatment options. Together you can decide what is right for you.
Keeping Lines of Communication Open
You should feel comfortable discussing your treatment plan with your oncologist. The more information you communicate with your doctors and nurses about how you are feeling, the more they can help you achieve the best quality of life during treatment. Don’t hesitate to ask questions.
Find out if your doctor's office offers any support resources, like patient handouts about chemotherapy and how to manage side effects. Some hospitals and cancer treatment centers offer a patient navigator service to help you cope with the psychosocial, emotional, and financial challenges of cancer.
Be proactive about learning about your chemotherapy treatment and ovarian cancer care. Your doctor may recommend additional treatments such as radiation therapy, hormone therapy, or targeted therapy.By keeping the lines of communication open with your doctors and nurses, you can help ensure you get the highest quality of care.
Printable Checklist of Questions
Here's a basic checklist to help you discuss chemotherapy with your doctor:
- Do you have any patient handouts about chemotherapy and ovarian cancer?
- Which clinical trials am I eligible for? What are the pros and cons?
- What type of CVC do you recommend and why?
- Am I a candidate for IP chemotherapy? If so, what are the risks and benefits?
- What are potential side effects of my chemotherapy treatment?
- What resources do you suggest to help manage side effects?
- What signs should I look for that might indicate the ovarian cancer has come back?
- What's the best way to contact you or a nurse with questions in between visits?