Advanced ovarian cancer is treatable, but some of the treatments can have long-lasting complications and side effects. Ovarian cancer is considered advanced when it has spread beyond the ovaries or fallopian tubes, as in stage 2, stage 3, and stage 4. Specific treatments selected for ovarian cancer vary based on several factors including the type, stage, and grade of the tumor as well as a person’s age, overall health, and other medical conditions.
The treatment options for ovarian cancer usually involve a combination of surgery, chemotherapy, targeted therapy, or hormone therapy. Radiation therapy is also sometimes used. Additionally, new experimental treatments are always being developed and may be available through clinical trials. Each of these treatments is important for removing or destroying cancer cells, but they each also carry risks for long-term complications.
Surgery for ovarian cancer may include removal of one or both ovaries (oophorectomy), fallopian tubes (salpingectomy), uterus (hysterectomy), lymph nodes, and other affected tissues and organs. Debulking surgery may also be used to decrease the size of the tumor before chemotherapy.
Chemotherapy for ovarian cancer includes intravenous (through a vein) or intraperitoneal (into the abdomen) administration of a variety of chemotherapy drugs. Chemotherapy may be given before surgery (neoadjuvant chemotherapy) and after surgery (adjuvant chemotherapy).
Targeted therapy for ovarian cancer may include medications called angiogenesis inhibitors, immunotherapy, PARP inhibitors, and TRK inhibitors, depending on the type of ovarian cancer.
Hormone therapy for ovarian cancer may include drugs that block the production of estrogen or that block the effects of estrogen on cells.
Radiation is not commonly used to treat most ovarian cancers, but sometimes localized radiation (the use of high-energy beams to kill cancer cells) may be used.
New treatments are tested in clinical trials and may include new chemotherapy drugs, chemotherapy combinations, and targeted therapy. The risks involved in clinical trials may be the same as current treatments, but there may also be additional potential complications.
Treatments for ovarian cancer come with several potential complications.
Chemotherapy involves killing rapidly growing cancer cells, but it also affects healthy cells that undergo constant growth, such as the hair follicles, cells in the bone marrow that make blood cells, and the lining of the digestive tract. Many side effects seen with different types of cancer therapy can be due to impaired bone marrow function, which can cause low blood cell counts. Low blood cell counts can lead to:
Other common side effects of chemotherapy include:
Many of these side effects go away once treatment is finished, but some may persist long after therapy.
Infertility (the inability to get pregnant) and the early onset of menopause are common complications of ovarian cancer treatment, especially in advanced cases. Both fertility and the menstrual cycle require normal function of the ovaries to produce estrogen and progesterone.
Surgical removal of both ovaries (bilateral oophorectomy) or the uterus (hysterectomy) always results in infertility. Chemotherapy and hormone treatment may also cause infertility even if the uterus and one ovary are intact, as is the case in some types of early-stage ovarian cancer. Early menopause (the end of menstruation) may result from removal of the ovaries, chemotherapy, or hormone therapy. Talk to your health care team about ways to address fertility issues.
When ovarian cancer has spread to other abdominal organs, portions of those organs may be removed. After removing tissue from the bladder, a urinary catheter may be required to allow the bladder to heal. If a portion of the intestines is removed, a colostomy may be needed.
Any abdominal surgery can result in the development of abdominal adhesions. These adhesions are internal scar tissue that can form on internal organs (such as the intestines, bladder, uterus, and liver) and can cause pain, bloating, and bowel obstruction. Severe adhesions may require additional surgery to treat.
Ascites, the collection of fluid in the abdomen, can occur after surgery or chemotherapy for ovarian cancer. Ascites can cause bloating, nausea, pain, and shortness of breath. Excessive ascites fluid may need to be drained using a procedure called paracentesis.
Edema, collection of fluid in the extremities, is a common complication of surgical removal of lymph nodes in the pelvis and abdomen. Fluid that is normally drained by the lymphatic system can build up in the feet and legs, leading to swelling and pain.
Bleeding and irritation of the lining of the bladder can occur with the chemotherapy drug Mitoxana (ifosfamide).
In rare instances, long-lasting damage to the bone marrow from chemotherapy can result in myelodysplastic syndrome and acute myeloid leukemia, a blood cancer.
Also sometimes called “chemo brain,” long-term cognitive impairment can develop after chemotherapy. Chemo brain involves problems with memory, concentration, and the ability to learn new things. Treatments are available to help improve cognitive function.
The chemotherapy drug cisplatin may cause nerve damage that can lead to loss of hearing and dizziness.
Chemotherapy with cisplatin may also result in long-term kidney damage. However, kidney damage is usually prevented by giving adequate amounts of intravenous (IV) fluids.
Osteoporosis is the loss of bone mass that can occur as a result of old age, cancer, or hormone therapy. Osteoporosis can lead to an increased risk of broken bones, but it can be treated with supplementary calcium and vitamin D, or other drugs that help to preserve bone mass.
Peripheral neuropathy is nerve damage that causes numbness and tingling in the hands and feet. Some types of chemotherapy can lead to nerve damage.
Surgery, chemotherapy, and hormone treatment can result in sexual dysfunction, including a loss of sex drive, pain, and difficulty achieving arousal and orgasm.
Knowing what to expect from your treatment can better prepare you to face the challenges that lie ahead. Consider the risks and benefits of various treatments when working with your oncologist to develop a treatment plan that addresses your concerns and desired outcomes. Palliative care to address side effects and complications of treatment can also lead to a better quality of life.
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